Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, CH-1211, Geneva 27, Switzerland.
Division of General Medicine, University of Michigan, 2800 Plymouth Road, NCRC, B16/ 400S03, Ann Arbor, USA.
BMC Public Health. 2019 Dec 19;19(1):1707. doi: 10.1186/s12889-019-8080-7.
Globally 214 million women of reproductive age in developing regions have unmet needs in modern contraceptives. Intrauterine contraception (IUC) is highly effective, has few medical contraindications, low discontinuation, and is a low cost modern contraceptive method. However, there is relatively low use of IUDs in LMICs. One reason for this may be policies that restrict IUD availability and use. This study assess national policies pertaining to IUD from a diverse set of countries.
Between December 2015 and February 2016, a 12-question survey pertaining to IUD policy was sent to WHO regional and country representatives.
Sixty-nine surveys were used from countries through WHO regional offices. Among those surveyed, 87% (n = 60) had policies pertaining to IUD use. Among them, 84% (n = 58) reported that hormonal IUDs were available, but only 42% (n = 29) had them in the public sector. Free IUDs in the public sector were available in 75% (n = 52) of countries. For IUD promotion, 75% (n = 52) of countries reported cooperation with NGOs, and 48% (n = 33) received free devices from donors. Policy restrictions beyond the WHO guidelines existed in 15 countries and included restrictions to use for women who were nulliparous, adolescent, unmarried, or had multiple partners.
National policy is important in facilitating modern contraceptive uptake. While many countries who responded in the survey, have policies about IUD use in place, 16% still had none on IUD. Another gap identified was low availability of hormonal IUDs, especially in the public sector. Private sector remains untapped potential in expanding method choice by making IUDs available and accessible in developing countries. Most countries do have policy in place to facilitate IUD use, though there are still gaps in the accessibility of IUDs in many countries. Lastly there is a need to revisit restrictive policies that prevent IUD use for specific populations of women for whom IUDs can be beneficial in realizing their reproductive needs.
全球发展中地区有 2.14 亿育龄妇女对现代避孕药具存在未满足的需求。宫内节育器（IUD）避孕效果好、禁忌症少、续用率低，是一种低成本的现代避孕方法。然而，在中低收入国家，IUD 的使用相对较低。造成这种情况的原因之一可能是限制 IUD 供应和使用的政策。本研究评估了来自不同国家的与 IUD 相关的国家政策。
2015 年 12 月至 2016 年 2 月，向世卫组织区域和国家代表发送了一份关于 IUD 政策的 12 个问题的调查问卷。
从世卫组织区域办事处收到了来自 69 个国家的调查。在所调查的国家中，87%（n=60）有关于 IUD 使用的政策。其中，84%（n=58）报告称可获得激素 IUD，但只有 42%（n=29）在公共部门有供应。75%（n=52）的国家的公共部门可提供免费的 IUD。为促进 IUD 的使用，75%（n=52）的国家报告与非政府组织合作，48%（n=33）从捐助者那里获得免费设备。在 15 个国家存在超出世卫组织指导方针的政策限制，包括对未生育、青少年、未婚或有多个伴侣的妇女使用的限制。
国家政策对于促进现代避孕药具的使用非常重要。虽然许多做出回应的国家都制定了有关 IUD 使用的政策，但仍有 16%的国家没有制定相关政策。另一个发现的差距是缺乏激素 IUD，尤其是在公共部门。私营部门在发展中国家提供和普及 IUD 方面仍有很大潜力。大多数国家都制定了促进 IUD 使用的政策，但在许多国家，IUD 的可及性仍然存在差距。最后，需要重新审视那些限制特定人群使用 IUD 的政策，因为对于这些人群来说，IUD 可以在满足其生殖需求方面带来益处。
