Population Reports : February 2006

*The IUD: An Important Method with Potential Programmatic challenges and safety concerns have held back IUD use in many countries.Most recent research finds that serious complications are rare with modern IUDs. Some family planning programs now are taking action to create or renew interest in the method. *Providing High-Quality IUD Services Successful IUD services require a holistic approach that pays attention both to policy and service delivery on one hand and to the public and potential users’ knowledge and perceptions on the other. *Spotlight: Kenya Commits to Renewing Interest in the IUD In Kenya levels of IUD use have dropped since the 1980s while overall contraceptive use has risen.The Kenya Ministry of Health recently began an initiative to reintroduce the IUD. *Feature: Good Counseling Increases Client Satisfaction Informative and empathic counseling helps clients make good family planning choices and use their chosen methods successfully.Using visual aids, such as pelvic models, can help clients fully understand what to expect with use of the IUD. *Very Low Overall Risk of Infection with IUDs The majority of evidence indicates that a woman who does not already have an STI—in particular, gonorrhea or chlamydia—cannot get pelvic inflammatory disease (PID) just from having an IUD inserted. A woman with gonorrhea or chlamydia at the time of IUD insertion, however, is at higher risk of PID in the first few weeks after insertion than she is later. After the first few weeks, an STI may be no more likely to progress to PID in an IUD user than in another woman. *Box: Evidence Shows Many Women with HIV Can Use IUDs Recent evidence shows that IUDs do not increase a woman’s chances of acquiring HIV infection or the risk that an infected woman will pass HIV to a sex partner. Also, HIV infection does not appear to lead to more complications of IUD use. *Minimizing the Risk of Infection Where laboratory testing for STI diagnosis is not available, medical and sexual history, client self-assessment, and pelvic examination can help assess whether a woman might have gonorrhea or chlamydia and so should not have an IUD inserted. *Clinical Characteristics of IUDs IUDs are highly effective, quickly reversible, and require little action from the user. Increased bleeding with copper IUDs is common. Complications, including expulsion and perforation, are not.