Postpartum Intrauterine Contraceptive Device Research Articles

Pregnant mothers intention to use postpartum intrauterine contraceptive device and its associated factors in Arba Minch Town, Southern Ethiopia, 2022

IntroductionPostpartum intra-uterine device use contributes to the happiness and health of women, children, and families who are of reproductive age. Out of the 210 million pregnancies that happen worldwide each year, about 80 million are unintended. Increasing postpartum intrauterine contraceptive device intention can help reduce unplanned pregnancies and the incidence of abortion. Methodsa cross-sectional study was conducted in pregnant mother’s home from March to April 2022 to assess the intension to use PPIUCD and to identify factors. Through simple random selection, 482 pregnant women were surveyed using a pretested, structured questionnaire and in-person interviews. Four randomly selected Kebeles were involved in the study by using simple random sampling. The data was imported into Epi-data version 4.6.0.2 and then analysed using Stata version 14. Bivariate and multivariable logistic regressions were used to identify associated factors. Results482 pregnant women have participated in the study, and 98.5 % of them responded. 13.7 % (95 % CI: 11.0–17.0) of the participants stated that they planned to use an intra-uterine devices after giving birth. The intention to use a postpartum intrauterine contraceptive device had a significant association with the participants' educational level (AOR = 4.69; 95 % CI: 1.31–16.81), moderate level (AOR = 3.77; 95 % CI: 1.90–7.50), high knowledge (AOR = 4.82; 95 % CI: 1.96–11.87), and favorable attitude (AOR = 7.26; 95 % CI: 3.39–15.52), according to the results of the multivariable analysis. ConclusionIn Ethiopia, compared to earlier research, there was a decreased intention to use postpartum intrauterine contraceptive devices. Encouraging the use of postpartum intrauterine contraceptives for social and behavioural changes can be more effective.

Evaluation of Short-Term Complications of PPIUCD

Background: Postpartum intrauterine contraceptives device (PPIUCD) offers an effective means of providing contraceptive services to women in countries with high rates of unmet needs for family planning services. Scientific literature estimating the long-term retention rates is scarce. The complications following PPIUCD insertion at the three follow-up visits. The PPIUCD can be placed immediately following delivery of the placenta, during cesarean section or within 48 hours following childbirth. Objectives: The aim of the study was to assess the evaluation of short-term complications of Post-Partum Intrauterine Contraceptive Device (PPIUCD). Methods: This is a prospective observational study was conducted at Department of Obstetrics and Gynecology, Dhaka Medical College Hospital (DMCH). 360 eligible postpartum women were counselled for PPIUCD insertion. These women were also interviewed for their reasons for accepting and rejecting PPIUCD. After consent, Cu-T 380A insertion was done. Follow-up was done at 6 weeks or when reported with any complaint. Results: PPIUCD implantation was performed on 48 (13.3%) of 360 eligible counseled postpartum patients. Acceptance of PPIUCD was higher in the age range of 25 - 30 years (43.75%), women from middle socioeconomic status (58.3%), those with family support (75%), those who had previously had PPIUCD health counselling (70.8%), and multipara (68.75%). Missing thread (8.3%), lower abdomen pain (6.25%), and irregular per vaginal bleeding (4.2%) were the most prevalent problems. There was 86% continuation of IUCD, 8% discontinuance, 6% expulsion, and no occurrence of unintended pregnancy. Conclusion: The awareness about availability of PPIUCD is quite low because it is recently introduced in the family planning methods. The most common reason for refusal is disagreement between the husband and his family. Acceptance can be increased further by disseminating information and providing proper counseling in antenatal clinics.

