Uptake Of Intrauterine Device Research Articles

A mixed-methods study of factors influencing postpartum intrauterine device uptake after family planning counseling among women in Kigali, Rwanda.

Rwanda has high unmet need for family planning (FP), especially in the postpartum period when women are advised to space pregnancies at least two years for improved maternal-child health. Despite interest in the copper intrauterine device (IUD), a highly cost-effective method, access and uptake remain low. This study aimed to determine factors associated with postpartum IUD (PPIUD) uptake after postpartum family planning (PPFP) counseling as well as provider perceptions of facilitators and barriers to clients' PPIUD uptake. Postpartum women who received PPFP counseling and were less than 6 weeks postpartum were recruited for a case-control study in Kigali, Rwanda in 2018. We recruited n = 74 women who had accepted and n = 91 women who had declined the PPIUD. Multivariate logistic regression analyses evaluated associations between women's socio-demographics, FP knowledge and decision-making, and the outcome of PPIUD uptake. Six focus groups (FGs) were conducted with FP providers (n = 24) and community health workers (n = 17) trained to deliver PPFP counseling to assess perceptions of PPFP counseling and facilitators and barriers to PPIUD uptake. FG discussions were recorded, translated, and analyzed for themes. Factors associated (P<0.1) with PPIUD uptake included citing its non-hormonal nature, effectiveness, and duration of protection against pregnancy as advantages. Exclusive male partner control over FP decisions (relative to women's control or joint decision-making) was associated with non-use. Overall, limited knowledge about some aspects of the PPIUD persisted among clients even after counseling. Provider FGs highlighted client concerns, inconsistent FP messaging, and lack of male partner involvement as factors influencing non-use. Knowledge of the IUD and its benefits was associated with PPIUD uptake. There is need to refine PPFP counseling messages to address remaining knowledge gaps and concerns. Additionally, male partner involvement in FP counseling and decisions with their partners could be a key strategy to increase both PPIUD and FP uptake in Rwanda.

Using machine learning to understand determinants of IUD use in India: Analyses of the National Family Health Surveys (NFHS-4)

Intra-uterine devices (IUDs) are a safe and effective method to delay or space pregnancies and are available for free or at low cost in the Indian public health system; yet, IUD uptake in India remains low. Limited quantitative research using national data has explored factors that may affect IUD use. Machine Learning (ML) techniques allow us to explore determinants of low prevalence behaviors in survey research, such as IUD use. We applied ML to explore the determinants of IUD use in India among married women in the 4th National Family Health Survey (NFHS-4; N = 499,627), which collects data on demographic and health indicators among women of childbearing age. We conducted ML logistic regression (lasso and ridge) and neural network approaches to assess significant determinants and used iterative thematic analysis (ITA) to offer insight into related variable constructs generated from a series of regularized models. We found that couples’ shared family planning (FP) goals were the strongest determinants of IUD use, followed by receipt of FP services and desire for no more children, higher wealth and education, and receipt of maternal and child health services. Findings highlight the importance of male engagement and family planning services for IUD uptake and the need for more targeted efforts to support awareness of IUD as an option for spacing, especially for those of lower SES and with lower access to care.

Can an online educational video broaden young women’s contraceptive choice? Outcomes of the PREFER pre-post intervention study

IntroductionContraceptive knowledge mediates access and use. We aimed to assess whether an online educational video describing all methods and their benefits, side effects and mode of action increased young women’s...

Differences in postpartum contraceptive choices and patterns following low- and high-risk pregnancy

