Q&A

Our faculty answer questions asked during the webinar

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Question: Dr. Ali, you mentioned that the IUD use data you’ve shared doesn’t give a full picture of client preference to use it. Do you know of any efforts to institute *client preference* into our global FP metrics? For example, to measure IUD use that could be considered coercive?

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Moazzam Ali: In the process of reviewing various aspects of intra-uterine contraception we did not come across any efforts that indicates any coercive efforts on the part of providers to promote IUD use. Qualitative studies from low-income settings have shown that while providers are regarded as useful sources of information, reassurance from friends or relatives who have used IUDs is a crucial factor in attitude formation. For details, I refer to the publication below: 

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Daniele, M.A.S., Cleland, J., Benova, L. Ali, M. Provider and lay perspectives on intra-uterine contraception: a global review. Reprod Health 14, 119 (2017). 

https://doi.org/10.1186/s12978-017-0380-8

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Question: Curious if you looked at insurance status as a predictor of IUD use.

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Megan Kavanaugh: We have examined the association between insurance coverage and contraceptive use at both the national level and state level.  At the national level using NSFG data, we documented a significant association specifically between private insurance coverage and IUD use. At the state level, a level that is often more appropriate to examine insurance coverage given fluctuations across the states in state-based insurance programs, we used BRFSS data and found that having any insurance coverage (public or private) was associated with use of contraception, overall, and use of provider-controlled methods. 

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Question: Dr Kavanaugh, was your IUD use by ethnicity data normalized to representation in US population?

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Megan Kavanaugh: Findings presented on the associations between race/ethnicity and IUD use were based on data from the NSFG. The NSFG is nationally representative of women 15-44 years of age in the civilian, noninstitutionalized, household population of the United States.

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Question: How can we get the tool Dr. Dehlendorf mentioned in her presentation?

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Christine Dehlendorf: It's available here. 

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Question: Please share the continuation rates for IUDs in this study, and the patient-centered modules you referenced?

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Christine Dehlendorf: https://www.fpntc.org/sites/default/files/resources/fpntc_bcmoption_chart_2017.pdf

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Question: Can you post a link to your RCT study of using your counseling tool?

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Christine Dehlendorf: 

https://pubmed.ncbi.nlm.nih.gov/30763545/

https://pubmed.ncbi.nlm.nih.gov/31404538/

https://pubmed.ncbi.nlm.nih.gov/31537316/

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Question: Is there data on the recommendations made by providers who use IUDs themselves?

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Christine Dehlendorf: Not that I know of.

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Question: How can these principles inform traditional clinical research on safety and effectiveness

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Christine Dehlendorf: In addition to Dr. Perritt’s excellent comments at the time of the presentation, I would add that we need to reconsider what “Effective” means, and consider a more comprehensive perspective that is inclusive of people’s lived experiences of using methods. While research about new methods should of course continue to measure pregnancy rates, this should be alongside other measures that capture these other aspects of method use. This commentary addresses some of these issues: https://pubmed.ncbi.nlm.nih.gov/29545022/.

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Question: Often the challenge at frontline public health facilities in lower or middle income countries is limited time and few healthcare workers. Any ideas on what we can do in redesigning the experience of care?

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Christine Dehlendorf: I would encourage working to deliver information to patients outside of and prior to their clinic or telehealth visit, in order to optimize time with the health care provider. We are working to operationalize this type of use of our decision support tool, and have also been working with an e-commerce platform in Kenya (Kasha) to incorporate a decision support module around contraception into their website based on this principle.