Contraception 101 - Provider Perspective

Uploaded by NationalCampaign on 06.01.2009

Eve Espey, MD [Faculty, OBGYN, University of New Mexico]: So just a few comments
about uh, about provider perspectives particularly on, on IUDs and Implanon. Uh,
there’s, it’s still unfortunately a mystique about IUDs uh, that, that, that there’s,
it’s somehow complicated to put in and and OB/GYNs
do you know, we do hysterectomies and complicated abdominal uh,
and vaginal surgeries. But, you know, putting an IUD in is a trivial procedure,
but there’s still more uh, reluctance to do it than
there should be given how easy it is to put one in. Uh, research has shown that providers
uh, particularly OB/GYN physicians have very favorable attitudes about the IUDs. So
they they think it’s a good thing, but they just don’t put very many in and the two major
reasons is because they’re worried about litigation. Uh, litigation is a big issue
in this country around contraceptive methods. Several
great contraceptive methods have gone down uh, based on on litigation uh, but there’re
really since the the copper IUD was reintroduced in the late eighties, there has
been very little litigation, successful litigation, around the IUD. So uh, providers should be
quite uh, encouraged by that. And there’s this concern that that IUDs cause pelvic
infections, that the bacteria, you know, climb up the string and wind up in the uterus and
cause an infection and cause infertility, etc.
There’s really good evidence that that’s that that’s not the case. Uh, most providers
have pretty restrictive criteria. Like Karen was mentioning that, you know, that require
that you have four children and you smoke and you don’t want a tubal ligation and,
so it’s it’s gotten into the consciousness
that it’s a method of last resort whereas it really
should be a method of I, I think a, you know, a first-line method. And and birth
control pills I think should be the method of last resort. Uh, Im Implanon is new. Uh,
there are still not a lot of providers that are trained. We’ve got, we we use it a lot.
We’ve got great uptake in our clinic. Uh, again uh, we have a a large Hispanic
population. Im-Implanon has been around in Mexico for some time so we have women
uh, who come up asking for it. Uh, but even uh, among our uh, our general population
we have now that we’re doing it, we’re know, it’s known that we that we do that.
The FDA’s required a three-hour training. Uh, so for providers to learn how to put it
in, I can’t just teach my residents, for an example,
how to put in an Implanon. They have to go through a training. The company that makes
Implanon has just changed hands and they haven’t had trainings for several months.
So so there are some logistical issues that have made it more difficult to get Implanon
out there like like it should be. Uh, but I, there there’s also a very cumbersome
process for actually getting uh, the devices stocked in your formulary. So I think that
over the next five years, we’re going to see a
lot more Implanon used as these things get worked out. Uh, and I think what’s what’s,
the snapshot of what’s going on right now is that in university centers where there
are people that are fanatic uh, or I mean interested
in family planning uh, there’s a lot of IUDs. I mean in our, you you know, at the
University of New Mex New Mexico in, in our immediate, in our clinics, about
twenty percent of women use an IUD or
Implanon. I think that’s true in Oregon and Washington in in many centers, but it
hasn’t diffused that to the general population. I think that that’s what we’ll see happening
in the years to come.