ObjectiveTo assess the impact of a high-risk pregnancy on postpartum contraceptive planning and use. MethodsWe conducted a retrospective cohort study of women who gave birth in a teaching hospital in 2020. We classified women into 2 groups based on their risk status according to the Society for Maternal-Fetal Medicine. The World Health Organization (WHO) tiers of contraceptive efficacy were used to categorize contraceptive planning and administration. The primary outcome was the utilization rate of Tier 1contraceptive methods at their postpartum visit in women with prior high-risk pregnancy. Univariate and multivariate analyses were carried out to determine the relationships between risk status, characteristics, contraceptive preference, and actual utilization. ResultsThis study included 788 low-risk and 482 high-risk postpartum women. High risk women indicated greater interest in (43.5% low-risk vs 52.2% high-risk, p < 0.01) and usage rates of (45.7% low-risk vs 54.3% high-risk, p = 0.01) Tier 1 contraception. The most commonly chosen contraceptive methods among low- and high-risk women were progestin-only pills (30.6%) and tubal ligation (36.4%), respectively. Uptake rates of immediate postpartum contraceptive implants did not differ between low (9.3%) and high-risk (11%) women (p = 0.32). Few patients adopted intrauterine devices (1.1%). ConclusionHigh-risk status was associated with intention to use and uptake of effective contraceptive methods, which persisted through the postpartum period. ImplicationsTo assist women in achieving the recommended interpregnancy intervals, counseling tailored to their individual risks and needs should be provided. Reasons for low intrauterine devices uptake should be explored. Postnatal care should include immediate postpartum long-acting reversible contraception (LARC) services.

Understanding factors associated with continuation of intrauterine device use in Gujarat and Rajasthan, India: a cross-sectional household study

The Government of India has promoted the expansion of access to and uptake of intrauterine devices (IUDs), during both the interval (IIUD) and postpartum (PPIUD) periods, as part of its Family Planning 2020 initiative. This study, conducted by EngenderHealth as part of the Expanding Access to IUD Services in India project, examines IIUD and PPIUD continuation rates over time and investigates factors associated with IUD continuation. We recruited respondents (N = 5024) through a repeated cross-sectional household study between February and December 2019. We identified respondents using IUD client data from public health facility registers in 20 districts of Gujarat and Rajasthan. We compared continuation rates for IIUD and PPIUD adopters and used regression analyses to measure the association between continuation and demographic, quality of care, and counselling variables. IIUD continuation rates decreased from 85.6% to 78.3% and PPIUD rates decreased from 78.5% to 70.7% between month 3 and month 12. Clients experiencing side effects or other problems were 15 times more likely to discontinue IUD use than clients who did not. Clients who received IUD counselling prior to insertion were more likely to continue than those who did not. IUD continuation increased significantly in cases where both partners jointly selected the method compared to situations where women decided alone. Several sociodemographic factors were associated with continuation. Our study demonstrates the value and benefits of programmes offering IUD services emphasising quality counselling and client-centred care to increase access, uptake, and continuation.

Associations between Smoking, Intrauterine Device Uptake, and Ectopic Pregnancy: A Meta Analysis

Background: Ectopic pregnancy is an import­ant cause of maternal morbidity and mortality, estimated to occur in approximately 1-2% of pregnancies worldwide. Smoking and history of using intrauterine devices are risk factors for ectopic pregnancy. This study aims to estimate the magnitude of the relationship between smoking and a history of using intrauterine devices on the incidence of ectopic pregnancy based on a number of previous primary studies. Subjects and Method: This study is a syste­matic review and meta-analysis. The articles used in this study were obtained from several databases, including: PubMed, Google Scholar, and Science Direct which were published from 2000-2020. The inclusion criteria used are full text articles with Case Control design. The keywords used to search for articles were as follows: smoking AND "ectopic pregnancy" AND multivariate; "use of intrauterine device" AND "ectopic pregnancy" AND multivariate; smoking OR cigarette AND “use of intrauterine device” AND “ectopic pregnancy” OR “tubal pregnancy” AND multivariate. Articles were collected using PRISMA flow diagrams and analyzed using the Review Manager 5.3. Results: A meta-analysis of 7 articles showed that women of reproductive age who smoked had a 2.20 times risk of ectopic pregnancy compared to women of reproductive age who did not smoke (aOR= 2.20; 95% CI= 1.45 to 3.34; p= 0.002). A meta-analysis of 9 articles showed that women of reproductive age with a history of using intrauterine devices had a 2.28 times risk of ectopic pregnancy compared to women of reproductive age who did not use intrauterine devices (aOR= 2.28; 95% CI= 1.74 to 2.98; p&lt;0.001). Conclusion: Smoking and a history of using intrauterine devices increase the risk of ectopic pregnancy. Keywords: smoking, intrauterine contracep­tives, ectopic pregnancy, meta-analysis Correspondence: Ridha Rossela Yanuari. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: ridharosselayanuari@gmail.com. Mobile: 085747311182 Journal of Maternal and Child Health (2021), 06(04): 388-399 https://doi.org/10.26911/thejmch.2021.06.04.01

