Advancing Sexual and Reproductive Health and Rights
 
Perspectives on Sexual and Reproductive Health
Volume 45, Number 4, December 2013

Counseling for IUDs and Implants: Are Health Educators And Clinicians on the Same Page?

By Kirsten M.J. Thompson, Lisa Stern, Marsha Gelt, J. Joseph Speidel and Cynthia C. Harper

CONTEXT: Low knowledge of long-acting reversible contraceptives (LARC) and restrictive counseling practices have been documented among contraceptive care clinicians. However, little is known about health educators’ counseling on LARC, how their practices compare with clinicians’ and their specific training needs.

METHODS: A survey conducted in 2011–2012 assessed knowledge and practices related to LARC counseling and provision among 410 staff at 40 Planned Parenthood clinics. Clinicians’ and health educators’ knowledge and prac- tices were compared via chi-square tests; use of evidence-based criteria was assessed in multivariable logistic regres- sion analyses.

RESULTS: At least half of both types of staff routinely discussed LARC with clients, and nearly all considered the methods safe. Health educators considered a smaller proportion of clients candidates for LARC than did clinicians (57% vs. 77%), and they were less likely to consider IUDs for teenagers (79% vs. 96%), nulliparous women (82% vs. 98%) and unmarried clients (90% vs. 99%). In a multivariable model, health educators were less likely than clinicians to counsel clients using the least restrictive evidence-based criteria (odds ratio, 0.1). Sixty-four percent of health edu- cators and 40% of clinicians desired additional LARC training.

CONCLUSION:Even in clinics that specialize in reproductive health care, health educators are less likely than clinicians to apply current evidence-based criteria in counseling about LARC. To provide evidence-based contraceptive counseling, health educators need training on LARC eligibility and indications.

Perspectives on Sexual and Reproductive Health, 2013, 45(4):191–195, doi: 10.1363/4519113

DOI:10.1363/4519113







 

AUTHOR AFFILIATIONS

Kirsten M.J. Thompson is project director, J. Joseph Speidel is professor and Cynthia C. Harper is associate professor, all at the Bixby Center for Global Reproductive Health, University of California, San Francisco. Lisa Stern is associate director of research, Planned Parenthood Federation of America, New York. Marsha Gelt is program director, National Training Center for Family Planning Service Delivery, Cardea Services, Oakland, CA.