J Womens Health (Larchmt). 2017 Jan 31.

Healthcare provider attitudes regarding contraception for women with obesity

Jatlaoui TC, Zapata LB, Curtis KM, Folger SG, Marchbanks PA, Mandel MG and Jamieson DJ

Abstract

Background: Whether providers who regularly provide family planning services consider contraceptive methods as unsafe for women with obesity is unknown.

Methods: We analyzed questionnaire responses received from December 2009 to March 2010 from 635 office-based physicians and 1323 Title X clinic providers delivering family planning services, who were randomly sampled (response rate 65%) before the release of national evidence-based contraception guidelines. We examined provider and clinical setting characteristics and clinic patient demographics for association with provider misconceptions about safety of combined oral contraceptives (COCs), depot medroxyprogesterone acetate (DMPA), or intrauterine devices (IUDs) for women with obesity. If providers considered methods as unsafe or do not know, we categorized those responses as misconceptions. We used multivariable logistic regression to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

Results: A substantial proportion of respondents had misconceptions about the safety of COCs (31%), DMPA (24%), copper (Cu) (18%), and levonorgestrel (LNG)-IUDs (16%) for women with obesity. Provider type was associated with increased odds of misconceptions for all four methods compared with office-based obstetrician/gynecologists. Not having the method available onsite was associated with safety misconceptions of DMPA (aOR 1.90, 95% CI 1.07-3.36), Cu-IUD (aOR 4.19, 95% CI 1.51-11.61), and LNG-IUD (aOR 5.25, 95% CI 1.67-16.49).

Conclusion: While the majority of providers considered all four contraceptive methods safe for women with obesity, substantial proportions had misconceptions about safety of COCs, DMPA, and IUDs. Provider education, particularly among certain specialties, is needed to increase knowledge regarding moderate and highly effective contraceptive methods among this patient population.

Comment: We all regularly see women with obesity in our practice, who need contraception. It is important to remember that all contraceptives, hormonal and non-hormonal, and oral and non-oral, are as safe and effective in obese women as in women with a more normal weight. We should treat obese women the same. (HMV)