Associations between Smoking, Intrauterine Device Uptake, and Ectopic Pregnancy: A Meta Analysis

Background: Ectopic is an import­ant cause of maternal morbidity and mortality, estimated to occur in approximately 1-2% of pregnancies worldwide. Smoking and history of using intrauterine devices are risk factors for pregnancy. This study aims to estimate the magnitude of the relationship between smoking and a history of using intrauterine devices on the incidence of based on a number of previous primary studies. Subjects and Method: This study is a syste­matic review and meta-analysis. The articles used in this study were obtained from several databases, including: PubMed, Google Scholar, and Science Direct which were published from 2000-2020. The inclusion criteria used are full text articles with Case Control design. The keywords used to search for articles were as follows: smoking AND ectopic pregnancy AND multivariate; of intrauterine device AND ectopic pregnancy AND multivariate; smoking OR cigarette AND “use of intrauterine device” AND “ectopic pregnancy” OR “tubal pregnancy” AND multivariate. Articles were collected using PRISMA flow diagrams and analyzed using the Review Manager 5.3. Results: A meta-analysis of 7 articles showed that women of reproductive age who smoked had a 2.20 times risk of compared to women of reproductive age who did not smoke (aOR= 2.20; 95% CI= 1.45 to 3.34; p= 0.002). A meta-analysis of 9 articles showed that women of reproductive age with a history of using intrauterine devices had a 2.28 times risk of compared to women of reproductive age who did not use intrauterine devices (aOR= 2.28; 95% CI= 1.74 to 2.98; p<0.001). Conclusion: Smoking and a history of using intrauterine devices increase the risk of pregnancy. Keywords: smoking, intrauterine contracep­tives, pregnancy, meta-analysis Correspondence: Ridha Rossela Yanuari. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: ridharosselayanuari@gmail.com. Mobile: 085747311182 Journal of Maternal and Child Health (2021), 06(04): 388-399 https://doi.org/10.26911/thejmch.2021.06.04.01

Meta-Analysis the Effect of Intrauterine Device Uptake on the Risk of Ectopic Pregnancy in Women of Reproductive Age

Background: Indonesia has a high Maternal Mortality Rate (MMR) and has not met the Millennium Development Goals (MDGs) target. Maternal mortality in Indonesia is caused by bleeding, hypertension, infection with abortion, and prolonged labor. One of the causes of bleeding in the first trimester is ectopic preg­nancy. Several studies have shown an increased risk of ectopic pregnancy in women using intra­uterine contraceptives. Subjects and Method: A literature review was carried out in this study with a case control study design. The exposure was intrauterine contraception, and the outcome of the study was an ectopic pregnancy. The initial screening limits studies by time, language and appro­priate themes. Furthermore, the selection of research articles was carried out based on the content according to the topic, namely ectopic pregnancy and intrauterine contraceptives, the literature obtained was not duplicated, and each literature was reviewed. Statistical analy­sis was performed using Rev.Man 5.3 software with a random effects model. Value: the I² statistic was used to calculate hetero­geneity. Results: Pooled OR estimates from all studies are (RR= 1.53; 95% CI= 0.48 to 4.80; p= 0.47) with a heterogeneity of 85%. Conclusion: Based on a review of the litera­ture, it can be concluded that intrauterine contraceptives can cause ectopic pregnancy, but the results of the study still show quite varied OR. Keywords: intrauterine contraceptives, ectopic pregnancy, meta analysis Correspondence: Yulita Endah Mayaningrum. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36 A, 57126, Surakarta, Central Java 57126. Email: yulita.maya95@gmail.com. Mobile: +6285817887585. Journal of Maternal and Child Health (2021), 06(02): 165-175 https://doi.org/10.26911/thejmch.2021.06.02.04

Predictors of Severe Pain During Insertion of the Levonorgestrel 52 mg Intrauterine System Among Nulligravid Women

(Abstracted from Contraception 2020;102:267–269) A barrier to uptake of intrauterine devices (IUDs) is fear of pain at the time of insertion. Although nulliparity is a common factor associated with pain at IUD insertion, it is often underestimated by health care professionals.

