IUD use in France: women's and physician's perspectives

Objective While the intra-uterine device (IUD) is the second most popular contraceptive method in France, its use remains low among women most at risk of unintended pregnancies. Acknowledging the conjoint role of women and physicians in contraceptive decision making, we investigate the determinants of IUD use and IUD recommendations from the user and prescriber perspectives. Study design Data are drawn from 2 national probability surveys (population-based and physician surveys) on sexual and reproductive health in France. The population based survey comprised 3,563 women ages 15–49 at risk of an unintended pregnancy in 2010 and the physician survey included 364 general practitioners (GPs) and 401 gynecologists practicing in private offices in 2010–2011. Analyses were performed using logistic regression models. Results Altogether, 21.4% of women were IUD users, with substantial differences by age and parity. Less than 1% of young women (<25 years) and 3% of nulliparous were current IUD users in 2010. The odds of IUD use were four times higher in women followed by a gynecologist as compared to a GP. Mirroring these results, gynecologists were more likely to recommend IUDs than GPs. Misconception about IUD risks was widespread among women and providers. Medical training and information, professional practice settings, and ever use of IUDs also informed physician’s likelihood of recommending IUDs, regardless of specialty. Conclusions The study reveals the intersection of individual and professional influences on contraceptive use patterns. The considerable age discrepancy in IUD use in France, with very few young women most at risk of an unintended pregnancy using the method, reflects a knowledge gap shared by users and providers. These findings suggest there are significant opportunities to improve contraceptive care in France. Implications This study stresses the need to inform women and doctors about the benefits and risks of IUDs for all women. Substantial efforts are required to improve the medical curriculum, in order to promote evidenced based family planning counseling and provide GPs with the technical skills to insert IUDs

La crise de la pilule en France : vers un nouveau modèle contraceptif ?

Le débat médiatique de fin 2012 - début 2013 sur les pilules n’a pas entraîné de désaffection vis-à-vis de la contraception mais le recours à la contraception orale a diminué, passant de 50 % en 2010 à 41 % en 2013. Une partie des femmes ayant opté pour d’autres méthodes, notamment le stérilet (pour les plus diplômées), le préservatif ou des méthodes dites naturelles (pour les plus précaires). De nouvelles inégalités sociales vis-à-vis du recours à la contraception sont par ailleurs apparues. Le débat de 2013 a contribué à une diversification des pratiques contraceptives, même si la pilule reste prépondérante

Unplanned or unwanted? A randomized study of national estimates of pregnancy intentions

Objective: To evaluate the effect of question wording on national estimates of pregnancy intentions. Design: Data drawn from a national probability survey. Setting: The FECOND study in France in 2010. Patient(s): Five thousand two hundred and seventy-two women and 3,373 men who reported 11,603 pregnancies. Intervention(s): Participants randomly assigned to answer 1 of 2 questions on whether they had planned or wanted each of their pregnancies. Main Outcomes Measure(s): Generalized estimated equation regression models used to test for differences in pregnancy intentions by question wording. Result(s): The use of different wording yielded a 6%point difference in estimates: 33.5%pregnancies were ‘‘unplanned,’’ and 27.4% were ‘‘unwanted.’’ The addition of information on reasons for not using contraception at the time of conception lead to significant recoding, which resulted in a significant reduction in the wording effect: 23.7% (95% CI 22.4–25.0) of pregnancies were unplanned, and 21.2% (95% CI 19.9–22.5) were unwanted. Results from the multivariate analysis confirm the greater chance of reporting an unplanned as compared with an unwanted pregnancy (relative risk 1.25 [95%CI 1.17–1.33]), even after recoding (relative risk 1.15 [95%CI 1.06–1.24]). Conclusion(s): This study shows the strong effect of question wording on estimates of pregnancy intentions. The results also support the value of adding information on reasons for nonuse of contraception when assessing pregnancy intentions

The French pill scare : towards a new contraceptive model?

The media debate in late 2012 and early 2013 on contraceptive pills did not reduce contraceptive prevalence,but the use of oral contraception decreased, falling from 50% in 2010 to 41% in 2013. A portion of women opted for other methods, notably IUDs (among the most educated), condoms, or "natural" methods (among the most disadvantaged). New social inequalities in contraceptive use appeared. The 2013 debate contributed to a diversification of contraceptive practices, although the pill remains dominant