Factors limiting IUD use in South Asia.
Studies that examine programmatic factors limiting IUD use are rare. They would allow one to estimate the expected level of IUD use in an area. If IUD use declines below that expected level, one could compare and identify factors restricting its use in that area. Perhaps either the government does not approve IUD use or the IUD is not readily available in countries where IUD use is less than 1%. The IUD may be the only method available in countries where IUD use is very high. Duration for which the IUD has been available does not influence the IUD use in Taiwan and India. Their IUD prevalences differ (19% and 1.9%, respectively), even though the IUD was introduced at the same time. Differences in IUD prevalence appear to be the result of different reactions of policymakers and program managers to IUD use when IUD performance does not satisfy unrealistic expectations. In India, policymakers and program managers focused on the IUD as a solution to high population growth. In Taiwan, they followed the women instead. At 24-29 months after accepting the IUD, 41% of women were still using the IUD initially inserted; 13% had inserted another IUD, 20% had switched to another method, and 10% had aborted all unwanted pregnancies. Overall, IUD use in South Asia is low (1-2.5%). An overemphasis on sterilization and heavy reliance on targets and incentives linked to sterilization limit IUD use in India and Bangladesh. IUD use varies widely in India (0.4-11.2%). One assumes that unfavorable attitudes of managers and providers lead to a lack of availability and indifference among field workers towards the IUD. In the lack of any empirical studies on IUD use in South Asia, unfavorable attitudes of policymakers and program managers towards IUDs and an overemphasis on sterilization and the associated system of targets and incentives may be the factors limiting IUD use in South Asia.