February 12, 2015 — Pediatricians often lack training on intrauterine device insertion, even though the method is an appropriate contraceptive option for adolescents, Kaiser Health News reports.
Whereas adult women often access contraceptive services through their gynecologists, many teens still visit a pediatrician for their health care needs and thus may not have access to IUDs if their providers are not trained on insertion, according to KHN.
IUDs use copper or hormones to prevent pregnancy. Unlike pills, condoms or other contraceptives that require frequent attention, IUDs can remain in place for several years. They are also more than 99% effective at preventing pregnancy, with few risks.
IUDs have grown in popularity in recent years, with about 12% of women who used birth control from 2011 to 2013 reporting that they used a long-acting reversible contraceptive, like an IUD. Under the Affordable Care Act (PL 111-148), most health plans must cover IUDs without copayments.
Last fall, the American Academy of Pediatrics recommended that IUD be considered as a first choice for adolescents seeking contraception. The American College of Obstetricians and Gynecologists also has recommended the method as an appropriate option for teenagers.
Shortfalls in Training, Access
According to KHN, pediatrics residents only receive about one month of training in adolescent medicine. Jane McGrath, chief of adolescent medicine at the University of New Mexico, said that even if residents have a chance to learn about IUDs during that period, one month is "certainly not enough time to learn how to put in an IUD."
Moreover, many instructors who teach adolescent medicine to residents lack training in IUD insertion themselves, according to Julia Potter, a physician in the pediatrics department of New York-Presbyterian Hospital and co-author of an editorial on the topic published in JAMA Pediatrics in December.
A 2013 survey published in the Journal of Adolescent Health found that 26% of pediatricians and internal medicine physicians offered IUDs or other LARC, compared with 88% of ob-gyns.
Pediatricians who do not offer IUD insertion can refer a patient to another provider, such as a gynecologist, according to KHN. However, referrals can present privacy concerns for adolescents, who might not want their parents to see the gynecologist visit on their health insurance records. Lack of control over how they spend their time and failure to follow up on referrals are also barriers to IUD access for adolescents, KHN reports.
Adolescent medicine physician Mandy Coles, an assistant professor of pediatrics at the Boston University Medical School and a co-author of the JAMA Pediatrics editorial, said, "The bottom line is this is going to take more time and advocacy and research to improve training" (Luthra, Kaiser Health News, 2/11).