Development and Uptake of Long-Acting Reversible Contraception Services in Rwanda, 2009-2016.

Background: Long-acting reversible contraception (LARC) is highly effective at preventing pregnancy. However, in sub-Saharan Africa, LARC education for clients is relatively limited and providers are often not skilled in their insertion. Before 2009, only 1% of family planning clients in Rwanda received an LARC. Materials and Methods: We trained Rwandan government clinic nurses to promote, insert, and remove copper intrauterine devices (IUDs) and hormonal implants. Training started in two large urban clinics, and those nurses trained three successive waves of clinic nurses. Initial LARC promotions were clinic based, but in 2015 included community-based promotions in eight clinics. We compare IUD and implant insertions by year and clinic and discuss implementation successes/obstacles. Results: From 2009 to 2016, 222 nurses from 21 government clinics were LARC trained. The nurses performed 36,588 LARC insertions (19% IUD, 81% implant). LARC insertions increased over time, peaking at 8,897 in 2013. However, in 2014, the number dropped to 4,018 after closure of one large clinic, funding discontinuation, and supply stock-outs. With new funding in 2015, insertions increased reaching 8,218 in 2016. Catholic and non-Catholic and rural and urban clinics performed similarly, whereas clinics affiliated with community-based promotions performed better (p > 0.05). Between 2012 and 2014, 13% of family planning initiators chose the implant and 4% the IUD. Conclusions: LARC supply-demand services increased the proportion of family planning initiators choosing LARC to 17%. Challenges included inconsistent funding, irregular supplies, and staff turnover. Rural and Catholic clinics performed as well as urban and non-Catholic clinics. Concerted efforts to improve IUD uptake are needed.

Prevalence and predictors of initiation of intrauterine devices and subdermal implants immediately after surgical abortion

ObjectivesTo estimate uptake of long-acting reversible contraception (LARC) methods immediately after surgical abortion in a system that makes these methods readily available, and to determine demographic, medical, social, and visit-specific predictors of immediate post-abortion intrauterine device (IUD) and implant initiation. Study designWe performed a retrospective cohort study of LARC (levonorgestrel intrauterine system [IUS], copper IUD, and subdermal implant) initiation at the time of surgical abortion up to 21w0d gestation at Planned Parenthood League of Massachusetts from 2012 through 2017. We calculated proportions of IUD and implant initiation and used mixed effect logistic regression to estimate predictors of each outcome. ResultsAmong 26,858 surgical abortion patients, 25.4% received immediate post-abortion LARC: 14.2%, 4.2%, and 7.0% received a levonorgestrel IUS, copper IUD, and implant, respectively. Compared to White women, Black women had lower odds of initiating an IUD (aOR 0.81, 95% CI 0.74–0.89). Multiparous women had greater odds than nulliparous women of initiating an IUD (aOR 1.69, 95% CI 1.57–1.82) or implant (aOR 1.36, 95% 1.20–1.53). We found age was the strongest predictor of implant initiation (<18 versus≥35: aOR 3.26, 95% CI 2.26–4.71), but was not associated with IUD uptake. Gestational age was not associated with IUD or implant uptake. Implant uptake increased from 2.4% (2012) to 8.7% (2017) (aOR 3.65, 95% CI 2.36–5.65) while IUD uptake remained fairly constant. ConclusionAbout 25% of women chose to initiate intrauterine or implantable contraception immediately after surgical abortion when these methods are readily available. Implant uptake has increased significantly in recent years. Women who initiated IUDs and implants differed in their demographic and social profiles. ImplicationsWomen seeking surgical abortion should have same-day access to IUDs and implants. Clinicians and researchers should analyze IUD and implant initiation separately.

