Health care providers' knowledge about contraceptive evidence: a barrier to quality family planning care?

Abstract

Background

The underuse of effective contraceptive methods by women at risk for unintended pregnancy is a major factor contributing to the high rate of unintended pregnancy in the United States. As health care providers are important contributors to women's contraceptive use, this study was conducted to assess provider knowledge about contraception.

Study Design

Bivariate and multivariate analyses were performed using data collected from a convenience sample of health care providers (physicians, nurse practitioners and physician assistants) at meetings of the professional societies of family medicine and obstetrics and gynecology.

Results

Younger providers were more knowledgeable, as were obstetrician/gynecologists, female providers and providers who provide intrauterine contraception in their practice.

Conclusions

The lack of consistent and accurate knowledge about contraception among providers has the potential to dramatically affect providers' ability to provide quality contraceptive care for their patients, which could have an impact on their ability to prevent unintended pregnancies.

Introduction

The underuse of effective contraceptive methods by women at risk for unintended pregnancy is a major factor contributing to the high rate of unintended pregnancy in the United States, with over 10% of women at risk for unintended pregnancy not using any form of contraception, and many more relying on low-efficacy methods such as barrier or fertility awareness methods [1]. In addition, very few women of reproductive age in the United States (approximately 2%) use long-acting, reversible contraception such as intrauterine contraception (IUC), compared to the more than 20% of reproductive age women using these methods in European countries [2].

Several factors contribute to the underuse of contraceptive methods by women in the United States, including patient preferences and health system factors such as inadequate health insurance coverage of contraceptives [3], [4]. An additional contributing factor is the information that women receive from their providers about contraceptive methods. While the impact of contraceptive counseling on use of contraception is not well understood [5], several studies have linked quality of care, including the quality of information provided, to use of contraceptive methods [6], [7], [8]. Further, a study of patients presenting for termination of pregnancy found a direct effect of counseling on unintended pregnancy. In this study 14% of women requesting an abortion had experienced a communication failure or received misinformation from their provider about contraception that resulted in the use of a less effective method of contraception or the incorrect use of a contraceptive method [9].

One contributor to poor communication between providers and patients about contraceptive methods may be that providers have incomplete knowledge of evidence-based information about contraceptive methods. This is particularly relevant currently, as there has been a rapid expansion of contraceptive technology in the past decade [10]. Several studies have suggested that provider knowledge is in fact deficient in some aspects of contraception. For example, in a recent study about provider knowledge about IUC, just under half the providers were not aware of the evidence-based guidelines for eligibility for IUC [11], including a commonly held, yet incorrect, belief that nulliparous women and women with a history of pelvic inflammatory disease (PID) were not appropriate candidates for this method [12]. A similar finding was identified in a Canadian study of family physicians, which found that 60% of family physicians thought PID and ectopic pregnancy were major risks of IUC [13]. Another study assessed the contraceptive knowledge of family medicine, obstetrics and gynecology, pediatric and internal medicine residents on a variety of topics and found that, overall, residents answered just over 50% of these questions correctly. Being an obstetrician/gynecologist, being female and inserting IUC were associated with higher levels of knowledge [14].

While these previous studies suggest that provider knowledge about contraception may be limited, they have primarily focused on IUC, have utilized small samples from limited geographic areas or have only investigated provider demographics among doctors in training. Our study expands on this previous literature by investigating providers' knowledge about a variety of contraceptive methods, utilizing a national sample and determining which provider characteristics were associated with higher knowledge among practicing providers.