Pregnancy and birth rates among people aged 24 or younger in the United States have declined over the past several years since they peaked in the early 1990s, but these rates remain higher in the U.S. than those of other high-income countries.1,2 Decreasing the rate of unintended pregnancies and increasing access to and use of hormonal contraception in this population continues to be a priority of public health organizations.3

The American College of Obstetrics and Gynecology and the American Academy of Pediatrics both endorse the use of intrauterine devices (IUDs) for contraception in adolescents and young adults (AYA).4 The Contraceptive CHOICE study demonstrated that when provided structured counseling and no cost contraception, the majority of AYA choose long-acting reversal contraceptive (LARC) methods including the IUD and the contraceptive implant.5,6 LARC use by young patients remains much lower nationally, however, with only 20% of sexually active females aged 15-19 between 2015 and 2017 using an IUD or implant.2

One possible explanation for the disparity between desirability of IUDs by AYA in an ideal setting and actual use in the general population is providers’ concerns regarding IUD placement in the AYA population. To explore this concern, one study demonstrated that the success rate of IUD placement in AYA was 96.2% at first attempt with few ancillary measures required, and with most placements performed by advanced practice clinicians such as physician assistants, certified nurse midwives, and nurse practitioners.7 This study is limited by the uniqueness of the setting—an AYA-focused contraception clinic where IUDs were provided at no cost. The providers also had immediate access to ultrasound guidance, other experienced providers to assist, and additional ancillary measures to improve the likelihood of successful first attempt IUD placement. They found that ancillary measures were required in nulliparous women more than in multiparous women, but this study did not stratify results based on type of delivery (vaginal vs. cesarean) in the multiparous group.

In contrast to the favorable rates in a highly specialized, academic setting, another small study at two Planned Parenthood clinics found that for patients presenting for Copper T380 IUD placement, failure rates were 19.6% in nulliparous patients and 13.6% in multiparous patients. 8 These findings suggest that parity and lack of access to ancillary tools for difficult placements might contribute to failure rates. Thus, the primary aim of our study was to determine the success rate of first-attempt IUD placement among AYA seen at community-based reproductive health clinics, and whether success differs by history of prior vaginal delivery (VD).