Postpartum Intrauterine Contraceptive Device Perception among Antenatal Women Attending Private Obstetric Health-care Facility: A Study on Knowledge, Attitude, and Practices

Abstract Background: Postpartum intrauterine contraceptive device (PPIUCD) is a highly safe, effective, reliable, long-acting contraceptive used during the immediate postpartum period that promotes the health of mother and child by preventing health-related complications associated with closely spaced pregnancies. Methodology: The study was a cross-sectional observational study design. A total of 100 antenatal women registered at the hospital were questioned for data collection. Recruitment of the study population was done based on inclusion and exclusion criteria, and a prevalidated prestructured questionnaire was used. Informed consent was obtained, and answers were recorded on a case record form. Results: Majority (89.9%) of the women in the study were aware of some contraceptive methods. Only 39% were aware specifically regarding PPIUCD and only 2% had previously used it. Antenatal mother’s education was found to be remarkably associated with its usage. Conclusion: The data collected highlight that major proportion of antenatal women lacked knowledge regarding PPIUCD, had a resistant attitude toward it, and very few had ever used it, thus showing the excessive need to focus on PPIUCD literacy and awareness to fulfill the family planning needs of the community.

Knowledge and Practice regarding Post-Partum Intra-Uterine Contraceptive Device among Antenatal Women Attending AMDA Hospital, Jhapa

Introduction: Family planning was set up in 1936. It was at first known as the sex hygiene and birth regulation society. Intrauterine contraception is one of the most cost-effective methods of contraception. PPIUCD can be inserted in 48 hours postpartum, referred to here as postpartum intrauterine contraceptive device. Failure to plan a pregnancy can adversely affect the health of the family as a whole. High parity is related to increased maternal, perinatal and infant deaths and is associated with nutritional problems of both mother and child. Objectives: The aim of this study is to assess knowledge and practice regarding PPICUD among the Antenatal mothers attending AMDA Hospital, Damak, Jhapa. Methodology: A cross-sectional observational design was used for the study. One hundred sixty-four antenatal mothers will be taken in the study. Self-administered questionnaire and interview method used for the study. Data will be summarized using descriptive statistics and inferential statistics. Results: One hundred sixty-four antenatal mothers participated in the study, 121 antenatal mothers (73.8%) had moderate, 20 antenatal mothers (12.2%) had adequate and 23 antenatal mothers (14%) had inadequate knowledge. there was a significant association between knowledge with age, sex, religion, educational status, marital status, type of family, occupation, type of family, monthly income, parity, pervious source of information. Conclude: The study concludes that awareness and knowledge among antenatal mothers are high but the usage is low. Many educational and motivational activities are needed.

COMPARISON OF CONTINUATION OF POST-PLACENTAL INSERTION OF COPPER T AFTER CESAREAN SECTION AND NORMAL VAGINAL DELIVERY

Objective: The objective of this study was to assess the efficacy of post-placental copper T insertion following vaginal and cesarean delivery. Methods: This is a prospective study conducted for the period of 1 year on pregnant females undergoing deliveries at Department of Obstetrics and Gynecology, Sardar Patel Medical College and AGH, Bikaner. The total number of postpartum intrauterine contraceptive device inserted participants included in the study were 200, divided into two groups vaginal (group A) and lower segment cesarean section (LSCS) (group B) groups. Results: Mean age of the patients was 26.15±4.02 years. Most of the acceptors in both the groups were para-2 with 30% in vaginal group and 76% in LSCS group. The complaints at 6 weeks follow-up, in both groups, were similar, but the rate of removal was higher in vaginal group (9%) compared to LSCS group (2%). At 3 months follow-up, in vaginal group, the most common complaint was bleeding per vagina (PV) in 7.31% cases whereas missing thread 31.25% in LSCS group. Over a period of 3 months, the main reason for intrauterine contraceptive devices (IUCD) removal was bleeding PV in both group (six cases in vaginal group and three cases in LSCS group). Conclusion: Immediate post-partum insertion of IUCD appears to be safe and effective method of contraception.

