Transferred from one person to another by word of mouth

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Rumors and Misconceptions About IUDs1

Rumors are unconfirmed stories that are transferred from one person to another by word of mouth.

In general, rumors arise when:

• an issue or information is important to people, but it has not been clearly explained.

• there is nobody available who can clarify or correct the incorrect information.

• the original source is perceived to be credible.

• clients have not been given enough options for contraceptive methods.

• people are motivated to spread them for political reasons.
A misconception is a mistaken interpretation of ideas or information. If a misconception is imbued with elaborate details and becomes a fanciful story, then it acquires the characteristics of a rumor.
Unfortunately, rumors or misconceptions are sometimes spread by health workers who may be misinformed about certain methods or who have religious or cultural beliefs pertaining to family planning which they allow to impact on their professional conduct.
The underlying causes of rumors have to do with people's knowledge and understanding of their bodies, health, medicine, and the world around them. Often, rumors and misconceptions about family planning make rational sense to clients and potential clients. People usually believe a given rumor or piece of misinformation due to immediate causes (e.g., confusion about anatomy and physiology).
Methods for Counteracting Rumors and Misinformation

  1. When a client mentions with a rumor, always listen politely. Don't laugh.

  2. Define what a rumor or misconception is.
  3. Find out where the rumor came from and talk with the people who started it or repeated it. Check whether there is some basis for the rumor.

  4. Explain the facts.

  5. Use strong scientific facts about family planning methods to counteract misinformation.

  6. Always tell the truth. Never try to hide side effects or problems that might occur with various methods.

  7. Clarify information with the use of demonstrations and visual aids.

  8. Give examples of people who are satisfied users of the method (only if they are willing to have their names used). This kind of personal testimonial is most convincing.

  9. Reassure the client by examining her and telling her your findings.

  10. Counsel the client about all available family planning methods.

  11. Reassure and let the client know that you care by conducting home visits.

Rumors or Misinformation and Facts and Realities

Rumor or Misinformation

Facts & Realities: Information to Combat Rumors

The thread of the IUD can trap the penis during intercourse.

The strings of the IUD are soft and flexible, cling to the walls of the vagina and are rarely felt during intercourse. If the string is felt, it can be cut very short, (leaving just enough string to be able to grasp with a forceps). The IUD cannot trap the penis, because it is located within the uterine cavity and the penis is positioned in the vagina during intercourse. The string is too short to wrap around the penis and cannot injure it. (For greater reassurance, use a pelvic model to show how an IUD is inserted or demonstrate with your fingers how it would be impossible for the IUD to trap the penis.)

A woman is only protected for as long as she actually takes the pill every day. (Reinforce this by using an analogy or personal example.)

A woman who has an IUD cannot do heavy work.

Using an IUD should not stop a woman from carrying out her regular activities in any way. There is no correlation between the performance of chores or tasks and the use of an IUD.

The IUD might travel inside

a woman’s body to her heart or her brain.

There is no passage from the uterus to the other organs of the body. The IUD is placed inside the uterus and unless it is accidentally expelled, stays there until it is removed by a trained health care provider. If the IUD is accidentally expelled, it comes out of the vagina, which is the only passage to the uterus.

The provider can teach the client how to feel for the string, if the client is comfortable doing so.

A woman can’t get pregnant

after using an IUD.

A woman’s fertility returns to normal very soon after the IUD is removed. Studies have shown that most women who discontinue the IUD become pregnant as rapidly as those who have never used contraception.

A woman who was wearing an IUD became pregnant. The IUD became embedded in the baby’s forehead.

The baby is very well-protected by the sac filled with amniotic fluid inside the mother’s womb. If a woman gets pregnant with an IUD in place, the health provider will remove the IUD immediately due to the risk of infection. If for some reason the IUD is left in place during a pregnancy, it is usually expelled with the placenta or with the baby at birth.

The IUD rots in the uterus after prolonged use.

Once in place, if there are no problems, the IUD can remain in place up to 12 years. The IUD is made up of materials that cannot deteriorate or “rot.” It simply loses its effectiveness as a contraceptive after 12 years.

Note: The information and misconceptions below apply more directly to health workers.

An IUD can’t be inserted until 12 weeks postpartum.

If health-care providers are specially trained, the IUD can be inserted immediately after the delivery of the placenta or immediately following a Cesarean section, or up to 48 hours following delivery. Expulsion rates for postpartum insertion vary greatly, depending on the type of IUD and the provider’s technique. Current information indicates that expulsion rates may be higher during the period from 10 minutes to 48 hours after delivery, as compared with the first 10-minute period. To minimize the risk of expulsion, only properly trained providers should insert IUDs postpartum. Use of an inserter for IUD insertion tends to reduce the expulsion rate.

After the 48 hour postpartum period, a TCu 380A may be safely inserted at four or more weeks postpartum.

The withdrawal technique for TCu 380A insertion helps minimize perforations when inserting IUDs four to six weeks postpartum. Other types of IUDs may have different perforation rates.

It has been shown that IUDs do not affect breast milk and can be safely used by breastfeeding women postpartum.

The IUD causes ectopic pregnancy.

There is no evidence that the use of an IUD increases the risk of an ectopic pregnancy. One study (Vessey, et. al., 1979) showed the risk of ectopic pregnancy to be the same for all women (with or without an IUD). Both the copper and levonorgestrel releasing contraceptives reduce the risk of ectopic pregnancy, when compared with no use of contraception. (Sivin et al 1991 and Ory

1981). In WHO trials, the 12-year cumulative discontinuation rate for ectopic pregnancy was only 0.4 per 100 women. (WHO, 1997)

In IUD that is discolored in the package is dangerous and can’t be used.

The copper on IUDs sometimes changes color in the package as it oxidizes (reacts to air). The IUD can still be used and is safe as long as the package is not torn or broken open and as long as it is not past the expiration date printed on the packaging.

Women who have never given birth cannot use an IUD.

Uterine enlargement by pregnancy, even when the pregnancy ends in abortion or miscarriage promotes successful IUD use. WHO carefully reviewed all of the literature before listing nulliparity as Category 2, (generally use, some follow-up may be needed).

However, women who have never been pregnant have an increased rate of expulsion.

Women infected with HIV cannot use an IUD.

IUD use appears to be safe for HIV-infected women who are well and for women with AIDS who remain well on antiretroviral treatment. A cohort study of IUD use among HIV-infected women in Nairobi showed no significant increase in the risk of complications, including infection, in early months of use. Also, viral shedding did not increase among these users.

IUDs increase the risk of Pelvic Inflammatory Disease (PID) and must be removed when it occurs.

Many studies have confirmed that the risk of infection and infertility among IUD users is very low (Hatcher, 2004). However, studies also indicate that the insertion process and not the IUD or its strings, pose the temporary risk of infection. Good infection prevention procedures should be practiced. Antibiotic prophylaxis should not be used routinely prior to insertion. The risk of infection following IUD insertion returns to a very low or normal level after 20 days (Farley et al., 1992).

1 Cathy Solter, Intrauterine Devices (IUDs) Second Edition (Watertown, MA: Pathfinder International, 2008).

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