INTRAUTERINE CONTRACEPTION: A LITERATURE REVIEW INVESTIGATING THE BARRIERS LIMITING USE BY CANADIAN WOMEN.

Intrauterine Contraception: A Review of Barriers for Canadian Women

Authors

  • PA Michelle Houston University of Manitoba

DOI:

https://doi.org/10.5203/jcanpa.v1i5.870

Keywords:

Health Care Barriers, Contraception, Contraception Devices, Systemic Limitations to Healthcare

Abstract

Abstract

Intrauterine contraceptive devices (IUCDs) are highly effective and recommended as first-line contraceptives for women. Very few Canadian women use these forms of contraception, and even fewer youths use these methods. Multiple research search engines allowed a literature review of papers about IUCDs, healthcare systems, patient and provider barriers, published between 2000 and 2020.  Using a preference for Canadian studies identified and allowed investigating the barriers preventing the more widespread use of IUCDs by Canadian women with an emphasis placed on at-risk groups, in order to make recommendations for decreasing unintended pregnancies.

Barriers broadly fit into the three categories of the healthcare system, the patients', and practitioner-based. Evidence suggests that there is an overall lack of awareness and limited knowledge regarding IUCDs among the public, provider misconceptions and lack of confidence in insertion capabilities, high upfront cost, and the systemic issues of limited access to contraceptive providers. Studies have shown that evidence-based education and removal of cost and access related barriers increase patient acceptance of and adherence to IUCDs. 

To increase the use of IUCDs by Canadian women, large scale subsidy and policies to create programmes targeted at improving public and provider education and awareness are required. Additionally, increased hands-on training and task sharing with allied providers is necessary to increase patient access and timely availability of these highly effective contraceptives.

Author Biography

PA Michelle Houston, University of Manitoba

PA Michelle Houston is a recent graduate of the University of Manitoba Master of Physician Assistant Studies. Michelle was born and raised in Winnipeg and has a Bachelor of Science in biology. Her research includes studying mental health and addictions in adolescent Indigenous populations living in northern communities.

