Intrauterine Device Acceptors Research Articles

Clinical outcomes of intrauterine device insertions by newly trained providers: The ECHO trial experience

ObjectivesTo assess the rates of failed insertion, expulsion, and perforation when intrauterine device (IUD) insertions were done by newly trained clinicians, and to examine factors that may affect these outcomes. Study designWe evaluated skill-based outcomes following IUD insertion at 12 African sites in a secondary analysis of the Evidence for Contraceptive Options and HIV Outcomes (ECHO) randomized trial. Before trial initiation, we provided competency-based IUD training to clinicians and offered ongoing clinical support. We used Cox proportional hazards regression to examine factors associated with expulsion. ResultsAmong 2582 IUD acceptors who underwent first attempted IUD insertion, 141 experienced insertion failure (5.46%) and seven had uterine perforation (0.27%). Perforation was more common among breastfeeding women within three months postpartum (0.65%) compared with non-breastfeeding women (0.22%). We recorded 493 expulsions (15.5 per 100 person-years, 95% confidence interval [CI] 14.1─16.9): 383 partial and 110 complete. The risk of IUD expulsion was lower among women older than 24 years (aHR 0.63, 95% CI 0.50─0.78) and may be higher among nulliparous women. (aHR 1.65, 95% CI 0.97─2.82). Breastfeeding (aHR 0.94, 95% CI 0.72─1.22) had no significant effect on expulsion. IUD expulsion rate was highest during the first three months of the trial. ConclusionsIUD insertion failure and uterine perforation rates in our study were comparable to those reported in the literature. These results suggest that training, ongoing support, and opportunities to apply new skills were effective in ensuring good clinical outcomes for women receiving IUD insertion by newly trained providers. ImplicationsData from this study support recommendations to program managers, policymakers, and clinicians that IUDs can be inserted safely in resource-constrained settings when providers receive appropriate training and support.

What are the prospects for the hormonal IUD in the public sector? A mixed-method study of the user population in Zambia

BackgroundThe levonorgestrel-releasing intrauterine device (IUD)—also known as the hormonal IUD—is a highly effective contraceptive method that has not been widely available in the public sector in Zambia. Early introduction efforts can provide critical insights into the characteristics of users, reasons for method choice, and experiences getting their method.MethodsWe conducted a survey with 710 public sector clients who received a hormonal IUD, copper IUD, implant or injectable in two provinces of Zambia, and additional in-depth interviews with 29 women. We performed descriptive analyses of survey data and fitted multivariable logistic regression models to assess factors associated with hormonal IUD use. Qualitative interviews were analyzed thematically.ResultsFactors associated with hormonal IUD use included full-time or self-employment (relative to both implant and copper IUD use), as well as being older, wealthier, and partner not being aware of method use (relative to implant use only). Common reasons for choosing long-acting methods were duration, perception that the method was “right for my body,” and convenience. In addition, a portion of hormonal IUD acceptors mentioned effectiveness, potential for discreet use, few or manageable side effects, and treatment for heavy or painful periods. Between 83 and 95% of women said that they were counseled about menstrual changes and/or non-bleeding side effects; however, more hormonal IUD acceptors recalled being counseled on the possibility of experiencing reduced bleeding (88%) than amenorrhea (43%). Qualitative interviews indicate that women seek methods with minimal or tolerable side effects. While most women reported their partner was aware of method use, men may be more consistently involved in the decision to use contraception rather than in the choice of a particular method. Qualitative results show an appreciation of the lifestyle benefits of reduced bleeding (especially lighter bleeding), although amenorrhea can be cause for concern.ConclusionsInitial efforts to introduce the hormonal IUD can provide valuable learnings that can inform broader method introduction to expand choice and better suit women’s needs in Zambia and elsewhere. Scale-up plans should include emphasis on high quality counseling and demand generation.Plain English SummaryThe government of Zambia is committed to increasing access to high-quality contraception and making more choices available to users. To date, the hormonal IUD, a highly effective, long-lasting contraceptive has not been widely available in the country. A study in pilot introduction settings provided insights into why women chose the methods, their characteristics, and their experiences getting their methods. The 710 women in the study received family planning services in public sector settings in two provinces in Zambia. Women in the study who received a hormonal IUD, copper IUD, implant, or injectable completed a quantitative survey; in-depth interviews were also conducted with 29 women. Results showed common reasons for choosing the long-acting methods (hormonal IUD, copper IUD or implants) were their duration, perception that the method was “right for my body,” and convenience. In addition, some hormonal IUD acceptors indicated that they were attracted to the method’s effectiveness, potential for discreet use, few or manageable side effects, and treatment for heavy or painful periods. Qualitative interviews with women also showed that women want contraceptive methods that lead to minimal or tolerable side effects. Male partners were typically aware of contraceptive use; however, men were less involved with decisions about the particular method women selected. Use of the hormonal IUD can lead to reduced menstrual bleeding, and in the interviews, women indicated that they liked reduced bleeding (especially lighter bleeding), although amenorrhea (paused bleeding) can be cause for concern. The results can help inform broader method introduction.