An Exploratory Analysis of Factors Associated With Interest in Postpartum Intrauterine Device Uptake Among Pregnant Women and Couples in Kigali, Rwanda.

Background:The desire to space or prevent future pregnancies is high among postpartum women in Rwanda. However, the use of long-acting reversible contraception (LARC), especially the highly effective and cost-effective copper intrauterine device (IUD), is very low, whereas the rates of unintended pregnancy are high. This study aims to identify factors associated with pregnant women’s and couple’s interest in receiving a postpartum intrauterine device (PPIUD) within 6 weeks after delivery.Methods:A total of 150 pregnant women or couples attending antenatal care (ANC) in Kigali, Rwanda participated in this cross-sectional study. After participating in a postpartum LARC counseling session, surveys assessed participants’ demographics, pregnancy experiences and desires, and PPIUD knowledge, attitudes, practices, and interest. Multivariable logistic regression was used to model factors associated PPIUD interest within 6 weeks postpartum.Results:Although only 3% of women had ever used an IUD previously, 124 (83%) women were interested in receiving a PPIUD after counseling. Self-reporting physical side effects (adjusted odds ratio [aOR], 0.21; 95% confidence interval [CI], 0.06-0.75) and infection (aOR, 0.19; 95% CI, 0.04-0.85) as disadvantages to the IUD were significantly associated with no interest in receiving a PPIUD. Interest did not differ by male involvement.Conclusion:Recommendations to increase PPIUD uptake include educating pregnant women and couples about the method during ANC and addressing client myths and misconceptions about the IUD. This strategy allows pregnant women and couples to make informed decisions about their future contraception use, reduce unmet need for family planning, and reduce unintended pregnancy.

Medicaid savings from the Contraceptive CHOICE Project: a cost-savings analysis

Forty-five percent of births in the United States are unintended, and the costs of unintended pregnancy and birth are substantial. Clinical and policy interventions that increase access to the most effective reversible contraceptive methods (intrauterine devices and contraceptive implants) have potential to generate significant cost savings. Evidence of cost savings for these interventions is needed. The purpose of this study was to conduct a cost-savings analysis of the Contraceptive CHOICE Project, which provided counseling and no-cost contraception, to demonstrate the value of investment in enhanced contraceptive care to the Missouri Medicaid program. The Contraceptive CHOICE Project was a prospective cohort study of 9256 reproductive-age women who were enrolled between 2007 and 2011. Study follow-up was completed October 2013. This analysis includes 5061 Contraceptive CHOICE Project participants who were current Missouri Medicaid beneficiaries or were uninsured and reported household incomes <201% of the federal poverty line. We created a simulated comparison group of women who were receiving care through the Missouri Title X program and modeled the contraception and pregnancy outcomes that would have occurred in the absence of the Contraceptive CHOICE Project. Data about contraceptive use for the comparison group (N=5061) were obtained from the Missouri Title X program and adjusted based on age, race, ethnicity, and income. To make an accurate comparison that would account for the difference in the 2 populations, we used our simulation model to estimate total Contraceptive CHOICE Project costs and total comparison group costs. We reported all costs in 2013 dollars to account for inflation. Among the Contraceptive CHOICE Project participants who were included, the uptake of intrauterine devices and implants was 76.1% compared with 4.8% among the comparison group. The estimated contraceptive cost for the simulated Contraceptive CHOICE Project group was $4.0 million vs $2.3 million for the comparison group. The estimated numbers of unintended pregnancies and births averted among the simulated Contraceptive CHOICE Project group compared with the comparison group were 927 and 483, respectively, which represented a savings in pregnancy and maternity care of $6.7 million. We estimated that the total cost savings for the state of Missouri attributable to the Contraceptive CHOICE Project was $5.0 million (40.7%) over the project duration. A program providing counseling and no-cost contraception yields substantial cost savings because of the increased uptake of highly effective contraception and consequent averted unintended pregnancy and birth.

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.