Comparison of Complication of Postpartum Intrauterine Contraceptive Device With Interval Placed IUCD

For prevention of unintended and closed interval pregnancies through the first year following childbirth, postpartum family the planning is required. A wide range of reliable and cost-effective contraceptive methods are available for postpartum women. Objective: To compare the frequency of complications of postpartum intrauterine contraceptive device (PPIUCD) versus interval placed intrauterine contraceptive device (IUCD). Methods: It was a randomized control clinical trial which was conducted in Unit 3, Department of Obstetrics & Gynecology, Lady Willingdon Hospital, Lahore. The time period of this study was 6 months extending from January 2018 to June 2018. After fulfilling the inclusion criteria, 160 patients were enrolled in the study. These patients were followed up for time period of 6 months in both groups. The complications named perforation, pelvic infection and expulsion were noted. All the gathered information regarding variables was analyzed on SPSS version 20.0. Results: The mean age and gestational age of females of the PPIUCD group was 26.50±5.05 years and 38.94±1.42 weeks and interval IUCD group was 28.25±4.40 years and 39.08±1.29 weeks respectively. In this study the pelvic infection was noted in 8 females in which 2 were from PPIUCD group and 6 were from interval IUCD group. Statistically insignificant difference was found between the study groups with pelvic infection i.e. p-value=0.147.  Expulsion was noted in 1 female from PPIUCD group and 3 females from interval IUCD group. The difference was insignificant (p>0.05). Conclusions: There was no statistical difference found in frequency of complications with PPIUCD versus interval placed IUCD.

Knowledge and perception with intention in the selection of postpartum intrauterine contraceptive device in third trimester pregnant women

Family Planning Program was one strategy to reduce the risk of maternal death. The first year postpartum was the most important time for contraceptive use. The percentage of intrauterine contraceptive device(IUCD) usage was still low compared to other contraceptive methods. The aim of this study was to know the relationship of knowledge and perception with intention in the selection of postpartum intrauterine contraceptive device(PPICD) in third trimester pregnant women. This study was an analytic observational study with a cross-sectional design. The study was conducted in June 2022. Data for pregnant women in the third trimester of July 2021 - August 2021 at the Dadirejo Public Health Center are 72 people. This research uses total sampling. The research instrument is a questionnaire. Data analysis in this study was univariate, bivariate (Chi-square and likelihood) and multivariate (logistical regression) analysis. The proportion of postpartum contraceptive use was 52%. Knowledge level (p=0.000), perception (p=0.000) was related to the intention to use the PPIUCD. The variable that most influenced the intention to use the PPIUCD was the level of knowledge OR 15.315 (95% CI 3.337-69.4531; p=0.000). Knowledge level is the most dominant factor.

EFFICACY AND SAFETY OF INTRA CAESAREAN IUCD

The objective of this study was to evaluate the effectiveness and complications of post-partum intrauterine contraceptive device (PPIUCD) insertion during cesarean delivery. The study was conducted at Nishtar Medical Hospital from June to December 2022. A total of 150 women were included in the study. In the first phase, medical eligibility for the intervention was assessed, while in the second phase, WHO Medical Eligibility Criteria were evaluated. The IUCD was manually inserted after delivery with its string towards the cervix. The patients were followed up at 2 and 6 months. After 6 months, 9 (6%) cases reported abdominal pain, 22 (15%) had menorrhagia, and 23 (15.3%) had missed threads with the IUCD in place. None of the patients reported pregnancy or perforation of the uterus. After 6 months, 133 (88.6%) patients continued to use this method of contraception, while 9(6%) were lost to follow-up, 4 (2.6%) had the device removed due to complications, and 4 (2.6%) had spontaneous expulsion. The study concluded that PPIUCD is a safe and effective long-term contraceptive method. Clinicians should evaluate patients' eligibility for PPIUCD and counsel women on adopting this method.

