Racial, Regional, and Socioeconomic Disparities in Approach to Pain Management During Intrauterine Device (IUD) Placements Among Adolescents and Young Adults: A Cross-Sectional Analysis.

OBJECTIVE: To examine how race/ethnicity, region, and insurance status influence sedation and analgesic use during IUD insertions and the setting of these procedures and explore the implications for equitable care. METHODS: Cross-sectional analysis of adolescents and young adults undergoing IUD placements in pediatric hospitals, using data from the Pediatric Health Information System. Data included all sex assigned female at birth individuals who received an IUD insertion between January 2000 and December 2023. Cases were excluded if associated with pregnancy, delivery, or abortion related procedures; other principal procedures; or the removal of a previous contraceptive device. Multivariable logistic regression was used to assess associations between patient characteristics and operating room (OR) placement, and receipt of anesthetics, sedatives, or analgesics/anti-pyretics. RESULTS: 4453 IUD insertions were included in the final analytic cohort. While there were no racial disparities in whether or not IUDs were placed in the OR, in the adjusted model, procedures from the Midwest were more likely to have an OR flag than those in the West or South, and OR placement likelihood also increased with higher child opportunity index score, older patient age, and when a gynecologist performed the procedure. Racial and ethnic differences, as well as other disparities, were seen across all types of pain control medications examined in this study. CONCLUSIONS: There appear to be systematic inequities in pain management during IUD placements. This underscores the need for targeted interventions to ensure equitable access to comfortable and dignified care.