Immediate Postpartum Copper IUD: A Comparative Analysis between Profiles of Women who Accept and who Refuse it.

To analyze the profiles of women who accepted and who refused the insertion of the copper intrauterine device (IUD) postpartum and to learn the motivations related to the refusal of the method. Cross-sectional study with 299 pregnant women. The women were informed about the possibility of inserting a copper IUD postpartum and were questioned about their interest in adopting or not this contraceptive. All participants answered a questionnaire with information relevant to the proposals of the present study. The sample size was limited to the number of devices available for the present study. A total of 560 women were invited to join the present study and 299 accepted. Out of the 299 women included in the present study, 175 accepted the copper IUD and 124 refused. As the number of pregnancies increased, the IUD acceptance rate raised (p = 0.002), especially between the groups with 1 and with ≥ 4 pregnancies (p = 0.013). Regarding the desire to have more children, the women who planned to have more children were more likely to refuse the method than the ones who did not (p < 0,001). Women with multiple pregnancies and desire to not have more children were more likely to accept the copper IUD. The profile of those who refused was first pregnancy and desire to have more children. Among the three most frequent reasons reported for copper IUD rejection, two responses stood out: no specific justification and desire to have more children.

Introducing the hormonal Intrauterine Device in Madagascar, Nigeria, and Zambia: results from a pilot study

BackgroundThe hormonal Intrauterine Device (IUD) is a highly effective contraceptive option growing in popularity and availability in many countries. The hormonal IUD has been shown to have high rates of satisfaction and continuation among users in high-income countries. The study aims to understand the profiles of clients who choose the hormonal IUD in low- and middle-income countries (LMICs) and describe their continuation and satisfaction with the method after 12 months of use.MethodsA prospective longitudinal study of hormonal IUD acceptors was conducted across three countries—Madagascar, Nigeria, and Zambia—where the hormonal IUD had been introduced in a pilot setting within the of a broad mix of available methods. Women were interviewed at baseline immediately following their voluntary hormonal IUD insertion, and again 3 and 12 months following provision of the method. A descriptive analysis of user characteristics and satisfaction with the method was conducted on an analytic sample of women who completed baseline, 3-month, and 12-month follow-up questionnaires. Kaplan–Meier time-to-event models were used to estimate the cumulative probability of method continuation rates up to 12 months post-insertion.ResultsEach country had a unique demographic profile of hormonal IUD users with different method-use histories. Across all three countries, women reported high rates of satisfaction with the hormonal IUD (67–100%) and high rates of continuation at the 12-month mark (82–90%).ConclusionsRates of satisfaction and continuation among hormonal IUD users in the study suggest that expanding method choice with the hormonal IUD would provide a highly effective, long-acting method desirable to many different population segments, including those with high unmet need.

