Department of Obstetrics Gynecology & Women's Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (BK, ZK, KK, RS).
School of Education, University of Bristol, Bristol, United Kingdom (AM).
Hawaii J Health Soc Welf. 2020 Oct 1;79(10):296-301.
Long acting reversible contraceptives (LARC), including intrauterine devices (IUDs) and contraceptive implants, can support an individual in meeting their reproductive goals by allowing them to prevent pregnancy effectively. These devices can also limit an individual's control over reproduction because they generally require an in-person visit to a health care provider for removal. Returning for another visit may be logistically challenging for many individuals who may need to arrange for transportation, childcare, or take time off from work. Effectively negotiating with a provider to request removal may be additionally challenging for medically underserved and disenfranchised people who may not feel empowered to do so. The objective of this study was to assess providers' willingness to honor patients' requests for IUD and contraceptive implant removal on the day of the request. A survey was conducted in which clinicians were presented with scenarios of women requesting IUD or implant removal. Clinicians were asked what they were most likely to do. A total of 105 clinicians were surveyed. The responses of 60 clinicians who inserted IUDs and 57 who provided the contraceptive implant were included in the analysis. When asked about same-day removal of an IUD or implant from a dissatisfied patient who requested removal, 40% stated they would remove the implant, and 57% stated they would remove the IUD on the day of the request. Findings from this study suggest many clinicians would be unwilling or unable to accommodate a patient's request for device removal at the time of their visit. This delay or refusal represents a significant barrier for patients and has implications for reproductive autonomy that should be further explored.
长效可逆避孕措施（LARC），包括宫内节育器（IUD）和避孕植入物，可以通过有效避孕来帮助个人实现其生殖目标。这些设备也可以限制个人对生殖的控制，因为它们通常需要个人亲自去医疗机构进行取出。对于许多需要安排交通、儿童保育或请假的个人来说，返回进行另一次就诊可能在后勤上具有挑战性。对于医疗服务不足和被剥夺权利的人来说，有效地与提供者协商以请求取出可能会更加具有挑战性，因为他们可能没有能力这样做。本研究的目的是评估提供者在请求当天是否愿意尊重患者对 IUD 和避孕植入物取出的请求。进行了一项调查，其中向临床医生介绍了女性请求取出 IUD 或植入物的情况。临床医生被问到他们最有可能做什么。共有 105 名临床医生接受了调查。对插入 IUD 的 60 名临床医生和提供避孕植入物的 57 名临床医生的回复进行了分析。当被问及对要求取出的不满意患者当天取出 IUD 或植入物时，40%的人表示他们会取出植入物，57%的人表示他们会在请求当天取出 IUD。这项研究的结果表明，许多临床医生可能不愿意或无法在就诊时满足患者的设备取出请求。这种延迟或拒绝对患者来说是一个重大障碍，对生殖自主权产生了影响，应进一步探讨。