To Determine the Frequency of Discontinuation of Post-Partum Intra Uterine Contraceptive Device (PPIUCD) within 3 Months and its Causes

To Determine the Frequency of Discontinuation of Post-Partum Intra Uterine Contraceptive Device (PPIUCD) within 3 Months and its Causes

Socio-Demographics and Contraceptive Acceptance of Women of Reproductive Age in Peshawar Pakistan: A Cross-sectional Study

Background: Delaying in the initiation of effective contraception in postpartum period and during lactation puts a woman at risk of rapid, repeat, and unintended pregnancy. Postpartum Intrauterine Contraceptive Device (PPIUD) insertion during a Caesarean section allows obstetrician to insert it under vision thus excluding any fear of perforating the uterus with major side effects that is bleeding and abdominal cramps being masked in the puerperium. The aim of the currents study was to investigate knowledge, attitude, and acceptance trends of contraception practices among women from Peshawar Pakistan. Methods: Current six-month duration (January 1,2019 to June 30, 2019) based cross-sectional study was conducted at Obstetrics and Gynecology Unit B, Lady Reading Hospital, Peshawar by following non-probability purposive sampling approach. Detailed socio-demographic and obstetric history was obtained from 316 women who were admitted for elective lower segment Caesarean section by informed ethical concern. The major socio-demographic details collected from the study participants may include age, education level and number of total pregnancies conceived. Further, profession and duration from last childbirth related factor were compared with the knowledge and acceptance rates of intra-uterine postpartum contraception by using Chi-Square test. Further data analysis was made by using SPSS v. 20 and Microsoft office 2010 different tools. Results: Out of 316 participants, only 22 (6.96%) women accepted PPIUCD during Caesarean section. The mean age of participants was 33.26 ± 5.1 SD. About 243 (76.89%) cases had no normal schooling, 15 (4.7%) had primary education, 57 (18%) had secondary and only 1 (0.3%) had higher education. Similarly, 294 (93%) were housewives while only 22 (7%) were employed at work., no significant difference was noted among the acceptance of the different age groups. Conclusion: The uptake of PPIUCD is very low as observed in this study. To improve the situation, health authorities should be encouraged to provide counseling on postpartum contraceptive methods during ante- and post-partum care visits.

The Acceptance of Postpartum Intrauterine Contraceptive Devices Among Women Who Receive Focused Family Planning Counseling in the Antenatal Period Compared to Those Who Receive Routine Counseling: A Randomized Controlled Trial.

Background and objective Unplanned pregnancies are very common in the postpartum period, and they often lead to negative outcomes such as abortion, low-birth-weight neonates, early delivery, postpartum bleeding, and fetal mortality. In the first 12 months after delivery, closely spaced and unintentional pregnancies can be prevented with postpartum contraception. The postpartum intrauterine contraceptive device(PPIUCD) is a method of family planning that may be used during the first few weeks after giving birth, and it is highly successful, reliable, affordable, non-hormonal, immediately reversible, long-acting, and does not interfere with lactation. Urban and educated women are largely aware of IUCD and its benefits, but the proportion of these women who use them is still small. In light of this, this study aimed to assess if providing focused antenatal counseling led to a greaterpostpartum IUCD acceptance ratewhen compared to routine counseling. Method We conducted arandomized controlled trial in the Department of Obstetrics and Gynaecology of a tertiary care center from January 2021 to December 2022. Based on the inclusion and exclusion criteria, 220 women were enrolled and were classified into two groups. Group A comprised 110 women (the focused counseling group) who received focused postpartum family planning (PPFP) counseling, and Group B consisted of the control group involving 110 women who received routine counseling. Results In both groups, the women who inserted IUCD were mostly gravida 2. Additionally, willingness to use IUCD was shown by 68% of women in the focused counseling group and 58% of women in the routine counseling group, and PPIUCD was accepted by 22% of women in the focused counseling group and 9% of women in the routine counseling group. Post-placental insertion was carried out in 18 (75%) cases in the focused counseling groupand seven (70%) cases in the routine counseling group. Extended postpartum insertion (insertion within one year of delivery) was carried out in six (25%) cases in the focused counseling group and three (30%) cases in the routine counseling group. The most common reasons for the refusal were a preference for tubal ligation (TL) and afear of side effects. When the patients were enquired about their contraceptive use over the past yearon telephone conversations after one year of delivery, it was observed that 21.81% inserted PPIUCD, 30% used injectable depot-medroxyprogesterone acetate (DMPA), 13.63% had undergone TL, 11.81% used barrier contraception, while 22.72% did not use any contraception in the focussed counseling group. In the routine counseling group, 16.36% of women inserted PPIUCD, 20% used injectable DMPA, 12.72% underwent TL, 18.18% used barrier contraception, and 32.72% did not use any contraception. Conclusion Although PPIUCD is a long-acting reversible contraceptive that is safe and reliable, only a few women choose it as a method of birth control. This may be due to ignorance, misconceptions, and worries/fears about potential difficulties/adverse effects associated with IUCD insertion. The IUCD stigma mostly results from misconceptions about the fear of complications. Hence, we recommend that proper IUCD counseling be provided during antenatal care visits to dispel misunderstandings and concerns regarding potential complications associated with PPIUCD insertion.