Effect of Knowledge of Self-removability of Intrauterine Contraceptives on Uptake, Continuation, and Satisfaction

ObjectivePreference for control over use is a consideration in choosing a contraceptive method. Counseling women on the possibility of intrauterine device (IUD) self-removal may increase interest in the method. This study tests whether counseling on self-removability as a stated feature of IUDs affects uptake, satisfaction, and continuation. Study DesignWe monitored clinic-level data on IUD uptake at clinics in Michigan, Missouri, New Jersey, and Utah over 6 months. During the first 3 months, counselors provided standard contraceptive counseling. During the second 3 months, they added information about IUD self-removal. Women who initiated IUD use in both periods were recruited and asked to complete baseline and follow up surveys at 3 and 6 months after insertion. Among 361 women who had IUDs inserted during the study, we compared outcomes for women who did and did not receive information about self-removability during contraceptive counseling. We conducted descriptive analyses to test for differences by group and used logistic regression and survival analysis to assess discontinuation. ResultsThere were no differences in IUD uptake, satisfaction, or discontinuation by receipt of self-removal information. Those who did not receive information about self-removal were more likely to report considering discontinuing use of the IUD. One-third of participants who considered discontinuation faced barriers to IUD removal. Knowledge of self-removability before the study was high in both groups, reducing our ability to find group differences. ConclusionsCounseling women on the possibility of self-removal may empower women when they face barriers to removal at facilities. More research is needed to understand whether knowledge of self-removal increases uptake and continuation.

Intrauterine device uptake among women seeking family planning services in Nairobi County, Kenya

Aims: The main objective of this study was to determine the uptake of the intrauterine device (IUD) among women seeking family planning (FP) services at Level 4 public hospitals in Nairobi County. Methods: This was a descriptive, cross-sectional study that used both quantitative and qualitative approaches. Interviewer-administered, semi-structured questionnaires, focus group discussions and key informant interviews were used to collect data. Sample size was 380 women with 100% response rate. Findings: The uptake of IUD was 7.9% (95% confidence interval (CI): 2.6–13.2%). The uptake increased with age, with those aged above 30 years using the device more compared with those aged below 30 years. Drivers of IUD uptake included: parity (adjusted odds ratio (aOR)=8.545 CI: 4.399–16.599%,P&lt;0.001), awareness of IUD provision in the facility (aOR=1.824, P=0.038) and a favourable perception of IUD (aOR=5.816, P&lt;0.001). The qualitative data from the focus group discussion included common myths such as: ‘IUD might travel to other body organs’ and ‘it spreads infection in the body’. Conclusion: Uptake is low in the two hospitals and more awareness should be created on IUD availability. Uptake should be encouraged among young women and those of lower parity.

Long-acting contraceptive placement among us army servicewomen

Objectives: We aimed to quantify the uptake of long-acting reversible contraceptive (LARC) methods — that is, intrauterine devices (IUD) and hormonal implants — among active-duty female soldiers in the US Army; and describe characteristics associated with LARC method uptake. Methods: We analyzed the Stanford Military Data Repository, which includes all digitally recorded health encounters for active-duty US Army soldiers from 2011 to 2014. We calculated percentages of soldiers receiving LARC methods and used multivariable logistic regression to test for associations between LARC method placement and diverse demographic and military characteristics. Results: Among 114,615 servicewomen aged 18–44 (median observation period 38 months, IQR, 30–47), 14.2% received a LARC method (8.5% IUDs, 6.4% implants). While annual IUD insertions were stable, implant insertions steadily increased between 2011 and 2014 (from 1468 to 2468/year). Implant uptake was more common among younger women: 44% of placements occurred among women younger than 23, compared with 22% of IUDs. Having had a child increased the likelihood of implant placement and more than doubled IUD placement (OR, 1.28; 95% CI, 1.18–1.38; OR, 2.20; 95% CI, 2.08–2.34, respectively). Married women were more likely to receive an IUD (OR, 1.60; 95% CI, 1.52–1.70), but marital status was not associated with implant placement. Conclusions: Uptake of contraceptive implants is increasing among women soldiers, while IUD uptake remains stable. Unmarried soldiers are less likely to receive IUDs and soldiers without children are less likely to receive either LARC method, suggesting a continued need for education about method safety and reversibility with the goal of preventing unintended pregnancies among women in the army.

