Abstract
Background: The hormonal intrauterine device or intrauterine system (IUS) also known as the levonorgestrel intrauterine system (LNG-IUS) is a highly effective hormonal intra-uterine contraceptive. However, services offering the method are not widely available in Nigeria and little evidence exists on the dynamics of its use. We examined the continuation rate and satisfaction with the IUS among the user population. Methods: This prospective longitudinal phone survey involved a baseline survey of users at two-weeks post-insertion of the LNG IUS, recruited from 40 clinics across 17 states in Nigeria, with a follow-up survey at the 3rd and 12th months. A total of 208 users were interviewed at baseline, 98 at three months, and 73 at 12 months. User family planning and the IUS use experiences were elicited, as well as the continuation rate and satisfaction with the method at three and 12 months. Results: At three- and 12 months post-insertion, 96.9% (95% CI: 91.3, 99.3) and 91.8% (95% CI: 82.9, 96.9), respectively, reported still using the LNG IUS, with none out of the few users who discontinued the method reporting a method failure. Discontinuation was mainly a result of the experience of menstrual bleeding or amenorrhea (25.0%), experiences of pain with the method (18.8%), and partner complaining about strings (16.7%). High satisfaction with the LNG IUS (76.5% at three months and 86.3% at 12 months post-insertion) was reported. Satisfaction with LNG IUS was significantly associated with not having breast tenderness/pain (88.2%) and no vaginal bacterial infection (87.5%) at 12 months compared to experiencing breast tender/pain (50.0%) and vaginal infection (0.0%) (p<0.05). Conclusion: High user continuation and satisfaction with IUS indicates the positive potential of the method as a contraceptive in Nigeria.
Highlights
Discontinuation of contraception among women in Nigeria is one of the main challenges with contraceptive use, together with generally low use of contraception
User background characteristics, family planning (FP) and intrauterine system (IUS) use experiences A total of 208 users were interviewed at baseline
For all other background characteristics, no statistical significance was observed in the background characteristics of the participants reached and those not reached in the follow-up surveys
Summary
Discontinuation of contraception among women in Nigeria is one of the main challenges with contraceptive use, together with generally low use of contraception. In Nigeria, it has been reported that an estimated 15.6% of unintended pregnancies are among women who discontinued contraception in the last seven months[4]. Methods: This prospective longitudinal phone survey involved a baseline survey of users at two-weeks post-insertion of the LNG IUS, recruited from 40 clinics across 17 states in Nigeria, with a follow-up survey at the 3rd and 12th months. User family planning and the IUS use experiences were elicited, as well as the continuation rate and satisfaction with the method at three and 12 months. Results: At three- and 12 months post-insertion, 96.9% (95% CI: 91.3, 99.3) and 91.8% (95% CI: 82.9, 96.9), respectively, reported still using the LNG IUS, with none out of the few users who discontinued the method reporting a method failure. Conclusion: High user continuation and satisfaction with IUS indicates the positive potential of the method as a contraceptive in Nigeria. Age category 18–24 years old 25 – years old – years old and older Highest level of schooling Never attended school Attended but did not complete school Primary Secondary or higher Marital status Single Married/living together Widowed Divorced/separated Religion Islam Christian (non-Catholic) Christian (Catholic) Parity 0 1–3 4–7 8 and more Age of youngest child Less than 1 year old 1–5 years 6 years and above Total n (%)
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