Effect of the timing of insertion of postpartum intrauterine contraceptive device (PPIUCD) copper T380A on expulsion rates.

Postpartum intrauterine contraceptive device (PPIUCD) is well accepted and recommended for contraception. However, anxiety at the time of delivery may restrict the acceptance of a PPIUCD for its immediate insertion. So far there is limited evidence to conclude anything concrete on the association between the expulsion rates and the timing of insertion following a vaginal delivery. Thus, this study was undertaken to compare the expulsion rates in immediate and early insertions and their safety and complications. This prospective comparative study was carried out over 17 months on women delivering vaginally in a tertiary care teaching hospital in South India. A copper device (CuT380A) was inserted using Kelly's placental forceps either within 10 min of placental delivery (immediate group, n=160) or between 10 min upto 48 h postpartum (early group, n=160). Ultrasound was done before discharge from the hospital. The expulsion rates and any other complications at six-week and three-month follow up were studied. Chi-square test was used to compare the difference in expulsion rates. The expulsion rate was five per cent in the immediate compared to 3.7 per cent in the early group (no significant difference). In ten cases, the device was found to be in the lower uterus upon ultrasound before discharge. These were repositioned. There was no case with perforation, irregular bleeding or infection up to the three-month follow up. Higher age, higher parity, lack of satisfaction and motivation to continue were predictors of expulsion. In the present study PPIUCD was found to be safe with overall expulsion in 4.3 per cent. It was marginally, though not significantly, higher in the immediate group.

Awareness and Acceptance of Post-Partum Intrauterine Contraceptive Device Insertion (PPIUCD) among Patients Attending a Tertiary Care Hospital Karachi

Background: The knowledge, awareness and acceptance regarding contraceptives are variable in different parts of world. Family planning is still considered a stigma in most parts of the world. Contraceptive use for family planning is a key to understand the profound changes in fertility and to improve reproductive health worldwide. Objective: To evaluate the awareness and acceptance of the post-partum intrauterine contraceptive Device Insertion (PPIUCD) among the pregnant women visiting the Outdoor Department of Obstetrics and Gynecology in a tertiary care Hospital Malir Cantt Karachi. Study design and setting: A cross sectional study was conducted during the period January 2022- June 2022. Material and Methods: This cross sectional study was conducted at the Tertiary care Hospital, Malir cantt, Karachi, for six months from (January 2022-June 2022) Data were collected using interviewer administered structured questionnaire was filled after the informed consent. The inclusion criteria: were the women agreed to participate the study and agreed to fill the questionnaires Urdu version, who visited outdoor department. The exclusion criteria were the women who refuse to ill the questionnaire. Results: This study shows the acceptance rate of PPIUCD is 12% of 200 women who participated this study. The commonest reasons for their denial were the inadequate information or knowledge of PPIUCD. The acceptance rate of PPIUCD was associated with their awareness and the long term effectiveness. Women who have completed their secondary or higher education were more informed and accepted than uneducated women. (AOR = 3, CI = 11.81, 53.91). The age group ranging from 25-30 years showed positive acceptance for PPIUCD. Conclusion: The rate of acceptance for postpartum intrauterine contraceptive device turns out to be low in this study, though this is an effective and safe method of postpartum family planning. The perceived concerns and fears about the PPIUCD are due to lack of awareness regarding its use among women attending the antenatal clinics. Keywords: PPIUCD, Contraception, Postpartum FP, awareness.

