Misconceptions and Myths About Intrauterine Contraceptive Devices and Their Impact on Usage

Introduction

Contraception is the deliberate use of artificial methods or techniques to prevent pregnancy resulting from sexual activity. Intrauterine devices (IUDs), hormonal techniques (pills, patches, injections), barrier techniques (condoms, diaphragms), sterilization, or behavioural approaches (abstinence, fertility awareness), are all the various forms of contraception.¹

IUDs are a safe, effective and readily reversible form of long-acting contraception, now primarily used to prevent high-risk or unwanted pregnancies in women.² Only 12% of women of reproductive age worldwide are estimated to be IUD users.³ IUDs are used by 50% of contraceptive users in Europe and nearly 33% in China.⁴ The World Health Organization, the American Academy of Pediatrics, and the American College of Obstetrics and Gynecology, have all extensively documented and advised on the safe use of IUDs in women. According to the America College of Obstetrics and Gynaecology, the device should be made available to both parous and nulliparous adolescents.⁵

Many facets of contemporary life, including social, economic, and cultural aspects are significantly impacted by unwanted pregnancies. Approximately 50% of unintended pregnancies end in abortion, making abortion one of the primary consequences of unwanted pregnancy. Prior to the legalization of abortion, an estimated one million procedures were performed annually, most of them illegal. As a result of unsafe and often substandard procedures, between 1,000 and 10,000 women died per year from related complications.⁶ Abortions and unplanned pregnancies remain major reproductive health challenges for women, with 40% of pregnancies worldwide still classified as unintended.⁷ According to the 2014 Indian Demographic Survey, 39% of women under the age of 20 have at least one kid.

The Indian government has implemented measures to ensure the availability of intrauterine contraceptive devices (IUCD) at all government hospitals. Despite the efforts, data from the Indian Demographic Health Survey 2000 show that IUD use declined by 40% from 25,000 users in 1995 to just 10,000 in 2000. The reported decline in utilization of these devices could be attributed to multiple factors including, misconceptions, poor publicity, infections, danger of ectopic pregnancies, and infertility.⁸ In general, the limited acceptability of contraceptives is largely driven by misconceptions. These misconceptions, often amplified by social media, are among the main reasons for the device’s suboptimal use and effectiveness.⁹

A few studies have reported that these misconceptions function as subjective norms, influencing women’s decision to use the device.¹⁰ Although other factors contribute to these false beliefs, misconceptions remain a significant deterrent for the contraceptive use. As previously mentioned, the decline in usage has been consistent. Myths that contribute to non-acceptance often stem from family, society, and even healthcare professionals who lack adequate knowledge about the method. Women's decisions are impacted by their individual circumstances and perspectives. To assess whether these misconceptions influence the adoption of the device, the current study examined them from the perspective of IUD users.

Materials and Methods

In this study, 296 women visiting the PNC OPD at Shri Atal Bihari Vajpayee Medical College and Research Institute between November 2024 and January 2025 were recruited. Women aged 20-40 years who had not undergone sterilization and whose partners were eligible for contraception were counselled for IUCD insertion. Those unwilling for device insertion were enquired about the reasons for non-acceptance. Their socioeconomic details were recorded. Women with a history of depression and sexual inactivity were excluded from the study to minimize potential bias in responses and to ensure reliability of findings. The study’s purpose was explained in detail to all the participants, and the participation was entirely voluntary. Myths and misconceptions about IUDs were identified. Excel from Microsoft was used to enter the data. With SPSS version 28, statistical analysis was carried out.

Results

Out of the 296 women counselled for IUCD insertion in the PNC OPD, only 36% (107) consented to the procedure, while 63.6% (189) declined.The demographic details of the women who did not consent for IUCD are listed in Table 1.

The majority of women who did not accept contraception were in the age groups of 20-25 years (27%) and 35-40 years (27%), followed by those aged 30-35 years (26%). Women aged 25-30 years accounted for 20% of the nonacceptance group.

In our study, non-acceptance of IUCD was highest among multigravida women (66%), while primigravida women accounted for 34%.

Women from lower socio-economic background demonstrated lower acceptance rates (74%) compared to those from higher socio-economic status (26%). Educated women (57%) accepted the method at a higher rate than the uneducated women (43%).Table 2 summarizes the reasons given by women who did not accept IUCD as a method of contraception.

