Copper intrauterine devices (copper-IUDs) are safer, more effective and cheaper than hormonal contraceptive methods and are the most widely used reversible contraception in the world. However, they are underused in developed countries. In an article published recently In Contraception, Myat Arrowsmith and colleagues from Imperial College London reviewed randomized controlled trials and controlled before-and-after studies to determine the effectiveness of interventions for improving uptake of copper-IUDs.
Nine studies representing 7960 women met our inclusion criteria, including seven randomized controlled trials and two controlled before-and-after studies. Meta-analysis from three studies showed contraceptive provision by community workers doubled uptake of IUD, and studies on antenatal contraceptive counselling showed similar increases. One study reported major increases in IUD uptake with postnatal couple contraceptive counselling; a study on postnatal home visits and two studies on post-abortion contraceptive counselling did not reach statistical significance.
Myat Arrowsmith and colleagues concluded that Community-based interventions and antenatal contraceptive counselling improved uptake of copper-IUD in studies mainly conducted in developing counties. Further research is needed on post-abortion contraceptive counselling as well as longer-term effectiveness of interventions to improve use of copper-IUD.