Non-hormonal and hormonal intrauterine contraception: survey of patients’ perceptions in four Latin American countries

ABSTRACT Objectives: This study sought to understand women’s perceived barriers to the use of hormonal and non-hormonal intrauterine contraception in Latin America. Methods: We developed an online survey for women in Argentina, Brazil, Colombia and Mexico who were seeking contraception. The questions aimed at evaluating patient awareness of negative stories and statements, as well as perceived barriers to the copper intrauterine device (IUD) and the levonorgestrel-releasing intrauterine system (LNG-IUS). Results: The survey was mailed to 2300 women. A total of 1953 responses were received from Argentina (n = 465), Brazil (n = 380), Colombia (n = 613) and Mexico (n = 495). More women reported having heard negative stories about the copper IUD than about the LNG-IUS. More women believed that the copper IUD, rather than the LNG-IUS, was suitable only for those who had already had children. More women believed that weight gain (14.3% vs. 38.2%; p < 0.001), mood swings (14.1% vs. 38.7%; p < 0.001) and infertility (16.3% vs. 19.9%; p = 0.016) were possible side effects of the LNG-IUS. By contrast, more women believed that abortion (36% vs. 22.7%; p < 0.001), pelvic infections (42.1% vs. 15.7%; p < 0.001) and ectopic pregnancy (43.5% vs 23.5%; p < 0.001) were side effects more associated with the copper IUD. More believed the copper IUD was associated with less pain during placement and removal compared with the LNG-IUS (42.8% vs. 31.2%; p < 0.001). The perception of increased risk of contracting a sexual transmitted disease did not differ between the methods (IUD vs. LNG-IUS, 21.7% vs. 20.3%; p = 0.388). Conclusions: Respondents to a web-based survey in four Latin American countries have misperceptions regarding the adverse effects and risks of intrauterine contraception, which may hamper the use of these safe and efficient contraceptive methods. Education about the true risks and benefits involved is fundamental to improving patient acceptance and compliance as well as reducing unplanned pregnancies and unsafe abortions.

[1]  S. Tregear,et al.  Impact of Contraceptive Education on Contraceptive Knowledge and Decision Making: A Systematic Review. , 2015, American journal of preventive medicine.

[2]  Kirk D. Wyatt,et al.  Women’s values in contraceptive choice: a systematic review of relevant attributes included in decision aids , 2014, BMC Women's Health.

[3]  L. Bahamondes,et al.  [Intrauterine contraception in nulliparous women as a strategy to reduce unplanned pregnancies in Latin America]. , 2014, Ginecologia y obstetricia de Mexico.

[4]  F. R. Nunes,et al.  Reasons for Brazilian women to switch from different contraceptives to long-acting reversible contraceptives. , 2013, Contraception.

[5]  E. Schwarz,et al.  Perceptions of intrauterine contraception among women seeking primary care. , 2011, Contraception.

[6]  Gynecologists.  Committee opinion no. 539: adolescents and long-acting reversible contraception: implants and intrauterine devices. , 2012, Obstetrics and gynecology.

[7]  K. Black,et al.  A review of barriers and myths preventing the more widespread use of intrauterine contraception in nulliparous women , 2012, The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception.

[8]  J. Peipert,et al.  Knowledge of contraceptive effectiveness. , 2012, American journal of obstetrics and gynecology.

[9]  J. Peipert,et al.  Effectiveness of long-acting reversible contraception. , 2012, The New England journal of medicine.

[10]  D. Grimes,et al.  Hormonal and intrauterine methods for contraception for women aged 25 years and younger. , 2012, The Cochrane database of systematic reviews.

[11]  E. Schwarz,et al.  The Impact of Contraceptive Counseling in Primary Care on Contraceptive Use , 2011, Journal of general internal medicine.

[12]  J. Peipert,et al.  Women's Knowledge About Intrauterine Contraception , 2011, Obstetrics and gynecology.

[13]  Susheela Singh,et al.  Unintended pregnancy: worldwide levels, trends, and outcomes. , 2010, Studies in family planning.

[14]  M. Schiff,et al.  Factors associated with contraceptive nonuse among US women ages 35-44 years at risk of unwanted pregnancy. , 2010, Contraception.

[15]  S. Rubin,et al.  Urban female family medicine patients' perceptions about intrauterine contraception. , 2010, Journal of women's health.

[16]  Abdulrazak H. Alnakash.  Influence of IUD perceptions on method discontinuation. , 2008, Contraception.

[17]  A. Arslan,et al.  Knowledge and Beliefs about Contraception in Urban Latina Women , 2008, Journal of Community Health.

[18]  C. D'arcangues.  Worldwide use of intrauterine devices for contraception. , 2007, Contraception.

[19]  N. Stanwood,et al.  Young Pregnant Women’s Knowledge of Modern Intrauterine Devices , 2006, Obstetrics and gynecology.

[20]  Sue Wilson,et al.  What is it about intrauterine devices that women find unacceptable? Factors that make women non-users: a qualitative study , 2006, Journal of Family Planning and Reproductive Health Care.

[21]  A. Berenson,et al.  Sociocultural and religious influences on the normative contraceptive practices of Latino women in the United States. , 2004, Contraception.