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Editor,— In the article by Lazcano Ponce et al,1 the proportion of women receiving IUDs fell in the intervention arm. As the authors state, most methods of contraception do not protect against STI acquisition. Most of the women choosing not to use IUDs in this trial probably selected oral contraceptives, another non-barrier method. These women, too, would be unprotected against STI, so the benefit of this intervention is unclear. In addition, most other methods of contraception have higher pregnancy failure rates than IUDs; thus, women deterred from IUDs in this trial may have had more unplanned pregnancies, with their attendant risks and cost, as a result of the intervention.
Fully informed choice for all family planning clients is an estimable standard of care. But the authors' unstated assumption seems to be that too many women at risk of STI receive IUDs for family planning.1 While IUDs cause a transient increase in the risk of pelvic inflammatory disease, they have no documented adverse effect on STI acquisition or ascent thereafter.2 IUDs offer safe, effective, affordable long term contraception. Given the low prevalence of cervical infection among family planning clinic attenders in this trial1 and others, we need guidelines to “rule in” the great majority of women who are uninfected, rather than inappropriately label large numbers of women ineligible for IUD use.