Use of postpartum intrauterine contraceptive device among women in northern Uganda: A cross‐sectional study

AbstractIntroductionThe aim of this study was to determine the prevalence and factors associated with postpartum intrauterine contraceptive device use among postpartum mothers in Lira district, northern Uganda.MethodsWe designed a cross‐sectional study among postpartum mothers with the outcome as postpartum intrauterine contraceptive device use defined as the insertion of an intrauterine contraceptive device within 10 min to 48 h following placental delivery. Data were collected using a researcher‐administered structured questionnaire. We descriptively summarized numerical data using the mean and the standard deviation and categorical data using frequency and percentages. We performed bivariate analysis using either the χ2 test or Fisher's exact test, and determined factors associated with the outcome using binary logistic regression analysis at a 5% level of statistical significance. We reported the results as adjusted odds ratio (aOR) and 95% confidence interval (CI).ResultsOf 384 postpartum women studied, 37 (9.6%) had used a postpartum intrauterine contraceptive device and the associated factors included maternal age <35 years with an aOR of 0.12 (95% CI: 0.02, 0.72), parity ≥3 with aOR of 4.25 (95% CI: 1.79, 11.03), at least secondary level of education with aOR of 0.27 (95% CI: 0.07, 0.92) and knowledge of adverse effects of a postpartum intrauterine contraceptive device with aOR of 9.56 (95% CI: 4.13, 24.36).ConclusionsThe prevalence of postpartum intrauterine contraceptive device use is low in this setting. Interventions to improve the use of a postpartum intrauterine contraceptive device such as health education should target younger and multiparous women including those without adequate knowledge about it.

Acceptance, safety and efficacy of postpartum intrauterine contraceptive device.

Postpartum intrauterine contraceptive device (PPIUCD) is safe method of contraception, but with low acceptability rate. Factors that govern acceptability needs to be addressed for increasing its rate. This study was done to assess the acceptance, efficiency, and complications of PPIUCD in tertiary centre of Jharkhand, India. This prospective study included antenatal women >34 weeks of gestational age who attended antenatal women in the department of Obstetrics and Gynaecology between 1st January 2020 to 1st September 2020. Details related to age, parity, education, awareness of PPIUCD, reasons for acceptance/refusal of PPIUCD were recorded. The types of insertion were postplacental, postcaesarean, and postabortal. Postinsertion counselling was done for PPIUCD, and women were followed-up at 6 weeks and 10 weeks for assessing complications. The overall acceptance rate was 36.23% (n = 100). The main reasons for rejecting the use of PPIUCD included fear of pain, bleeding, and other complications (59.09%) and COVID-19 (10.23%). In majority (80%), type of insertion was postplacental with postcaesarean in 18% and postabortal in 2%. Complications were present in 14% women that included abdominal pain (8%), heavy menstrual bleeding (6%), infection (4%), thread not visible (1%), and IUCD not located by USG or X-ray (1%). At 6 months, expulsion occurred in 2 women. There was no significant association of age (P = 0.312), religion (P = 1), tribal/non-tribal (P = 1), education level (P = 0.628), and type of insertion (P = 0.356) with complications. At 1 year of follow up, none of the women conceived again showing the efficacy to be 100% as a contraceptive. In spite of limited awareness, PPIUCD proved to be an effective and safe method of long-acting reversible contraception. However, it had low rate of acceptability. PPIUCD was related to lesser complications as expulsion occurred in only 2 women at 6 months. Factors such as age, religion, tribal/non-tribal, education level, and type of insertion were not associated with acceptability rate. PPIUCD was 100% effective as a contraceptive.

