Social and Medical Factors in the use and Effectiveness of IUDs

Abstract

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.