Do women know which IUD they are wearing?

CONTRACEPTION

DO

WOMEN

KNOW

WHICH

Robert Emory

A.

University Grady

IUD THEY Hatcher,

Family

Atlanta,

Carol

R.

Center

Measham,

M.D.

M.S.W.

Population of

M.A.

and

Physicians

Columbia New

Program

Hospital

Loewenstein,

for

College

M.D.

Georgia

Weiss,

Regina

WEARING?

Planning

Memorial

Anthony

ARE

Family and

Health

Surgeons

University

York,

New

York

Abstract Family they

were

Planning wearing,

examination. did

not

the

About

correctly

perception wearers

clinic and

that of

patients

the

actual

19 percent identify

might the

be

Dalkon

the

of

wearing

type 268

type

was women

that

IUDs wearing

they

a medical

risk

was

Shield.

Each

user

were

identified had.

held of

asked in the

four

types

Incorrect

by more an

IUD

the

than

should

type

pelvic of or

IUDs unknown

half be

of

given

a card stating IUD type, date of insertion, date of reinsertion if and instructions in case of complications. The problem of applicable, incorrect identification may be exacerbated as the number of devices increases and with the trend toward periodically removed and replaced. populations

of

Accepted

for

AUGUST

IUD

use of medicated IUDs which must Comparable studies in different

be

users are needed.

publication

1978 VOL. 1X NO. 1

June

26,

1978

163

CONTRACEPTION

INTRODUCTION

patient

Developments in recent know which IUD she

years have is wearing.

made clear

the

importance

that

a

The introduction of copper and hormone-containing devices made it necessary to remove these IUDs at the indicated time, usually after one to three years of use. However, it was the association of the Dalkon Shield and other devices with fatal second trimester abortions which brought home the fact that it was critical for a woman to know her particular device (I-4). METHODS This study was carried out in a large, urban, hospital-based family planning clinic” to ascertain the proportion of patients who could identify their IUD. The average client of the program is 22 years old, has parity 2 and a tenth grade education; more than two-thirds are black. From March 1975 to March 1577, patients seen by one clinician asked prior to the pelvic examination what device they were using. duration of use and pregnancy history were aiso noted. age, race, at the time of Finally, the IUD actually being worn was identified pelvic examination.

were Their the

The women in this study do not represent a random sample of those attending the clinic, nor are they all the patients seen by the particAn effort was made to ular clinician during the two-year period. collect this information on every patient, but this was not always which also prevented complete data being possible due to time pressures, The clinician collecting these data saw collected on every woman. women whose IUDs he had inserted, problem patients referred by paraand any woman requesting to be seen by him. NO medical personnel, known investigator bias was introduced and all women were interrogated During the two-year period of the study the indications in the same way. for insertion of a particular device and the information supplied to the patient followed standard procedures (5). Each woman received a walletsize card listing the type of device inserted, and some also received The wnllet-size card is the manufacturer’s card or instructions. The program stopped in,erting the Dalkon Shield reproduced as Figure I. in

January

1975

before

the

study

began.

RESULTS The interviews were Coil, Copper 7 or Dalkon characteristics in Table

from

“In

164

conducted Shield. I.

with 268 patyrnts using Lippes The results a. e shown by four

The overall correct IUD identification other studies are not available for

Grady

Memorial

Hospital,

Atlanta,

rate was 80.6 comparison.

percent.

Loop,

Saf-T-

Data

Georgia.

AUGUST

1978VOL.lSNO.2

CONTRACEPTION

YOUR DEVICE Devices (IUD’s) come in several sizes and shapes. Yours is checked below: Date of Insertion ~ LOOP -- A -B -C -D COPPER 7 SAF-T-COIL

-Large -Medium -Small DALKON SHIELD -Large -Medium -Small OTHER CALL US RIGHT AWAY IF YOU GET SEVERE PELVIC PAIN, DISCHARGE, BLEEDING OR FEVER. 659-1212, Ext. 291 or 720

F,igure

AUGUST

1

Patient's

1978 VOL. 18 NO. 2

Here are your important medical problems. Keep this in your wallet. It may help you someday. 1.

2. 3. 4.

5. Family

Planning Program Grady Memorial Hospital Atlanta, Georgia

Card

165

CONTRACEPTION

Table

I.