The Tupange Project in Kenya: A Multifaceted Approach to Increasing Use of Long-Acting Reversible Contraceptives.

Long-acting reversible contraceptives (LARCs) are safe and highly effective, and they have higher continuation rates than short-acting methods. Because only a small percentage of sexually active women in Kenya use LARCs, the Tupange project implemented a multifaceted approach to increase uptake of LARCs, particularly among the urban poor. The project included on-site mentoring, whole-site orientation, commodity security, quality improvement, and multiple demand-promotion and service-provision strategies, in the context of wide method choice. We report on activities in Nairobi between July 2011 and December 2014, the project implementation period. We used a household longitudinal survey of women of reproductive age to measure changes in the contraceptive prevalence rate (CPR) and other family planning-related variables. At baseline in July 2010, 2,676 women were interviewed; about 50% were successfully tracked and interviewed at endline in December 2014. A baseline service delivery point (SDP) survey of 112 health facilities and 303 service providers was conducted in July 2011, and an endline SDP survey was conducted in December 2014 to measure facility-based interventions. The SDP baseline survey was conducted after the household survey, as facilities were selected based on where clients said they obtained services. The project led to significant increases in use of implants and intrauterine devices (IUDs). Uptake of implants increased by 6.5 percentage points, from 2.4% at baseline to 8.9% by endline, and uptake of IUDs increased by 2.1 percentage points, from 2.2% to 4.3%. By the endline survey, 37.7% of clients using pills and injectables at baseline had switched to LARCs. Contraceptive use among the poorest and poor wealth quintiles increased by 20.5 and 21.5 percentage points, respectively, from baseline to endline. Various myths and misconceptions reported about family planning methods declined significantly between baseline and endline. Training, commodity security, multiple service delivery models, and demand promotion were the cornerstones of a successful approach to reach the urban poor in Nairobi with LARCs.

Success Providing Postpartum Intrauterine Devices in Private-Sector Health Care Facilities in Nigeria: Factors Associated With Uptake.

Use of modern contraceptive methods in Nigeria remained at 10% between 2008 and 2013 despite substantive investments in family planning services. Many women in their first postpartum year, in particular, have an unmet need for family planning. We evaluated use of postpartum intrauterine device (IUD) insertion and determined factors associated with its uptake in Nigeria. Data were collected between May 2014 and February 2015 from 11 private health care facilities in 6 southern Nigerian states. Women attending antenatal care in participating facilities were counseled on all available contraceptive methods including the postpartum IUD. Data were abstracted from participating facility records and evaluated using a cross-sectional analysis. Categorical variables were calculated as proportions while continuous variables were calculated as medians with the associated interquartile range (IQR). Multivariate logistic regression analysis was used to identify factors associated with uptake of the postpartum IUD while controlling for potential confounding factors, including age, educational attainment, marital status, parity, number of living children, and previous use of contraception. During the study period, 728 women delivered in the 11 facilities. The median age was 28 years, and most women were educated (73% had completed at least the secondary level). The majority (96%) of the women reported they were married, and the median number of living children was 3 (IQR, 2-4). Uptake of the postpartum IUD was 41% (n = 300), with 8% (n = 25) of the acceptors experiencing expulsion of the IUD within 6 weeks post-insertion. After controlling for potential confounding factors, several characteristics were associated with greater likelihood of choosing the postpartum IUD, including lower education, having a higher number of living children, and being single. Women who had used contraceptives previously were less likely to choose the postpartum IUD than women who had not previously used contraception (adjusted odds ratio, 0.68; 95% confidence interval, 0.55 to 0.84). A high percentage (41%) of women delivering in private health care facilities in southern Nigeria accepted immediate postpartum IUD insertion. Scale-up of postpartum IUD services is a promising approach to increasing uptake of long-acting reversible contraceptives among women in Nigeria.