Australians underuse Copper IUD as emergency contraception
The copper intrauterine device is the most effective emergency contraception and the only method to provide ongoing contraception, yet it is underutilised in Australia according to new research from Family Planning NSW.
Published in the European Journal of Contraception & Reproductive Health Care, the study 'Acceptability of the copper intrauterine device as a form of emergency contraception in NSW' found that only 2 per cent of people surveyed had used the copper IUD as emergency contraception, despite more than 60 per cent of respondents having accessed emergency contraception.
The copper IUD is the most effective form of emergency contraception, with a failure rate of less than 0.1%. To work, it must be inserted by a trained health professional within five days of unprotected sex or contraceptive failure. Once in place, it provides immediate, effective and ongoing contraception for up to 10 years and is instantly reversible when removed, with no impact on fertility.
Despite the effectiveness of the copper IUD, FPNSW Senior Research Officer Dr Jessica Botfield said the recent study clearly showed there were barriers for its uptake as emergency contraception for individuals and health workers.
"Our research explored the views of clients and health professionals on the copper IUD as emergency contraception," Dr Botfield said.
"What we found is that only 13 per cent of clients were even aware that the copper IUD could be used for emergency contraception, although nearly 50 per cent said they would consider it as an option once they had been given information.
"For health workers, around half had discussed copper IUDs as a form of emergency contraception with clients in the past 12 months, compared with nearly all discussing oral emergency contraception options."
According to Dr Botfield, health workers training, client awareness and cost are likely to be a few reasons behind the low awareness and limited uptake of the copper IUD.
"IUD insertions require special training, so it is limited to clinical settings with staff certified in this procedure. If this isn’t available, it may not be presented as an option to clients," Dr Botfield said.
"Clients may not even know the copper IUD is an option for them, particularly if they only speak to a pharmacist about emergency contraception. Even if they are familiar, the cost of the appointment plus the device, which isn’t covered by the PBS, can be a deterrent.
"They may also not have a clinician close to them who is qualified to insert an IUD, which is especially true for people in regional areas who often have to travel further for medical care."
Findings from the research suggest that increased education and information on the option of the copper IUD as emergency contraception is needed among both clients and health professionals, including pharmacists and non-IUD inserting primary care clinicians.
The upskilling of nurses and midwives to insert IUDs could also go a long way for relieving time pressures of accessing the device, with studies already showing successful insertion rates by nurses are comparable to medical officers. However, with no MBS item available for nurses to provide IUDs, remuneration of nurses is a significant barrier to client uptake.
According to Dr Botfield, all people requiring emergency contraception should be informed about and offered the copper IUD. This should be reflected in health service protocols with referral pathways in place for people who choose this option but cannot have one fitted immediately.
"Despite its advantages as emergency contraception and potential as ongoing contraception, the copper IUD is very underutilised as emergency contraception within Australia," Dr Botfield said.
"More information and improved access to copper IUDs, including MBS items for appropriately trained health professionals, would help shift this and increase the options available."
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Media enquiries: Family Planning NSW E: media@fpnsw.org.au M: 0402 880 653