Identification and Duration

of

of Type Use

of

IUD by Age,

Number of Users

Age 19 years

or

20-29 years 30 years or

over

Race Black Caucasian Number of None

living

52

78.8 85.5 71.1

109 50

87.2 88.0

children 76

86.8

69

78.3

20 44

90.0 72.7

112

88.4

44

72.7

I : or

more

Duration of 1 year or More than

;” Includes

166

use less 1 year

users

80.6

124 38

under

Parity

Percent Correct

268”

Total

Race,

with

one or

more

unknown characteristics

AUGUST

1978 VOL. 18 NO. 2

CONTRACEPTION

Women 20-29 correctly identified their IUD more frequently than Women with one or two children those in younger or older age groups. were correct less frequently than those with none or with three or more children. The proportion with correct response decreased with duration of use. There were no significant differences in percentage of correct responses between ethnic groups. Among women 20-29 the recall was much better for those with one year or less of use than among those with longer yse. There are insufficient cases in younger and older age groups to warrant statements about the relationship of accuracy to duration of use. The only two parity groups with sufficient patients for comparisons between duration groups were women with one or two children. In accuracy was better among women with shorter each of these groups, duratlon of use. No major differences were found among the different devices, with the exception of poorer recall of the Dalkon Shield. However, this finding was disturbing in view of the suggested higher risk of septic second trimester abortion with this IUD. The poorer recall may be due to longer average duration of use since this program stopped using this device before the survey started. The women who were not able to correctly identify their type of IUD were equally divided between those with incorrect answers and those with no answer. Those who gave no answer did not know which IUD was in place. In spite of being told the names of the IUDs and shown pictures of the IUDs, some did not know which IUD they had. In Table II are shown the combinations of and the reported IUD thought by the patient to those with the Dalkon Shield, 36 percent said Loop. About one-eight of those with Saf-T-Coil Lippes Loop. The second incorrect perception any medical risk. However, the women unaware Dalkon Shield were at greater risk in view of which may occur during pregnancy.

actual IUD in place be in place. Of they had the Lippes said they had the does not represent that they had a the severe infections

Since any type of IUD might, in the future, be associated or a particular IUD might be recalled because of manufacturing or some types might have to be removed or replaced, it is very that every woman who wears an IUD knows the type she is wearing is prepared to take appropriate action.

AUGUST

1978 VOL. 18 NO. 2

with problems defects, important and

167

CONTRACEPTION

Table

II.

Reported

Type

of

IUD

By Actual

Type

Actual

Reported Total Lippes

IUD

percent Loop

7

Copper

T

Shield

-'-Correct

168

IUD

Saf-T-

Loop

Coil

(n=l39)

(n=65)

Cni39)

(n=25)

100.0

100.0

100.0

100.0

5.1

36.0

89. 7" 2.6

44.0*

2.6

20.0

8::62*

Copper

Dalkon Shield

12.3 78.5" 1.5

0.7 11.5

Unknown

IUD

Lippes

Saf-T-Coil Copper Dalkon

of

k::

responses

AUGUST

1978VOL.18NO.

CONTRACEPTION

DISCUSSION Several 1.

implications

arise

from

this

study:

In retrospective studies of contraceptive not be assumed that all women know

use,

definitely

it should IUD they are

what

wearing. 2.

Each

date

user

of

of

Simple

instructions

should

also

There 3. populations 4. may

an

The be

be

be given

a card

reinsertion

regarding

is a need of

IUD

problem

of

what

stating

IUD

is necessary

to

in case

do

(if

of

type,

applicable).

complications

if the

to

out

correct

comparable

studies

identification

as

the

of

correct

trend

be

carry

in different

users.

importance

periodically

should when

included.

exacerbated

The 5. increase

IUD and

insertion,

number IUD

toward

removed

of

the

and

of

devices

the

IUD

identification use

of

replaced,

by

available by

medicated

the

patient

increases. the

IUDs,

patient which

may must

continues.

REFERENCES 1.

Kahn, of

2.

H.S.

IUDs.

Kahn,

H.S.

Shield

and

JAMA

and

and

Cates,

125:83-86 W.,

Ory,

Christian, sepsis

1976,

AUGUST

and

C.D.

association among

with

between

women

device-related

Rochat, from

68-69,

morbidity

with

R.W.

the

the

hospitalized Am

disorders.

and

Tyler,

spontaneous

Hefnawi

Stewart, an Table

and

IUDs,

Amsterdam,

Choosing C. Technology p.

An

Jr.

pregnancies

deaths

The (F.

Co., R.A.,

Hatcher, Godwin, ceptive

associated

use

Dalkon for

J Obstet

(1976)

associated

Publishing

Mortality

C.W.

The

abortion.

intra-

N Engl

J Med

(1976)

Contraception

5.

C.W.,

H.W.,

device

295:1155-1159 4.

Tyler,

Jr.

(1975)

contraceptive

Gynecol

uterine

C.W.,

complicated

intrauterine

3.

Tyler, 234:57-59

and

mortality

in Analysis S.

1975,

Segal, p.

of of

mid-trimester

Intrauterine

Editors)

North

G.K., Guest, F., Finkelstein, IUD for an individual patient,

1976-1977.

Holland

429.

Irvington

Publishers,

R. and in ContraNew

York,

9.

1978 VOL. 18 NO. 2

169