Intrauterine Devices: Take Up and Discontinuation in a Time of Change.

Abstract

Objectives: Intrauterine devices (IUDs) are a highly effective form of contraception. This paper examines who is more likely to use an IUD, who is more likely to discontinue IUD use due to dissatisfaction, and reasons for dissatisfaction, just before and after the Supreme Court's Dobbs decision that eliminated the federal right to abortion.

Methods: This study analyzes data from the 2017-2019 and 2022-2023 National Survey of Family Growth. Changes in IUD prevalence and removal for dissatisfaction were estimated. Logistic regression was used to examine IUD use and discontinuation due to dissatisfaction. Respondents' reasons for discontinuation were explored.

Results: IUD use increased very slightly but significantly, from 11.6 to 13.0%. Education, age, race, insurance status, living in a rural area, having given birth, and wanting any/more children were significant predictors of IUD use. The percentage of women who discontinued IUD use due to dissatisfaction decreased significantly, from 33.2 to 22.2%. Education and race/ethnicity were significant predictors of IUD removal. Most women who discontinued use due to dissatisfaction reported side effects.

Conclusions for practice: IUDs are an increasingly important contraceptive method in the post-Dobbs era. However, we need to keep an eye on possible patient problems with the devices, particularly side effects such as pain, bleeding, and device migration, and educate patients on these possible side effects in advance of inserting an IUD. We also need to maintain users' ability to remove their IUDs if its benefits no longer outweigh its side effects, to preserve patient autonomy and well-being.