Women's social communication about IUDs: a qualitative analysis.

Unintended pregnancy remains an important public health problem in the United States, contributing to poor outcomes for women and children at substantial societal cost.1–3 The burden of unintended pregnancy disproportionately falls on young, poor and minority women.4 Increased use of effective contraceptives has the potential to dramatically reduce the rate of unintended pregnancy.5 IUDs, in particular, have recently gained traction as a means of addressing the country’s stubbornly high unintended pregnancy rate. IUDs are at least as effective as female sterilization, yet are a fully reversible method of contraception.6 Unlike condoms or short-acting hormonal methods (such as oral contraceptives), IUDs present no risk of failure due to user error or poor adherence. Despite the method’s advantages, only 8% of U.S. women who practice contraception use IUDs.7 The low rate of IUD use in the United States is likely related to a variety of factors, including lack of provider knowledge,8 patient preferences for methods with particular characteristics9 and high up-front costs, which can be as much as $1,000.10 Widespread misconceptions and concerns about the method are additional contributors.11 These misconceptions and concerns may be influenced by women’s social networks, through such means as the diffusion of negative information, lack of diffusion of positive information, and generation and maintenance of social norms related to the use of the method.12,13 Studies conducted in developing countries have provided evidence that social networks and social communication influence women’s attitudes about contraception14,15 and their use of modern methods.16,17 Little research has been done in the developed world, however, to investigate how social networks influence attitudes toward and use of contraceptive methods in general, and of IUDs in particular. In qualitative studies, women have reported that although social networks and the media frequently provide misinformation about contraceptive methods,13,18–20 they consider information received through social contacts more trustworthy than information from medical providers.13,18,19 In addition, a quantitative study that used cross-sectional data from 1994 found that the likelihood that adolescents were using contraceptives was positively related to the number of their classmates who were doing so.21 One U.S. study examined the content of women’s social communication about contraception, but it focused primarily on oral contraceptives, and its study population was a small sample of college women.22 The two studies that have focused on IUDs found that having heard about a friend’s or an abortion clinic counselor’s positive personal experience with the method was associated with uptake23 and positive perceptions24 of the IUD; however, these studies were quantitative and did not explore the content of social communication. In this study, we sought to obtain greater understanding of how information about contraceptives, particularly IUDs, is spread through social networks and how this information influences women’s attitudes. We chose a qualitative approach because the richness and depth of the resulting descriptive data about the content of women’s discussions allowed us to gain a more nuanced picture than would likely be possible with quantitative methods. A better understanding of the types of information that are spread in women’s social networks, how this information is perceived by members of these networks and the types of information sought by women who have never used an IUD can help family planning providers tailor their contraceptive counseling to better address women’s needs.