"It seems too extreme”: The most salient reasons why US women are not using implants or intra-uterine devices for contraception

Background. Estimates indicate that approximately 3.5% of American women are currently using intra-uterine contraception (IUC) and 1.9% have ever used the contraceptive implant.  Despite widespread promotion, the availability of new products and expanded eligibility criteria, women’s uptake of IUCs and implants is low.  

Methods. Data presented here represent 194 women between the ages of 14 and 45 (mean=24.5) who enrolled in an online study after visiting a family planning clinic for a new contraceptive method.  We sought to determine the leading reasons for IUC and implant non-use through open-ended responses.

Results. Approximately 40% (n=76) of women expressed no interest in using an IUC, while almost half (n=90, 46.4%) stated they did not want to use the implant. Salient responses for not wanting to use an IUC included: 1) worries about potential or experienced side effects (n=42); 2) having no knowledge or awareness about these methods (n=37); and 3) apprehension about invasive procedures and pain (n=30).  The most common reasons for not using an implant were:  1) fears of invasive procedures and pain (n=17); 2) not wanting an object in the body (n=14); and 3) concern about potential side effects (n=13).  

Conclusions. Efforts to increase awareness and utilization of long-acting reversible methods have yet to overcome barriers to use.  Lack of knowledge and concern about side effects remain important reasons for low interest in using longer-acting methods.  To address fears and misinformation, contraceptive counseling should clarify insertion procedures, outline pain management options, and emphasize the benefits for young, nulliparous women.