THE DIFFERENCESS OF DISCONTINUITAS IUD IN POST PLACENTAL AND INTRA-CESAREAN IN MADIUN

AbstractBackground: Intra Uterine Device (IUD) which is placed after delivery of the placenta is an attempt to reduce the rate of population growth. However, the achievement is still very low, especially in the post-placental IUD insertion. It is this high expulsion rate that continues to be a concern for service providers, so this method is acceptable. The purpose of this study is to compare the sustainability of IUD acceptors in post-placental and intra-cesareann placement. Methods: The design of this study was cross sectional with an observational analytic method. Location of this research in the family planning clinic of Dr. Soedono Madiun Hospital, Banjarejo Health Center, Tawangrejo Health Center, and PMB Ny. “P” Madiun City in 2019.The sample used consecutive sampling as many as 114 acceptors. The independent variable was the time of IUD insertion. The dependent variable is the discontinuity of the IUD acceptor. The instrument used was the 2019 IUD acceptor medical record. The Fisher Exact Test on SPSS was used to perform data analysis. Results: From 114 acceptors, there was no difference in the discontinuity of IUD acceptors in post-placental and intra-cesarean placement (p=0.1). The incidence of expulsion was found in post-placental insertion (p=0.02). In intra-cesarean IUD acceptors more confirmed using ultrasound examination (p = 0.03). There was no perforation in both. Conclusion: There is no difference in IUD acceptor discontinuity in post-placental and intra-cesarean placement.

The Effect Of Douching Treatments Using Manjakani Seeds (Quercus Infectoria Gall) Boiled Into Water To Total Colony Of Streptococcus Sp And Escherichia Coli Among IUD Acceptors Who Experienced Vaginal Discharge

Intra Uterine Device (IUD) is a safe, effective, and reversible device made of plastic or metal which is inserted into the uterus through the cervical canal to prevent pregnancy. One of side effects of IUD is leucorrhoea or fluoralbus that is a whitish, intermittent and increased amount of discharge from vagina. Leucorrhoea is the most common complaint of women using IUD as it may cause uterus reactions to a strange object with excessive vaginal discharge characterized by increased amount of vaginal mucus, yellowish or gray, itchy, smelly, and causing inconvenience. A Moist condition and discharge in vagina among IUD acceptors is a good environment for pathogenic bacteria growth including Streptococcus sp and Escherichia coli. One of alternative treatments from herbal remedies is manjakani seeds (Quercus infectoria gall). Empirically, manjakani seeds have been used to clean genital organs for prevention and treatment of vaginal discharge. The active subtances of the seeds are tannin, saponin, alkaloid, steroid, flavonoid, and trapezoid that are believed as an antibacterial effect. This study aimed to determine the effect of douching treatments using manjakani seeds (Quercus infectoria gall) boiled into water to the total colony of Streptococcus sp and Escherichia coli among IUD acceptors who experienced vaginal discharge. The research methods of the study utilized quasi experiments with one group pretestpostest design. The sampling technique was consecutive sampling with IUD acceptors suffering vaginal discharge in puskesmasSukajadi and ledeng, Bandung as the samples. The results showed based on statistical test, there was a significant difference between the number of colonies of Escherichia coli, streptococcus sp and complaints of leucorrea pre-test and posttest test of douching of boiled manjakani seeds with p value 0.05.

FAKTOR-FAKTOR YANG MEMPENGARUHI KENYAMANAN SEKSUAL PADA AKSEPTOR KB IUD DI RS.BHAYANGKARA

Objective: Research Objective to know the factors affecting the Sexual Comfort on IUD KB Acceptors in Rs.Bayayangkara Makassar. Method: Research Method: This research is a cross sectional study. The sample of research with the number of 40 respondents by way of sampling random sampling. Data analysis using chi square test for 95% significance level. Discussion: IUD (Intra Uterine Device) is a widely used contraceptive tool in family planning program in Indonesia. Less than 4.5 million KB acceptor use IUD. However, the use of IUD contraceptives is not a perfect tool, so there are still some disadvantages including: spotting bleeding, menometrorargia, vaginal or flour albus, dysmenorrhea infection and sexual comfort. Result: Research Result: The result of statistical test by using chi square of all the factors that influence the known value of P smaller than a, it can be concluded that the Ho intervention group is rejected and Ha accepted. Conclusion: There is correlation between the factors influencing the Sexual Convenience on KB IUD Acceptors Dirs.Bhayangkara Makassar

