Interventions for increasing uptake of copper intrauterine devices: Systematic review and meta-analysis

Background: Copper intrauterine devices (copper-IUDs) are relatively safer, more effective and inexpensive compared with hormonal methods and are the most widely used reversible contraception in the world, but are underused in developed countries. We systematically reviewed randomized controlled trials and controlled before-and-after studies to determine the effectiveness of interventions for improving uptake of copper-IUDs. Study Design: We searched electronic databases for eligible trials. RevMan 5.1 was used to calculate Peto odd ratios with 95% confidence interval for dichotomous outcomes. Results: Nine studies representing 7960 women met our inclusion criteria, including seven randomized controlled trials and two controlled before-and-after studies. Meta-analysis from three studies showed contraceptive provision by community workers doubled uptake of IUD, and studies on antenatal contraceptive counselling showed similar increases. One study reported major increases in IUD uptake with postnatal couple contraceptive counselling; a study on postnatal home visits and two studies on postabortion contraceptive counselling did not reach statistical significance. Conclusions: Community-based interventions and antenatal contraceptive counselling improved uptake of copper-IUD in studies mainly conducted in developing counties. Further research is needed on postabortion contraceptive counselling as well as longer-term effectiveness of interventions to improve use of copper-IUD.