Among all the reasons for refusal, myths and misconceptions contributed the most (73%). Choosing other methods of contraception accounted for 9% of the refusals. Religious beliefs were the next most common reason (7%), followed by refusal by the husband (6%) and family members (3%). A small proportion of women (2%) declined ICUD insertion due to fear of pain associated with the procedure.

Table 3 lists the various myths and misconceptions reported by the participating women. The study identified a range of myths and misconceptions that contributed to the refusal of IUCD use among participants. The most commonly myth reported by 21% of women was that IUCD insertion causes drastic weight loss. Another widely held misconception, cited by 15% was that the device could migrate within the body. About 11% believed that the IUCD could be felt by the male partner during sexual activity, while 10% associated its use to pain during intercourse. About 8% of respondents expressed concerns that IUCD use could lead to difficulty in getting pregnant in the future, while few believed that using an IUD is equivalent to abortion (8%), which makes it unacceptable within certain religious beliefs. Additionally, 7% feared that IUCD can rust inside the body. Myths about IUDs causing damage to the womb or being suitable only for older women were each held by 6% of respondents.Four percent believed that IUCD could serve as the breeding ground for infections, while 3% thought it should not be used by women with more than three children. A small proportion (1%) held a belief that if an IUCD is used during pregnancy, the unborn child could hold the device.

Discussion

The majority of women who did not accept contraception belonged to the age groups 20-25 years (27%) and 35- 40 years (27%), followed closely by those aged 30-35 years (26%). Women aged 25-30 years accounted for 20% of non-acceptance group. Similar findings were reported in the study by Carneiro et al. ⁷ Additionally, non-acceptance was higher among multigravida women (66%) compared to primigravida (34%). Similar trend was reported in Esposito et al., study.⁸ The women belonging to lower socio-economic strata demonstrated lower acceptance (74%) compared to those from higher socio-economic background (26%). Educated women (57%) accepted the method at a higher rate than uneducated women (43%). Payne et al., similarly found that education positively influenced acceptance of the method.⁹ 

Elkhateeb et al., reported myths and misconceptions as the major reasons for refusal of contraceptive methods, a finding that was also observed in our study.¹⁰ Additionally, opting for alternative contraceptive methods was noted as a reason for refusal in the study by Guiahi et al. ¹¹

These misunderstandings are partly exacerbated by religious restrictions. Due to moral teachings and influence from certain religious organizations, many sexually active women avoid using long-term contraceptives, even when they are reasonably priced. For example, in the United States, where Catholics dominate the healthcare industry, IUD acceptance is generally low. In our study, refusal based on religious beliefs accounted for 11%.

IUD use remains low due to additional concerns, such as belief that partners can feel the device, or that it damages the womb and causes infections. Six percent of the women in our study provided this explanation for refusal.

The statement "IUDs cause significant reduction in weight" was the most frequently cited statement in this study. This finding aligns with the results of a study by Michie et al., which examined the beliefs and misconceptions regarding intrauterine contraception among women seeking pregnancy termination.¹²

The majority of women still believe that during sexual activity, the male partner can feel the IUD string. Manzouri et al., also identified this as the second most common misconception in their study. Proper insertion techniques can minimize this issue, and women should be reassured about their comfort.¹³

Four percent of the women in our study believed that IUD spreads infections. However, various measures have been implemented to prevent infections related to intrauterine devices such as, screening women for any history of infections and performing physical examinations to identify those at risk for future infections. Users should also be informed that the risk of infections is highest within the first twenty days after insertion and, if infection occurs, they can be managed with medications.¹⁴

Conclusion

Myths and misconceptions significantly influence IUD usage and can dissuade women from utilizing the device. These false beliefs remain major barriers to IUD acceptance and are a key reason for low utilization in many nations. Providing accurate knowledge and scientifically validated information to dispels these myths should be the central focus for community education. Comprehensive educational efforts can help bridge the gap between these misconceptions and the actual need for contraception. Counselling on contraception is one important strategy to promote awareness.

Additionally, educational interventions ought to follow a multifaceted approach, focusing on both individuals and society. To enhance societal acceptance, eliminate barriers, and encourage supportive partners' choices, contraceptive education must be extended to the husbands of women using the device. Such educational initiatives must be regularly reviewed and evaluated to gauge their effectiveness in dispelling these myths. These interventions will empower women to make informed decisions about their reproductive health. Despite prevailing misconceptions, increased education and awareness are likely to improve the social acceptance of IUDs, ultimately contributing to a reduction in unwanted pregnancies.

Conflicts of Interest

Nil