Inequalities in the health care system utilization for intrauterine device insertion.
Síntia Nascimento Dos Reis, Mery Natali Silva Abreu, Fernanda Penido Matozinhos and 3 others
PMID 41919823WHAT IT FOUND
Women seeking IUD insertion faced long waits and poor information: only 20.9% knew primary care could insert it, and 25.4% left without insertion.
Women without previous pregnancy had worse access. Nurses should counsel and refer actively.
Key findings
01Despite being scheduled for IUD insertion at a referral service, 25.4% of women did not have the device inserted; the main reasons were inability to rule out pregnancy (37.0%) and the desired IUD type being unavailable (24.0%).
02Only 20.9% of women knew that IUD insertion could be done at a primary care unit, although 74.4% had tried to have it inserted there, and 83.3% reached the referral clinic through friends, relatives, or others rather than professional referral.
03No differences were found by race/color, but education and parity shaped the pathway: women with more schooling were more likely to have attended primary care recently, yet less likely to have had a consultation to choose the IUD; women who had been pregnant before were more likely to know primary care could insert an IUD and less likely to think about giving up.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only women who reached a referral service for IUD insertion were interviewed, so women who never sought the method or could not get an appointment were not included; the authors say the system's coordination may be worse than measured. The study was done in one municipality and one referral service, so results may not apply to other places. It was cross-sectional and based on self-reported pathway, so it describes associations and reported barriers, not proven causes or the effect of nurse-led insertion. Some analyses had missing responses and excluded small race/color groups, and subgroup analyses among inserted women used fewer women than the total sample.
Declared interests
The work was funded by CNPq grants and was part of a PAHO/WHO Collaborating Centre for Nursing Research Development activity. The article is derived from a doctoral dissertation; the supplied text does not report competing interests.
The easy way to misread this
Do not read this as proof that nurse-led IUD insertion improves access. It describes women's reported pathway at one referral service; no intervention was tested, and local primary-care protocols still excluded nurses from insertion.