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Social and Medical Factors in the use and Effectiveness of IUDs

Published online by Cambridge University Press:  31 July 2008

Robert Snowden
Affiliation:
Family Planning Research Unit, University of Exeter
Peter Eckstein
Affiliation:
Department of Anatomy, University of Birmingham
Denis Hawkins
Affiliation:
Institute of Obstetrics and Gynaecology, Hammersmith Hospital, University of London

Extract

The possible influence of psycho-social factors on the use and effectiveness of the intrauterine contraceptive device (IUD) has not been seriously examined until recently. Inquiry into these factors has become feasible as large-scale projects—primarily designed to consider medical factors in IUD use—have been developed. Data obtained from a number of centres within and outside the United Kingdom indicate the existence of variation in the clinical efficacy of the same type of device. This variability suggests that success or failure of a given model does not necessarily depend on the device alone. Factors other than those generally considered ‘medical’ may play a significant role in IUD use and effectiveness.

The procedures involved in organizing large-scale multi-clinic IUD trials and including efficient data-retrieval systems are described in detail.

In addition, findings are reported on the trial of a stainless steel type of device, the M 213, which has been fitted in sufficient numbers in several UK clinics to permit analysis of variables associated with both the clinic and the doctor responsible for the IUD fitting. Evaluation of the data collected from two single-doctor clinics in two adjacent towns in the southwest of England using the M 213 and served by the same doctor, has revealed significant differences in the net cumulative pregnancy rate associated with the device. Age and parity of the IUD acceptors (and the interaction of age and parity) did not appear to be responsible for the difference. Although the general atmosphere and work load within the clinic setting may have differed it is not thought that this could fully account for the observed variations in the pregnancy rates between the two clinics.

There appears to be sufficient evidence to suggest that the traditional purely ’medical’ approach to the examination of IUD use—effectiveness should be extended to include the study of social and psychological variables associated with both the providers and the acceptors of the IUD service.

Type
Research Article
Copyright
Copyright © Cambridge University Press 1973

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References

Bernard, R.P. (1969a) IUD Performance Patterns, Geographic Series Nos. 1–3. The Pathfinder Fund, Chestnut Hill, Mass., USA.Google Scholar
Bernard, R.P. (1969b) The M 211 device—a possible turning point in approach. Advances in Planned Parenthood, V. Proceedings of Seventh Annual Meeting of the American Association of Planned Parenthood Physicians, San Francisco, Excerpta Medica, International Congress Series, 207, pp. 100–108.Google Scholar
Bernard, R.P. (1970a) IUD Performance Patterns, Geographic Series Nos. 4–5. The Pathfinder Fund, Chestnut Hill, Mass., USA.Google Scholar
Bernard, R.P. (1970b) IUD performance patterns—a 1970 world view. Int. J. Gynec. Obstet. 8, 926.CrossRefGoogle Scholar
Hawkins, D.F. (1969) Complications with IUDs. Br. med. J. ii, 381.CrossRefGoogle Scholar
Karim, M. & Rifai, S.F. (1968) Socio-medical evaluation of intrauterine devices in Railways family planning centre. J. Egypt. med. Ass. 51, 804.Google ScholarPubMed
Kleinman, R.L. (1972) Intrauterine Contraception. International Planned Parenthood Federation, London.Google Scholar
Lippes, J. (1967) Observations after 4 years of experience with the intrauterine plastic loop at the Buffalo Planned Parenthood Center. J. Sex Res. 3, 323.CrossRefGoogle Scholar
Pearl, R. (1932) Contraception and fertility in 200 women. Hum. Biol. 4, 365.Google Scholar
Potter, R.G. (1967) Application of life table techniques to measurement of contraceptive effectiveness. Proceedings of the World Population Conference, Belgrade (1965), pp. 301304. United Nations, New York.Google Scholar
Potter, R.G. (1969) Effectiveness of the IUD. Family Planning in Taiwan. An Experiment in Social Change, Chap. 10. Edited by Freeman, R. and Takeshita, J.. Princeton University Press.Google Scholar
Silberman, E., Chaft, M. & Stone, M. (1968) The M intrauterine contraceptive device. Fourth Asian Congress of Obstetrics and Gynecology. The Congress Proceedings, Singapore, p. 103.Google Scholar
Snowden, R. (1971) Social factors in use and effectiveness of the IUD. Ph.D. thesis, Exeter University.Google Scholar
Tietze, C. (1962) Intrauterine contraceptive rings: history and statistical appraisal. Intra-uterine Contraceptive Devices. Proceedings of the Conference, April 30th—May 1st 1962, pp. 920. Edited by Tietze, C. and Lewit, S.. International Congress Series, 54, Excerpta Medica Foundation, Amsterdam.Google Scholar
Tietze, C. (1964) Use and effectiveness of contraceptive methods in the United States. Manual of Contraceptive Practice, pp. 126137 Edited by Calderone, M.S.. Williams & Wilkins, Baltimore.Google Scholar
Tietze, C. (1967) Intrauterine contraception. Recommended procedures for data analysis. Stud. Fam. Plann. 18, Supplement, 1.CrossRefGoogle Scholar
Tletze, C. & Lewit, S. (1970) Evaluation of intrauterine devices: ninth progress report of the Co-operative Statistical Program. Stud. Fam. Plann. 55, 1.Google Scholar