Expanding contraceptive choice in Ethiopia: a comparative analysis of method mixes in post-abortion contraception versus routine family planning

Background: In Ethiopia, a low contraceptive prevalence and high unmet need coupled with skewed method mix clearly signify the need for comprehensive family planning delivery strategies. Ipas implemented problem-focused intervention to improve service delivery standards and provide accessible, high-quality family planning services. This analysis seeks to compare the contraceptive method mix in routine and post-abortion contraception services and to suggest how multifaceted service delivery approaches can help address the unmet family planning need. Methods: The intervention was implemented in 127 public health facilities providing both routine and post-abortion contraception services, from 2010 to 2017. The intervention focused on service delivery and program management gaps identified during the baseline assessment. Service data regularly collected from intervention facilities and entered into a Microsoft Excel database to conduct descriptive analysis, review trends, and monitor progress. Results: Trend analysis of method choice patterns revealed that the share of method mix for long-acting reversible contraceptives(LARCs) rose from 3% in 2010 to 40% in 2017 in routine family planning service, whereas in the post-abortion contraception service, the share for LARCs climbed from 2% in 2010 to 62% in 2017(P&lt;0.001). Trend analysis of LARC uptake in post-abortion contraception revealed that implant use rose from 2% in 2010 to 54% in 2017, while intrauterine device (IUD) use increased from 0.1% in 2010 to 9% in 2017. In routine program, proportion of implant acceptors increased from 3% in 2010 to 35% in 2017, while IUD acceptance increased far more slowly, from only 0.07% to 5% over the same period. Conclusions: Comprehensive contraceptive service delivery strategies, such as integration of family planning with other maternal health services can help the service to reach clients with a variety of needs, a key factor for a higher uptake of LARCs by abortion clients as compared to routine family planning program.

Religious Belief, Social Support, and the Acceptance of Intrauterine Device Among Women of Reproductive Age in Klaten, Central Java

Background: Indonesia is one of the developing countries with complex population problems. According to the Central Bureau of Statistics, the current population in Indonesia in 2016 reached 258,704,986 people. One of the government's efforts to reduce population growth is Family Planning (KB) program. This study aimed to determine the socioeconomic determinants, social norm, religion on the use of IUD contraceptive among women in Klaten, Central Java, using Theory of Planned Behavior . Subjects and Method : This was a cross-sectional study conducted in 25 community health centers in Klaten, Central Java, from November to December 2018. A sample of 200 women of reproductive age was collected by simple random sampling. The dependent variable was the use of IUD. The independent variables were education, husband support, health personnel support, employment, income, social norm, religion, intention, attitude, perceived behavior control. The data were measured by questionnaire and analyzed by a multilevel logistic regression. Result : The use of IUD was positively influenced by higher education (b= 1.40; 95% CI= 0.12 to 2.78; p= 0.047), strong husband support (b= 1.57; 95% CI= 0.12 to 3.03; p= 0.034), strong health personnel support (b= 1.70; 95% CI= 0.14 to 3.26; p= 0.033), employed (b= 1.50; 95% CI= 0.17 to 2.99; p= 0.047), high income (b= 2.14; 95% CI= 0.36 to 3.92; p= 0.018), supportive social norm (b= 1.50; 95% CI= 0.49 to 2.95; p= 0.043), supportive religion (b= 1.42; 95% CI= 0.12 to 2.84; p= 0.048), intention (b= 1.75; 95% CI= 0.15 to 3.35; p= 0.032), positive attitude (b= 2.16; 95% CI= 0.45 to 3.86; p= 0.013), and perceived behavior control (b= 1.57; 95% CI= 0.29 to 3.11; p= 0.046). Community health center had a contextual effect on the use of IUD contraception with ICC= 10.6%. Conclusion : The use of IUD is positively influenced by higher education, strong husband support, strong health personnel support, employed, high income, supportive social norm, supportive religion, intention, positive attitude, and perceived behavior control. The community health center has a contextual effect on the use of IUD contraception. Keywords : IUD contraceptive, utilization, community health center, multilevel analysis Correspondence : Veronica Fenny Wijaya. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: veronicafenny04@gmail.com. Journal of Maternal and Child Health (2019), 4(3): 201-211 https://doi.org/10.26911/thejmch.2019.04.03.07