Acceptance, utilization, and factors associated with immediate postpartum intrauterine contraceptive device among mothers delivered at public health facilities in Hawassa city, Ethiopia: Institution-based study

BackgroundImmediate postpartum intra-uterine contraceptive device (IPPIUCD) placement within 10 min after the expulsion of the placenta following vaginal delivery is a safe and effective method when provided after comprehensive counseling. Studies on its acceptance and utilization are scarce in the study area. This study aims to assess the acceptance and utilization of IPPIUCD.MethodsA cross-sectional study was conducted from January 1st up to February 31st, 2020, among 392 mothers who delivered at public health facilities in Hawassa city. EPI-Data version 7.2 was used for data entry and STATA 14 for analysis. Data were collected using an interviewer administered structured questionnaire. A binary logistic regression and a multivariable logistic regression model were used to assess association. Statistical significance was determined at a p-value of less than 0.05 with a 95% confidence interval.ResultsOf the 392 mothers enrolled, 16.3% (95% CI: 12.7–20.0) of them accepted immediate post-partum IUCD. However, only 10% (95%CI: 7.0, 12.9) utilized immediate post-partum IUCD. Counseling about IPPIUCD, Attitude, plan to have another child, and birth intervals were associated with acceptance of immediate PPIUCD while husband support for family planning use, delivery time, and the number of children had a significant association with utilization of immediate PPIUCD.ConclusionsThe study found a relatively low proportion of acceptors and utilizers of immediate post-partum IUCD in the study area. To improve the acceptance and utilization of immediate PPIUCD among mothers, all stakeholders concerned with family planning need to mitigate and promote the challenges and facilitating factors, respectively.

Study of acceptability for the use of postpartum intrauterine contraceptive device among women attending government general hospital, Guntur

Study of acceptability for the use of postpartum intrauterine contraceptive device among women attending government general hospital, Guntur

Factors associated with knowledge of the postpartum intrauterine contraceptive device and attitude towards its use among women attending antenatal care at Debre Tabor town, Northwest Ethiopia, 2021: a cross-sectional study

BackgroundIntrauterine contraceptive device is a highly effective, long-acting, reversible family planning method that is safe to use by most postpartum women including those who are breastfeeding. Family planning methods used mainly, the postpartum intrauterine contraceptive device can tackle unintended pregnancy, short birth intervals, and pregnancy-related maternal death. Knowledge and attitude about the postpartum intrauterine contraceptive device were significant predictors of subsequent method use. However, the magnitude, Knowledge, and attitude toward intrauterine contraceptive device is still low in Ethiopia. Nevertheless, limited studies were done to assess Knowledge and attitude toward the postpartum intrauterine contraceptive device and their associated factors. Therefore, this study aimed to assess Knowledge, Attitudes, and associated factors toward postpartum intrauterine contraceptive devices.ObjectiveThis study aimed to assess Knowledge, Attitudes, and associated factors toward postpartum intrauterine contraceptive devices among pregnant women attending antenatal care at Debre tabor town public health institutions Northwest Ethiopia, 2021.Methodsan institutional-based cross-sectional study was conducted from March 1- April–30/2021. Four hundred twenty-three participants were recruited by using a systematic random sampling technique. The data were collected through face-to-face interviews using a pretested and structured questionnaire. Multivariable logistic regression analyses were computed to identify factors associated with the outcome variable. An adjusted odds ratio with a 95% confidence interval was computed to determine the level of significance.ResultsKnowledge and attitude towards postpartum intrauterine contraceptive devices were found to be 36 and 48.7% respectively. Government employee (AOR = 4.98,95%CI:2.79–8.91), student (AOR = 5.29,95%CI:1.29–21.80), urban residence (AOR = 1.9095%CI: 1.02–3.53) and ever discussed on a postpartum intrauterine contraceptive device with health care provider (AOR = 6.01,95%CI:3.70–.7.44) were associated with the knowledge about the postpartum intrauterine contraceptive device. Attained secondary education (AOR = 3.22, 95%CI: 1.41–7.31), attended college and above education (AOR = 3.62, 95%CI: 1.75–7.51), government-employee (AOR = 2.76, 95CI:1.11–6.81), student (AOR = 32.10, 95%CI: 3.22–44.79), good knowledge,(AOR = 13.72, 95%CI: 6.63–28.42), ever discussed on a postpartum intrauterine contraceptive device with health care provider (AOR = 2.24,95CI:1.18–4.24), were associated with attitude toward postpartum intrauterine contraceptive device.Conclusion and recommendationknowledge and positive attitude toward postpartum intrauterine contraceptive devices were low as compared with other studies. Mothers’ employment status, residence, and discussions about a postpartum intrauterine contraceptive device with healthcare providers improve women’s knowledge about the postpartum intrauterine contraceptive device. Maternal educational status, occupational status, ever discussed postpartum intrauterine contraceptive devices with a health care provider and several antenatal cares follow up were improves women’s attitude towards the postpartum intrauterine contraceptive device. The finding highlights the importance of discussing postpartum intrauterine contraceptive devices during pregnancy, which in turn enhances the knowledge and attitude, of mothers about postpartum intrauterine contraceptive devices.

