Intrauterine Devices at Six Months: Does Patient Age Matter? Results from an Urban Family Medicine Federally Qualified Health Center (FQHC) Network

Anita Ravi; Linda Prine; Eve Waltermaurer; Natasha Miller; Susan E. Rubin

doi:10.3122/jabfm.2014.06.140091

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Figure 1.
Comparison of 6 month device continuation rates between adolescents and adults who had an IUD inserted at the IFH FQHC network in 2011.

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Table 1. Demographic Characteristics of Adolescents and Adults Who Had an Intrauterine Device (IUD) Inserted at the Institute for Family Health Federally Qualified Health Centers Network in 2011

Characteristics	Adolescents (n = 182)	Adults (n = 502)	P Value
Mean age ± SD (years)	18.0 ± 1.6	26.9 ± 3.8
<18	92 (50.5)	—
18–20	90 (49.5)	—
21–25	—	191 (38.0)
26–30	—	199 (39.6)
31–35	—	112 (22.3)
Race^*			<.001
African American	27 (14.8)	110 (21.9)
White	11 (6.0)	150 (29.9)
Other/mixed	74 (40.7)	144 (28.7)
Ethnicity^*			<.001
Non-Hispanic	44 (24.2)	257 (51.2)
Hispanic	82 (45.1)	184 (36.7)
Gravidity^*			<.001
0	96 (52.7)	140 (27.9)
1	45 (24.7)	107 (21.3)
>1	18 (9.9)	209 (41.6)
Parity^*			<.001
0	142 (78.0)	226 (45.0)
1	16 (8.8)	122 (24.3)
>1	4 (2.2)	110 (21.9)
IUD payment form^*			<.001
Grant funded	81 (44.5)	122 (24.3)
Insurance	101 (55.5)	377 (75.1)
Location of insertion			<.001
Residency site	141 (77.5)	331 (65.9)
Nonresidency site	41 (22.5)	171 (34.1)
Type of device^*			.71
Hormonal	131 (72.0)	356 (70.9)
Nonhormonal	50 (27.5)	146 (29.1)
Reason for insertion^{^†}
Routine contraception	131 (72.0)	336 (66.9)	.87
Postpartum contraception	5 (2.7)	62 (12.4)	<.001
Postabortion contraception	38 (20.9)	65 (12.9)	.01
Emergency contraception	0 (0)	6 (1.2)	.14
Menorrhagia	0 (0)	7 (1.4)	.11
Patients who initiated IUD-related contact^{^‡}	108 (59.3)	216 (43.0)	<.001

Data are number (%) unless otherwise indicated.
↵* The total may not sum to 100% because of missing data.
↵† The total may sum to >100% because patients could select multiple reasons.
↵‡ More than 95% of the total number of patients who had any contact with the Institute for Family Health during the 6 months after insertion also initiated intrauterine device (IUD)-related contact.
SD, standard deviation.

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Table 2. Follow-up Frequency and Reasons for Patient-Initiated, Intrauterine Device (IUD)–Related Contact With Providers Among Adolescents and Adults Who Had an IUD Inserted at the Institute for Family Health Federally Qualified Health Centers Network in 2011

	Adolescents (n = 108)	Adults (n = 216)
Median number of contacts (range)	2 (1–11)	1 (1–6)
Patients with ≥3 contacts	40 (37.0)	33 (15.0)
Most common reasons for contact
Bleeding change	54 (50.0)	93 (43.1)
Pelvic/abdominal pain	53 (49.1)	81 (37.5)
String check	33 (30.6)	69 (31.9)
Remove request	25 (23.1)	42 (19.4)

Data are number (%) unless otherwise indicated.

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Table 3. Device Discontinuation Frequency and Characteristics Among Adolescents and Adults Who Had an Intrauterine Device Inserted at the Institute for Family Health Federally Qualified Health Centers Network in 2011 and Who Had Any Clinical Encounters During the 6-Month Follow-up Period After Insertion

	Adolescents	Adult	P Value
Device continuation status			0.7
No removal or expulsion	84 (74.3)	169 (76.5)
Expulsion	10 (8.8)	14 (6.3)
Removal	19 (16.8)	38 (17.2)
Device discontinuation^*
Expulsion
Expulsion by type			0.20
Hormonal	9 (6.9)	11 (3.1)
Nonhormonal	1 (2.0)	3 (2.1)
Expulsion by gravidity^{^†}			0.70
0	4 (4.2)	4 (2.9)
≥1	4 (6.3)	9 (2.8)
Expulsion by parity^{^†}			0.50
0	5 (3.5)	7 (3.1)
≥1	3 (15.0)	6 (2.6)
Removal
Median contacts before removal (n)	3	2
Most common reasons for removal^{^‡}
Pain	12 (66.7)	20 (54.1)
Bleeding	8 (44.4)	11 (29.7)
Parent-related issues	2 (11.1)	0 (0)
Pain during intercourse	2 (11.1)	0 (0)
Other	0 (0)	5 (13.5)
Concern about harm	0 (0)	3 (8.1)
Removal by type^{^†}			0.73
Hormonal	15 (11.5)	26 (7.3)
Nonhormonal	4 (8.0)	11 (8.2)
Removal by gravidity^{^†}			0.12
0	10 (10.4)	5 (3.6)
≥1	6 (9.5)	28 (8.9)
Removal by parity^{^†}			0.11
0	15 (10.6)	11 (4.9)
≥1	1 (5.0)	23 (9.9)

Data are number (%) unless otherwise indicated.
↵* Denominator based on baseline data from Table 1.
↵† The total may not sum to 100% because of missing data.
↵‡ The total may sum to >100% because patients could select multiple reasons.

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Table 4. Sexually Transmitted Infection (STI)^* Testing and Infection Rates on the Day of Insertion and During the 6-Month Postinsertion Period Among Adolescents and Adults Who Had an Intrauterine Device Inserted at the Institute for Family Health Federally Qualified Health Centers Network in 2011

	Adolescent (n = 182)		Adult (n = 502)		P Value
STI testing time					<.01
No testing before insertion	29	(15.9)	188	(37.5)
Within 2 weeks before insertion	56	(30.7)	72	(14.3)
Day of insertion	97	(53.3)	242	(48.2)
Positive STI test on day of insertion					.91
Chlamydia	3	(3.1)	7	(2.9)
Gonorrhea	0	(0)	1	(0.4)
STI testing during postinsertion period^{^†}	57	(52.8)	102	(47.2)	.75
Positive STI test during postinsertion period^{^‡}					.70
Chlamydia	2	(3.5)	5	(4.9)
Gonorrhea	0	(0)	0	(0)