A 10- year experience with copper t intrauterine device (IUD) in Abuja, Nigeria

Background: The Intrauterine contraceptive device has been shown to be an effective form of long acting reversible contraception. Despite this however, its uptake in Nigeria has not reached the optimum level. Objective: The objective of this study was to determine the rate, pattern of uptake and reasons for discontinuation of use of the intrauterine contraceptive device at the University of Abuja Teaching hospital, Abuja. Materials and Methods: A retrospective study of record cards of all the women who attended the family planning clinic between January 2007 and December 2016. Data on socio-demographic characteristics, acceptance rate, discontinuation rate and reasons for discontinuation of the IUD were extracted. Results: Out of 3251 acceptors of various family planning methods, there were 1241 acceptors of IUD within the study period, giving an IUD acceptance rate of 38.2%. The contraceptive prevalence rate in relation to the number of deliveries (22,955) within the study period was 14.2%. Overall, IUD was the commonest form of contraceptive used (38.2%). The most frequent users of the IUD were women aged 35 years and above (43.5%), while the least users, (0.3%) were the teenagers. Acceptance rate of IUD was highest amongst women who were Para 4 (27.4%) and most of the women (99%) were married. The IUD was the most commonly used contraceptive in the first 5 years with more than 50% of women using the method by the third year. It subsequently became the second most commonly used contraceptive after the subdermal implant in the last 5 years. The average discontinuation rate was 12.1% and the commonest reason was the desire to get pregnancy 55(36.7%) women. The mean duration of use of IUDs in this study was 2.9+/- 1.6 years. A pearl index of 0.02 was recorded. Conclusion: The contraception prevalence rate is low in our center however, the IUD is among the most common methods utilized by the clients. It is effective and has a low discontinuation rate. Keywords: Copper T-380AIUD, acceptance rate, discontinuation rate, Abuja

Faktor yang Berhubungan dengan Penggunaan Intra Uterine Device (IUD) di Pusat Pelayanan Keluarga Sejahtera (Pusyan Gatra) Tahun 2016

The rate of growth population (LPP) becomes the main problem that is being faced by Indonesia today, one of them was East Java Province which increased 0.06 in 2000–2010 from 1990–2000 period. One effort to control LPP was family planning program by using contraception, especially Intra Uterine Device (IUD) to regulate the distance of pregnancy and to regulate birth spacing. Achievements of new Long Term Contraception Method (MKJP) acceptors especially IUD tend to decrease from 2013 to 2015 in Surabaya. The achievement of the proportion of new IUD acceptors in 2016 in Pusyan Gatra decreased by 6% became 34% from 2015 which is 40%. This study aimed to know and analyze the variables associated with the use of IUD in Pusyan Gatra in 2016 by using chi-square test. This research was an analytic quantitative research with cross-sectional design. This research data source were a new acceptor secondary data of MKJP in 2016. Population in this research were 270 new acceptors of MKJP from January to December 2016. The independent variables were age, educational level, employment status, and parity. The results from chi – square test were age (p = 0.002) and parity (p = 0.001) which related to IUD. Level of education and employment status of acceptors had no significant relationship with IUD in Pusyan Gatra. Therefore, the couple of reproductive (PUS) were &gt;35 years old who had parity &gt;2 and not using long–term contraception method yet, the counseling about using MKJP such as IUD must be improved.

