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Doctors' Fears Fuel IUD Avoidance

Survey finds U.S. doctors don't prescribe the birth-control device

THURSDAY, Jan. 31, 2002 (HealthDayNews) -- Doctors avoid prescribing the intrauterine birth control device for women because they have lingering misconceptions about its safety and a fear of being sued over possible complications, a major survey reveals.

The research, published today in the Journal of the American College of Obstetricians and Gynecologists, also says the small number of American women using the intrauterine device (IUD) is directly linked to doctors' lack of knowledge about the benefits and risks of the device.

"Like other researchers in the U.S., I feel that the IUD is a safe and effective method that is underused in the U.S," says study author Dr. Nancy L. Stanwood, an assistant professor of obstetrics and gynecology at the University of Rochester Medical Center in New York.

"In Europe, about 10 percent of women using contraception use an IUD. In the U.S., it is only 0.8 percent," she says. "If more women in the U.S. used an IUD, there would be fewer unintended pregnancies."

For Dr. Steven Goldstein, a professor of obstetrics and gynecology at New York University Medical Center, the fact that doctors don't prescribe IUDs doesn't come as a surprise. However, he doesn't agree with the reasons offered in Stanwood's study.

"I think that any established physician is well aware of both the risks and the benefits of an IUD, and I don't think it's fair to say they are uninformed or thinking only about litigation when they forgo prescribing this device," he says.

It is the patients who often have a bias against IUDs, and, if anything, that influences the doctors' behavior, he adds.

"You just don't want to work that hard to convince a patient of something, particularly if there are other options that work just as well and that she feels more comfortable using," Goldstein says.

Stanwood reports that 64 percent of the doctors surveyed said patients were receptive to learning more about an IUD.

If there is a patient or doctor bias against IUDs, it no doubt came as a result of the Dalkon Shield, a particular IUD design that was the center of controversy during the mid-1970s.

The Dalkon Shield was found to dramatically increase the risk of pelvic inflammatory disease, and was eventually taken off the market in 1974 after the manufacturer was flooded with lawsuits.

Although it was eventually shown that the problems were unique to the Dalkon Shield design, and not IUDs in general, other manufacturers voluntarily pulled their versions of the device off the market to avoid bad publicity.

Old fears die hard, though.

Other IUDs, with newer, better designs, eventually came back on the market. But, Stanwood contends, doctors never let go of the fears generated by the Dalkon Shield uproar -- or the fears of being sued.

Stanwood's study involved sending surveys to 811 practicing members of the American College of Obstetricians and Gynecologists. Approximately 50 percent responded, 37 percent of them females and the rest male.

Of the doctors surveyed, most agreed that the copper IUD -- a particular type of device -- is 95 percent safe and 98 percent effective. However, 20 percent of those same doctors said they had not prescribed an IUD for at least a year.

Of those who did, almost 80 percent said they prescribed an IUD for no more than 10 patients a year. Most of the doctors reported seeing up to 88 patients a week.

The most frequent reason cited by the doctors for not prescribing an IUD was the continued belief that IUDs cause pelvic inflammatory disease, a severe infection of the reproductive tract. Twenty-nine percent of the doctors believed that risk to be at least 10 percent.

Another leading concern was the fear of litigation, which was mentioned by 16 percent of the doctors, Stanwood says.

"Ironically, some physicians are more fearful of the very small risk of PID with IUD use -- about 0.06 percent in the first year -- than they are of the very real risk of unintended pregnancy with oral contraceptive pill use, [about] 7 percent in the first year of use," she says.

"Our study did not address my following comment, but I believe it to be true: When counseling women about contraceptive options, many physicians do not take into account the risk of unintended pregnancy," Stanwood adds.

The study concludes that doctors simply need more education on the safety of IUDs and the rarity of lawsuits surrounding this device today.

Goldstein believes such education should be directed more toward consumers than their doctors.

"There is no question that women -- at least the ones I see in my practice -- still don't feel comfortable about using an IUD," Goldstein says. "And no matter how hard I try to sell the idea as safe and effective, many women still have their minds made up against using it."

Efforts to educate consumers on the safety of IUDs, while simultaneously reminding doctors about the benefits, would most likely result in greater use of this type of contraceptive, Goldstein says.

What to Do: To learn more about IUDs, visit Planned Parenthood. Or click here for more information on all birth-control options.

SOURCES: Interviews with Nancy L. Stanwood, M.D., M.P.H., assistant professor, obstetrics and gynecology, Department of Obstetrics & Gynecology, University of Rochester Medical Center, Rochester, N.Y.; Steven Goldstein, M.D., professor, obstetrics and gynecology, New York University Medical Center, New York City; February 2002 Journal of the American College of Obstetricians and Gynecologists
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