Pediatricians need training with IUDs

The American Academy of Pediatrics (AAP) recently recommended, for the first time, intrauterine devices (IUDs) as a first-line contraceptive option for adolescent girls. However, few pediatricians have adequate training in placing the devices, which can limit their use.

In an October 2014 policy statement, backed by an accompanying technical report, the AAP said that long-acting reversible contraception (LARC), such as IUDs and the progestin implant, “should be considered first-line contraceptive choices for adolescents” because of their “efficacy, safety, and ease of use.” The American College of Obstetricians and Gynecologists also endorses LARC for use in teenagers.

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Intrauterine devices, which have a failure rate of less than 1%, can remain in place safely for as long as 5 to 10 years, and, unlike many other contraceptive methods, don’t require regular attention to be effective, an advantage for teenagers. Despite past concerns, IUDs have been found safe for nulliparous adolescents and don’t cause tubal infertility, the AAP statement emphasizes. Fertility appears to return rapidly after removal.

One stumbling block to expanding access to IUDs among teenaged girls, however, is that pediatricians often lack sufficient training in inserting them, according to a December 2014 editorial in the Journal of the American Medical Association Pediatrics. Use of LARC, although still small compared with other contraceptive methods, is increasing among 15- to 19-year-olds, the authors write, and research suggests that significantly more teenagers would adopt the methods if obstacles such as access and cost could be overcome.

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The AAP policy statement encourages pediatricians who don’t have the training to provide LARC themselves to identify local healthcare providers to whom they can refer patients for insertion of IUDs or implants. Adolescents often don’t follow through on referrals for a variety of reasons, however, and lack of LARC availability in primary care settings, where teenagers receive most of their medical care, “presents a significant barrier to LARC use in young women,” the authors of the editorial say.

They strongly advocate training pediatricians in placement of IUDs and implants so that they can offer all contraceptive options, including LARC, to patients. “We believe that LARC education and hands-on training are paramount for all adolescent medicine fellows and interested pediatric residents,” they write.

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Pediatric residents usually spend only about a month training in adolescent medicine, including contraception. Such training may include very little hands-on experience in LARC. For this reason, the editorial writers urge pediatric residency and adolescent medicine fellowship programs create models for LARC training within the current curriculum.