Differences in post-placental intra uterine device acceptance with and without couples counseling in private practice midwifery clinics, West Denpasar

Background and purpose: The post-placental intra uterine device (IUD) program is one intervention to increase IUD uptake however the acceptance remains low. Contraceptive counseling during pregnancy is expected to increase IUD uptake. The primary objective of this study is to determine the efficacy of counseling by involving the husband in order to improve post-placental IUD uptake. The secondary objective is to compare knowledge and perceptions of IUD before and after intervention.Methods: A randomized controlled trial was conducted with 58 pregnant women at 37-40 weeks' gestation in three private midwifery clinics in Denpasar, Bali. Subjects were divided into two groups: 29 intervention groups that were given couples counseling and 29 control groups that were given counseling without involving husbands. Base line interview was conducted during enrollment and follow up interview was carried out immediately after delivery.Results: Acceptance of post-placental IUD was found in 21 women (72.41%) in the intervention group and 10 women (34.48%) in the control group (RR=2.2; 95%CI: 1.23-3.84). The mean difference in pretest and post-test scores of knowledge, perceptions of susceptibility and benefits were found to be higher in the intervention group but not statistically significant. The result of multivariate analysis indicated that the variables influencing post-placental IUD acceptance were the child's gender (AOR=45.9, 95%CI: 4.53-465.25), couples counseling with husband (AOR=17.4, 95%CI: 2.55-119.56) and maternal education (AOR =7.1; 95%CI: 1.17-43.40).Conclusions: Couples counseling was found to increase post-placental IUD uptake. In addition, post-placental IUD acceptance is also influenced by the child's gender and maternal education levels. To increase uptake of post-placental IUDs there is a need for upscalling of couples counseling at the time of antenatal care.

Differences in post-placental intra uterine device acceptance with and without couples counseling in private practice midwifery clinics, West Denpasar

Background and purpose: The post-placental intra uterine device (IUD) program is one intervention  to increase IUD uptake however the acceptance remains low. Contraceptive counseling during pregnancy is expected to increase IUD uptake. The primary objective of this study is to determine the efficacy of counseling by involving the husband in order to improve post-placental IUD uptake. The secondary objective is to compare knowledge and perceptions of IUD before and after intervention.Methods: A randomized controlled trial was conducted with 58 pregnant women at 37-40 weeks' gestation in three private midwifery clinics in Denpasar, Bali. Subjects were divided into two groups: 29 intervention groups that were given couples counseling and 29 control groups that were given counseling without involving husbands. Base line interview was conducted during enrollment and follow up interview was carried out immediately after delivery.Results: Acceptance of post-placental IUD was found in 21 women (72.41%) in the intervention group and 10 women (34.48%) in the control group (RR=2.2; 95%CI: 1.23-3.84). The mean difference in pretest and post-test scores of knowledge, perceptions of susceptibility and benefits were found to be higher in the intervention group but not statistically significant. The result of multivariate analysis indicated that the variables influencing post-placental IUD acceptance were the child's gender (AOR=45.9, 95%CI: 4.53-465.25), couples counseling with husband (AOR=17.4, 95%CI: 2.55-119.56) and maternal education (AOR =7.1; 95%CI: 1.17-43.40).Conclusions: Couples counseling was found to increase post-placental IUD uptake. In addition, post-placental IUD acceptance is also influenced by the child's gender and maternal education levels. To increase uptake of post-placental IUDs there is a need for upscalling of couples counseling at the time of antenatal care.

Influence of Acculturation in Knowledge and Acceptability of Intrauterine Devices in Hispanic Adolescents

Influence of Acculturation in Knowledge and Acceptability of Intrauterine Devices in Hispanic Adolescents

Acceptance of Post-Placental Intrauterine Contraceptive Device in Denpasar

Background and purpose: The Indonesian Demographic Health Survey of 2012 indicated that the prevalence of contraceptive use in Bali Province has decreased compared to 2007. In addition, the proportion of the use an intrauterine device (IUD) also continues to decline. To increase number of IUD acceptors is to promote post-placental intrauterine device (PPIUCD), however the acceptance remains low. This study aims to determine factors associated with acceptance of post-placental intrauterine device in Denpasar.Methods: Study was cross sectional with a total of 100 respondents selected by consecutive sampling. Respondents were mothers who had gave birth in January-February 2016 at Wangaya General Hospital and three health centers (Dauh Puri Sub Health Center, East Denpasar I and South Denpasar IV). Data were collected by interview in hospital and health center. Chi square test was conducted for bivariate analysis and multivariate using logistic regression.Results: Proportion of PPIUCD acceptance was 35%. Multivariate analysis indicated that PPIUCD acceptance was associated with perception of benefits (AOR=10.39; 95% CI: 2.792-38.56), perception of low side effects (AOR=5.288; 95%CI: 1.085-25.761), role of health workers (AOR=7.1; 95%CI: 1.781-28.60) and support of the husband (AOR=12.020; 95% CI=2.888-50.01).Conclusion: Variables associated with PPIUCD acceptance were perception of low side effects, perception of benefits, role of health workers and husband support.

