A missed opportunity for care: two-visit IUD insertion protocols inhibit placement.

Background: The intrauterine device (IUD) is a safe, long-acting, highly effective method of birth control. Two-visit protocols for IUD insertion may represent a barrier to IUD uptake.

Study Design: This study is a retrospective database review. We identified Medicaid-insured women who requested IUDs in our urban university-based clinic, which employed a two-visit protocol for IUD insertion. The number of women who returned for IUD insertion was determined. To compare women who underwent insertion to those who did not, bivariate and multivariable analyses were used.

Results: Of the 708 women who requested IUDs at the initial visit, only 385 had an IUD inserted (54.4%). Single women were less likely to return for IUD placement compared to women who had ever been married (52.4% vs. 70.3%; p<.01). Patients who ordered IUDs at gynecologic visits were more likely to return as opposed to those who had them ordered at obstetrics-related visits (60.5% vs. 50.2%; p<.01). Women who lived >10 miles away from the clinic were less likely to return for IUD insertion than women who lived <10 miles away from the clinic (45.3% vs. 56.2%; p=.03). Race, age and type of IUD ordered were not significantly associated with probability of insertion.

Conclusions: Almost half of women who ordered IUDs did not return for insertion, suggesting that two-visit protocols hinder a woman's ability to have an IUD placed. We must eliminate barriers to IUD insertion.