Reasons for the Low Level of IUD Use in El Salvador

While the IUD is a safe and cost-effective method use is very low in some countries and the reason for this are not well understood. To examine the reasons that the IUD is little used in El Salvador data were collected in 1999 via three techniques. In-depth interviews were conducted with 30 providers; simulated clients made a total of 40 clinic visits; and 10 focus groups were conducted separately with sterilized women current or past IUD users of other clinical FP methods. Most FP clients who had never used an IUD reported a negative impression of the method mainly because of fear resulting from rumors and myths they had heard. In contrast nearly all IUD users viewed the method positively. Most providers interviewed reported a positive attitude. Providers agreed that rumors and myths are the biggest barrier to IUD promotion yet simulated clients reported that providers spontaneously tried to dispel myths in only half of visits. Most providers said they discussed the IUD with clients but many focus-group participants said they received information only on pills and injectables. According to simulated clients providers spontaneously mentioned pills and injectables more than any other method. While 23 of the 30 providers interviewed had been trained in IUD insertion many felt they did not have enough practical experience. Three main barriers impede IUD use in El Salvador: rumors and myths about the method; insufficient attention to the method during counseling sessions; and insufficient provider experience with it. (authors)