Current Practice and Determinants of Family Planning Methods among Married Females in the Reproductive Age Group (15-49yrs) in a Rural Setting, Kerala

Background and objectives: Contraceptive prevalence rate is an indicator of health, population, development and women’s empowerment. Contraceptive choice and use will vary according to the socio-cultural factors of that geographical area. This study was done to find out the percentage of married females who is currently using contraceptives as well as various factors associated with its use and along with that, assessed their current knowledge regarding various contraceptive methods. Methods: A community based cross sectional study done in Mulamkunnathukavu panchyat of Thrissur district in Kerala among 203 married females in the 15-49 age group using a pre-tested questionnaire. Results: The prevalence of current use of family planning methods was 48.8% with 95% CI was (47.8 - 49.8). In various contraceptives 16.7% were using Female sterilization, followed by IUD (14.8%) and rhythm method (7.9%). Mean age (SD) at marriage is 21.67(5.67) years. Contraceptive prevalence was shown statistically significant association with age of female (p=0.036) number of child (p=0.03), male preference (p=0.031), age of last child (0.013). Age of the female (p=0.005), spouse education (0.046) and spouse occupation (p=0.04) number of child (p=0.0001), male preference (p=0.001) were the statistically significant factors associated with pattern of use of contraceptive. Majority of study participants were aware about Copper T (80.8%), followed by Condom (73.9%), Rhythm method (72.9%) and female Sterilization (71.9%) Health workers played a big role in disseminating information regarding family planning (68%). Conclusion: Current use of family planning method and female sterilization was started to decline but knowledge and acceptance of Intra Uterine Device increased .Male participation in family planning method was very poor. So we have to think about the new initiatives to improve the male involvement in family planning practice. Intensify the measures to improve permanen

ANALISIS FAKTOR – FAKTOR YANG BERHUBUNGAN DENGAN PERILAKU PELAYANAN KONTRASEPSI OLEH BIDAN DI KABUPATEN KEBUMEN

IUD is one of the long term contraceptions which its usage is still below the target of Kebumen goverment on 11%. The local government has done a workshop of Contraception Technology Update (CTU) for the midwives in the Kebumen regency so the numbers of the IUD acceptors had increased to 6.57% in June 2012 but however, this is still below the government's target. Some efforts have been done by the local governement but it still can not show a good of IUD contraveption good services. Objective of the research is to give clear descrpition of the analysis of factors relate to intra Uterine Device (IUD) contraception services by midwives in Kebumen Regency.This study this is an observational research with analytic survey method and cross sectional approach. The data were collected using interview consited of strutured questioners to 80 midwives in Kebumen area. The data were analyzed using univariat, bivariat and multivariat analyses techniques.The results show that the variables of knowledge, motivation, acces, human resource availability and policy are in good category but there are still 40% of midwives who have low motivation so they still prefer to give the other more practical contraceptions instead of IUD, and 31% of the places for the IUD services still have not been provided with flipcharts. The variable of IUD contraception has correlation with the variables of knowledge with (p=0.037), motivation (p=0.045), and the availability of the human resources (p=0.021). Meanwhile the variables of service acces (p=0.691) and policy (p=1.000) have no correlation with the behaviour of IUD contraception service. Togetherly the variables of motivation and human resource availability have influenced the behaviour of IUD contraception service p≤ 0.05 with Exp.(B) &gt; 2.It is recomended to midwives to motivate them selves in giving more rasionally Family Planning service and it is necessary to hold an Up to date Contraception Technology Workshops for midwives to increase the quality of IUD contraception services. Keywords : IUD Contraception Services, CTU for midwives

