Objective: To assess the attitudes and practices of general practitioners (GPs) in New South Wales in regard to intrauterine device (IUD) use.
Design: Randomised group comparison of 100 rural and 100 urban GPs by questionnaire.
Subjects: Sixty-five rural and 66 urban general practitioners took part in the study.
Results: Almost 50% of GPs who responded to the questionnaire always discussed the IUD when counselling about contraception, whereas 6% never discussed IUDs. Rural GPs were more likely to discuss IUD use than urban GPs. In the past, 68.7% of GPs had inserted IUDs but only 20.6% still inserted them. Fifty per cent of GPs who did not currently insert IUDs felt they lacked expertise due to less demand for IUDs from women or inadequate training.
Conclusion: Prevailing community attitudes towards intrauterine devices have resulted in fewer requests to general practitioners for IUDs, resulting in a lack of expertise in IUD insertion. Increased litigation associated with IUD use, and subsequent publicity, has increased the cost of medical indemnity insurance. All these factors have contributed to fewer GPs being prepared to insert IUDs. Australian women are being deprived of balanced information about the benefits and risks of IUD use and of the possibility of using this very effective, low-cost, low-maintenance method of contraception.
PIP: Use of the IUD in Australia has decreased from 64,080 insertions in 1985 to 21,469 in 1989. In addition, the number of general practitioners (GPs) who inserted at least 50 IUDs a year dropped from 167 to 23, and adverse publicity has increased, especially that associated with the Dalkon Shield, Gravigard IUDs, and the perceived risk of pelvic inflammatory disease. To assess the attitudes and practices of GPs as they relate to IUDs in New South Wales, therefore, a randomized group of 100 rural and 100 urban GPs was surveyed by questionnaire. 65 rural and 66 urban GPs participated in the study. It was found that almost 50% of the GPs always discussed the IUD during family planning counseling sessions, 6% never discussed it, and rural GPs were more likely to discuss it than urban ones. In addition, only 21% often discussed IUDs with women of reproductive age and 25% did not recommend them at all. 68.7% of the GPs had inserted IUDs in the past, but only 20.6% still did, with only 9 inserting 10 or more annually. Reasons for not inserting IUDs included a perceived lack of expertise caused by a lack of practical experience or of training and the fact that the IUD acts as an abortifacient. Since new devices, such as the Copper-T 380A, which is licensed for 8 years use, are economical and not associated with a risk of pelvic inflammatory disease after the first 20 days, failure to inform Australian women about the availability of these contraceptives is depriving them of the opportunity to use a very effective, low-cost, low-maintenance method of contraception.