Reducing Barriers to the use of the Intrauterine Contraceptive Device as a Long Acting Reversible Contraceptive

Norman D. Goldstuck


The intrauterine device (IUD) is the oldest long acting reversible contraceptive (LARC) method. There remain widespread barriers to its general acceptance, although some have been overcome, others remain. These stem from a lack of understanding of uterine anatomy and physiology. Uterine measuring techniques did not become popular, probably because of the extra effort required prior to IUD insertion. Unfortunately the information they provided regarding IUD design was also not heeded. In some countries varying sizes of other IUDs (second generation) are now available. The third generation hormonal carrying IUDs have also reduced barriers by lowering side effects and producing added health benefits. Fourth generation IUDs will provide added health benefits in addition to contraception and should further reduce barriers to IUD use. Most remaining IUD barriers are due to provider perceptions. Most are based on psychological, moral and religious prejudices. These should not be allowed to interfere with the provision of LARC methods of contraception. There are also acceptor barriers which can be modified by providing education about the method. The use of the IUD as a LARC method is increasing in many developed and developing countries. New technology should help propel the IUD into a more mainstream contraceptive. (Afr J Reprod Health 2014; 18[4]: 15-25).


Keywords:  IUD, LARC, barriers, improvements




Le dispositif intra-utérin (DIU) est la plus ancienne méthode  contraceptive réversible à longue durée d’action (CRLDA). Il reste encore des obstacles généralisés à son acceptation globale ;  bien que certains aient été surmontés, d'autres restent toujours. Ceuxci découlent d'un manque de compréhension de l'anatomie et de la physiologie de l'utérus. Les techniques pour mesurer les  utérins ne sont pas devenues populaires, probablement en raison de l'effort supplémentaire nécessaire avant l’insertion d'un DIU. Malheureusement, l'information qu'ils ont fournie quant à la conception de DIU n’a pas également  été entendue. Dans certains pays,  des tailles différentes d’autres  DIU (deuxième génération) sont maintenant disponibles. L’hormonal de la a troisième génération qui portent les DIUs a également réduit les obstacles en diminuant  les effets secondaires et la production de bienfaits pour la santé. Les DIUs de la quatrième  génération offriront des avantages supplémentaires pour la santé, en plus de la contraception et devraient encore réduire les obstacles à l'utilisation d'un DIU. La plupart des obstacles de DIU qui subsistent sont dus à des perceptions des fournisseurs. La plupart sont basées sur des préjugés psychologiques, moraux et religieux. Ils ne devraient pas être autorisés à interférer avec la fourniture de méthodes de la conception à la CRLDA. Il y a aussi des obstacles des accepteurs qui peuvent être modifiés par une éducation sur la méthode. L'utilisation du stérilet comme méthode de la CRLDA) est en augmentation dans de nombreux pays développés et en développement. Maintenant, la technologie devrait aider à propulser le DIU en un contraceptif plus populaire. (Afr J Reprod Health 2014; 18[4]: 15-25).


Mots clés: DIU, CRLA, barrières,  améliorations

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