A minimalist technique for insertion of intrauterine devices

The world’s population is approaching 7 billion. As a general rule, the countries with the highest population have the least available healthcare resources, the most notable exception being the United States of America (USA). Most of these countries have an urgent need to reduce their populations. The intrauterine device (IUD) is used by the largest number of contraceptives world-wide and it has a proven record in reducing unwanted pregnancies. Its efficacy rate as a long-acting reversible contraceptive is matched only by subdermal implants which are not as cost effective. Although the rates of pelvic infection are elevated in many countries with low-resource health care systems, we now know that pelvic infection rates are independent of IUD usage. This is therefore no longer a contraindication for using IUDs on a large scale in family planning programs. The technique of IUD insertion as described in most textbooks and journals is unnecessarily complex and based on ritual rather than good clinical evidence. This is particularly interesting in that at a time where we prefer evidence based medicine there are still so many clinical practice sacred cows. This article advocates a simplification of the technique for inserting IUDs. The scientific rationale for simplifying the technique is presented, as well as evidence that it is as safe if not safer than the currently suggested methods, if used for the correct type of IUD acceptors.

Intrauterine contraceptive device acceptors in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Southeastern Nigeria - A 5-year review

Background: Unsafe abortions of unintended pregnancies contribute significantly to maternal deaths in Nigeria. The intrauterine device (IUD) is a widely used method of contraception. Objectives: This study aimed to determine the contraceptive prevalence at this center, the proportion of the acceptors adopting the IUD method, and the sociodemographic characteristics and other parameters among the IUD clients. Findings from this study and the analysis of similar studies elsewhere will help improve contraceptive services, especially counseling and acceptance. Materials and Methods: This was a retrospective study of the period January 2004-Dec. 2008. The family planning register was used to trace the case records of the clients who had accepted IUDs over the 5-year period. Labor ward registers were used to calculate the number of deliveries over the same period. EPI Info Version 6 (2002) for Windows was used to analyze the data. Chi-squared tests were used and differences were considered significant if P < 0.05. Results: The total number of deliveries at our center in the studied period was 2,791, while the total number of contraceptive clients (for all methods) was 607, giving a contraceptive prevalence rate of 21.75%. IUD was the most accepted method, used by 344 (56.67%) women, followed by injectable progestogens, used by 172 (28.34%). Among IUD acceptors, most were multiparous women (para 2-5), numbering 168 (50.91%); most were in the age group of 26-30 years 100 (30.30%); male sterilization was not done at all (0%). Conclusion: IUD is a preferred contraceptive option among our women; however, the prevalence rate of modern contraceptive use at our center is still unacceptably low. More aggressive health education using the mass media, nongovernmental organizations (NGOs), religious and community leaders, and easy access to the commodities are required to reverse the trend.

Understanding benefits and addressing misperceptions and barriers to intrauterine device access among populations in the United States.

Three intrauterine devices (IUDs), one copper and two containing the progestin levonorgestrel, are available for use in the United States. IUDs offer higher rates of contraceptive efficacy than nonlong-acting methods, and several studies have demonstrated higher satisfaction rates and continuation rates of any birth control method. This efficacy is not affected by age or parity. The safety of IUDs is well studied, and the risks of pelvic inflammatory disease, perforation, expulsion, and ectopic pregnancy are all of very low incidence. Noncontraceptive benefits include decreased menstrual blood loss, improved dysmenorrhea, improved pelvic pain associated with endometriosis, and protection of the endometrium from hyperplasia. The use of IUDs is accepted in patients with multiple medical problems who may have contraindications to other birth control methods. Yet despite well-published data, concerns and misperceptions still persist, especially among younger populations and nulliparous women. Medical governing bodies advocate for use of IUDs in these populations, as safety and efficacy is unchanged, and IUDs have been shown to decrease unintended pregnancies. Dispersion of accurate information among patients and practitioners is needed to further increase the acceptability and use of IUDs.