26 International Family Planning Perspectives Modern

IUDs are very safe and highly effective.1 They are also an inexpensive family planning method that should be an important component of the contraceptive method mix in almost any national program. Use throughout the world, however, is highly variable. Whereas more than 25% of women of reproductive age use the IUD in some coun-tries in Central Asia, Vietnam and Egypt, fewer than 1 % rely on it in Brazil, Nepal and most of Sub-Saharan Africa.2 The IUD has the potential to fill an important niche in countries where it is not commonly used. Adding the IUD to the method mix may give women an option that suits their needs better than other available methods and may increase contraceptive use. The IUD can provide short-term protection to women who want to delay another pregnan-cy and has many advantages over injectables and pills. It does not require resupply visits, and it requires little action on the part of the user (although strings must be checked periodically, which some women dislike doing). In addi-tion, the IUD is more cost-effective than other methods used to space births. Finally, the IUD can be an attractive option for women who do not want more children but are not ready or do not want to accept a permanent method. Conse-quently, a shift away from sterilization to the IUD can re-duce regret, especially in countries where young and low-parity women are commonly sterilized. While much has been written about the clinical aspects of IUD use and discontinuation, less is known about the reasons why use is so low in some countries. Some research has pointed to the many misconceptions providers and po-tential acceptors have about the IUD. In the United States, where IUD use is very low, some think that the method is an abortifacient, and that it increases the risk of pelvic in-flammatory disease and ectopic pregnancy.3 In addition, many women lack knowledge about the IUD. A 1991 sur-vey of U.S. women found that respondents knew much less about the IUD than about other methods, but many per-ceived it to be unsafe. After being read a description of the method, however, 46 % expressed an interest in using it.4 In some countries, provider training in IUD services may not be sufficient to dispel similar misconceptions and in