References

1. Oulman E, Kim THM, Yunis K, Tamim H. Prevalence and predictors of unintended pregnancy among women: an analysis of the Canadian Maternity Experiences Survey. BMC Pregnancy Childbirth. 2015 Dec;15(1):260.
2. Black A, Yang Q, Wen SW, Lalonde AB, Guilbert E, Fisher W. Contraceptive Use Among Canadian Women of Reproductive Age: Results of a National Survey. J Obstet Gynaecol Can. 2009 Jul;31(7):627–40.
3. Secura GM, Allsworth JE, Madden T, Mullersman JL, Peipert JF. The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception. Am J Obstet Gynecol. 2010 Aug;203(2):115.e1-115.e7.
4. Mcnicholas C, Madden T, Secura G, Peipert JF. The Contraceptive CHOICE Project Round Up: What We Did and What We Learned. Clin Obstet Gynecol. 2014 Dec;57(4):635–43.
5. Canadian Contraception Consensus Chapter 1 Contraception in Canada. J Obstet Gynaecol Can. 2015 Oct;37(10):S5–12.
6. Canadian Institute for Health Information. Induced Abortions Reported in Canada in 2018. Canadian Institute for Health Information; 2019.
7. Black A, Guilbert E, Costescu D, Dunn S, Fisher W, Kives S, et al. Canadian Contraception Consensus (Part 3 of 4): Chapter 7 – Intrauterine Contraception. J Obstet Gynaecol Can. 2016 Feb;38(2):182–222.
8. Di Meglio G, Crowther C, Simms J. Contraceptive care for Canadian youth. Paediatr Child Health. 2018 Jun 12;23(4):271–7.
9. Mirena Product Monograph [Internet]. Bayer Inc; 2019. Available from: https://www.bayer.ca/omr/online/mirena-pm-en.pdf
10. Wildemeersch D. New intrauterine technologies for contraception and treatment in nulliparous/adolescent and parous women. F, V & V IN OBGYN. 2009;1(3):223–32.
11. Dickerson LM, Diaz VA, Jordan J, Davis E, Chirina S, Goddard JA, et al. Satisfaction, Early Removal, and Side Effects Associated With Long- Acting Reversible Contraception. Fam Med. 2013 Dec;45(10):7.
12. Morris M. Capstone Feedback, email to Michelle Houston housto13@myumanitoba.ca. 2020.
13. Hladky KJ, Allsworth JE, Madden T, Secura GM, Peipert JF. Womenʼs Knowledge About Intrauterine Contraception: Obstet Gynecol. 2011 Jan;117(1):48–54.
14. Di Meglio G, Yorke E. Universal access to no-cost contraception for youth in Canada. Paediatr Child Health. 2019 May 15;24(3):160–4.
15. Buhling KJ, Hauck B, Dermout S, Ardaens K, Marions L. Understanding the barriers and myths limiting the use of intrauterine contraception in nulliparous women: results of a survey of European/Canadian healthcare providers. Eur J Obstet Gynecol Reprod Biol. 2014 Dec;183:146–54.
16. Stubbs E, Schamp A. The evidence is in. Why are IUDs still out? Can Fam Physician. 2008 Apr;54:560–556.
17. Hulme J, Dunn S, Guilbert E, Soon J, Norman W. Barriers and Facilitators to Family Planning Access in Canada. Healthc Policy Polit Santé. 2015 Feb 25;10(3):48–63.
18. Fleming KL, Sokoloff A, Raine TR. Attitudes and beliefs about the intrauterine device among teenagers and young women. Contraception. 2010 Aug;82(2):178–82.
19. Black KI, Lotke P, Lira J, Peers T, Zite NB. Global survey of healthcare practitioners' beliefs and practices around intrauterine contraceptive method use in nulliparous women. Contraception. 2013 Nov;88(5):650–6.
20. Cook J, Waddington A, Black D, Costescu D, Desjardins D, Duchesne E, et al. Intrauterine Contraception: Knowledge and Prescribing Practices of Canadian Health Care Providers. J Obstet Gynaecol Can. 2019 Aug;41(8):1084–92.
21. Di Meglio G, Yeates J, Seidman G. Can youth get the contraception they want? Results of a pilot study in the province of Quebec. Paediatr Child Health [Internet]. 2019 May 2 [cited 2020 Mar 21]; Available from: https://academic.oup.com/pch/advance-article/doi/10.1093/pch/pxz059/5482487
22. Whitaker AK, Johnson LM, Harwood B, Chiappetta L, Creinin MD, Gold MA. Adolescent and young adult women's knowledge of and attitudes toward the intrauterine device. Contraception. 2008 Sep;78(3):211–7.
23. Secura GM, Madden T, McNicholas C, Mullersman J, Buckel CM, Zhao Q, et al. Provision of No-Cost, Long-Acting Contraception and Teenage Pregnancy. N Engl J Med. 2014 Oct 2;371(14):1316–23.
24. Falk J, Friesen K, Budgen Shawn. Price Comparison Of Commonly Prescribed Medications In Manitoba 2020. 2020.
25. Jones I. Mb PA Query, email to Michelle Houston michelleokabehouston@gmail.com. 2020.
26. Norman W, Stirling B. Contraception Cost-Effectiveness in British Columbia. The University of British Columbia Contraception Access Research Team; 2018.
27. Canada H. A Prescription for Canada: Achieving Pharmacare for All - Final Report of the Advisory Council on the Implementation of National Pharmacare [Internet]. aem. 2019 [cited 2020 Mar 26]. Available from: https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/implementation-national-pharmacare/final-report.html#3.2
28. World Health Organization Model List of Essential Medicines, 21st List [Internet]. World Health Organization; 2019. Available from: https://apps.who.int/iris/bitstream/handle/10665/325771/WHO-MVP-EMP-IAU-2019.06-eng.pdf
29. Bahamondes L, Mansour D, Fiala C, Kaunitz AM, Gemzell-Danielsson K. Practical advice for avoidance of pain associated with insertion of intrauterine contraceptives. J Fam Plann Reprod Health Care. 2014 Jan;40(1):54–60.
30. DB Robinson, V MacLaughlin, J Poole. Sexual health education outcomes within Canada's elementary health education curricula: A summary and analysis. The Canadian Journal of Human Sexuality. Vol. 28, No. 3 DOI: 10.3138/cjhs.2018-0036 Volume 28 Issue 3, November 2019, pp. 243-256

Downloads

Published

2020-08-12

How to Cite

Houston, M. (2020). INTRAUTERINE CONTRACEPTION: A LITERATURE REVIEW INVESTIGATING THE BARRIERS LIMITING USE BY CANADIAN WOMEN.: Intrauterine Contraception: A Review of Barriers for Canadian Women. The Journal of Canada’s Physician Assistants, 1(5), 28–42. https://doi.org/10.5203/jcanpa.v1i5.870