Contraception access and provision in rural areas
Awarded 2011
Complex Family Planning Fellowship Research
Britt Lunde, MD, MPH
University of Illinois

Objectives: Unplanned pregnancy is a public health problem in the United States, including in rural areas. Primary care physicians are the main providers of health care to women in rural areas, and are uniquely positioned to help reduce unplanned pregnancy in rural women. This study documents provision of contraception by rural primary care physicians, focusing on the most effective, long acting methods, intrauterine devices (IUDs) and contraceptive implants.
Methods: We surveyed all primary care physicians practicing in rural areas of Illinois and Wisconsin. Bivariate analysis was performed using Chi Squared and Fisher’s exact test, and multivariable analysis was performed with logistic regression to determine factors associated with provision.
Results: The response rate was 862 out of 2312 physicians (37%). Nine percent of respondents provide implants and 35% provide IUDs. Eighty-seven percent of physicians had not had training in implant placement, and 41% had not had training in IUD placement. In multivariable analysis, factors associated with provision of long acting contraception include provision of maternity care, and female gender of the physician. The most common reasons for not providing the methods were lack of training and perceived low demand from patients.
Conclusions: Many rural primary care providers are unable to provide long acting methods of contraception due to lack of training. Female physicians and those providing maternity care are the most likely to place these methods. Increased training for primary care physicians both during and after residency would help increase access to these options for women in rural areas.