Abstract
BackgroundRwanda has a high unmet need for family planning which could be reduced by improving access to postpartum intrauterine contraceptives device (PPIUCD) insertion. The objective of the study was to assess the prevalence and factors associated with the uptake of PPIUCD among postpartum women in Muhima Hospital.MethodsA concurrent mixed-method study was used. Three hundred eight three (383) immediate postpartum mothers, and 10 health services providers were interviewed using a structured questionnaire and in-depth interviews respectively. Logistics regression was done to assess for factors associated with PPIUCD uptake and thematic analysis was used for qualitative data.ResultsThe prevalence for PPIUCD use was 28.1%, women who had spontaneous vaginal delivery were more likely to take up PPIUCD (Adjusted Odds Ratio (AOR) 2.623, 95% CI = 2.017–6.507 compared to those who had cesarean section; women who received PPIUCD counselling during the antenatal period were more likely to use PPIUCD ((AOR 2.072, 95% CI = 1.018–4.218) as compared to those who didn’t receive any form of counselling; mothers who received spouse approval were more likely to use PPIUCD (AOR 2.591,95% CI = 1.485–4.492); as compared to those who didn’t receive any spousal approval; women who had more than one child were more likely to use PPIUCD (AOR =2.265, 95% CI = 1.472–3.163) as compared to prime gravida; Mothers with birth to pregnancy interval less than two years were more likely to use PPIUCD (AOR =2.123, CI =1.477–2.706) as compared to those who had birth to pregnancy interval more than 2 years. From the qualitative findings, health education of mothers and partners on PPIUCD, training of health care providers, and availability of supplies to provide PPIUCD influenced the use of PPIUCD.ConclusionThe acceptability to use for PPIUCD was high in this population. PPIUCD uptake was associated with normal birth, PPIUCD counselling, spousal approval, parity, birth interval, level of education. Health education of mothers and partners on PPIUCD, training of health providers, and availability of supplies to provide PPIUCD influenced uptake of PPIUCD.
Highlights
Rwanda has a high unmet need for family planning which could be reduced by improving access to postpartum intrauterine contraceptives device (PPIUCD) insertion
A significant number of women were informed on PPIUCD used during antenatal care (39.9%), while others got the information during family planning services (37.1%)
Most of the women are not aware of immediate postpartum family planning, we focus on it a lot during antenatal care and give to women the time to think about it and they come to deliver when they have already made their choice, it is the right time for us ... as we have a lot of time to discuss with women, we told them that they can get the method PPIUCD within 48 hours before discharge, we explain about all side effects for the methods and let them make choice, but most of the time we emphasize a lot on methods depending on mother preference and the methods that can fit the mother”
Summary
Rwanda has a high unmet need for family planning which could be reduced by improving access to postpartum intrauterine contraceptives device (PPIUCD) insertion. It is estimated that 214 million women of reproductive age in low-income countries want to avoid pregnancy but are not using a modern contraceptive [2]. Data from 27 countries, shows 95% of women who are 0–12 months postpartum want to avoid pregnancy in the 24 months; but 70% of them are not using contraception [1, 3]. Research has demonstrated that long-acting methods such as intrauterine devices (IUDs) are a cost-effective and sustainable way of reducing the unmet need and unintended pregnancy in low resources settings [6]
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