Immediate postpartum intrauterine contraceptive device use among pregnant women attending antenatal clinics in Jimma town public healthcare facilities, Ethiopia: Intentions and barriers.

This study aimed to assess the intention and barriers to the use of immediate postpartum intrauterine contraceptive devices among pregnant women attending antenatal clinics in Jimma town public healthcare facilities, southwest Ethiopia. A facility-based cross-sectional study design was conducted from 1 September to 30 October 2020 by using a systematic sampling technique. Data were entered into Epi-data 3.1 version and exported to Statistical Package for Social Sciences 23 for analysis. A binary logistic regression analysis was done to sort candidate variables for multiple logistic regression, and multivariable logistic regressions were done to identify factors associated with the intention to postpartum intrauterine contraceptive devices. Factors associated with intention to use immediate postpartum intrauterine contraceptive device declared at 95% confidence interval. This study finding showed that 37.6% (95% confidence interval (31.5, 43.7)) of pregnant women intended to use the immediate postpartum intrauterine contraceptive device after their delivery. The main reason women refused to use immediate postpartum intrauterine contraceptive devices was being satisfied with other methods to use after they gave birth (27.5 %), the concern of health harm (22.2%), and the fear of impaired future fertility (16.4%). The identified factors that were statically significant with the intention to use immediate postpartum intrauterine contraceptive devices among pregnant women were included: attended secondary education (adjusted odd ratio = 2.36; p = 0.03; 95% confidence interval (1.089, 5.128)), attended college and above (adjusted odd ratio = 2.99; p = 0.020; 95% confidence interval (1.189, 7.541)), have high knowledge on immediate postpartum intrauterine contraceptive devices ((adjusted odd ratio = 2.10; p = 0.006; 95% confidence interval (1.236, 3.564)), the previous history of LACM used (adjusted odd ratio = 6.85; p = 0.0001; 95% confidence interval (3.560, 10.021)), parity >4 (adjusted odd ratio = 1.86; p = 0.043; 95% confidence interval (3.99, 8.703)). The intention of pregnant women to use after they gave birth in the study area was low. Maternal educational level, high knowledge, history of previous long-acting contraceptive methods use, and parity were significantly associated with pregnant women's intention to use immediate postpartum intrauterine contraceptive devices. Healthcare providers should focus on delivering crucial information about immediate postpartum intrauterine contraceptive device benefits for postpartum women, particularly concerning reducing barriers during antenatal care follow-up as they plan to use it after their delivery.

Acceptability, Safety and Compliance of Copper T 380A as a Postpartum Intrauterine Contraceptive Device Inserted via Vaginal or Intracaesarean Route: A Cohort Study

Introduction: Considering the high unmet need for family planning in India, especially in postpartum mothers, there is a necessity for reliable, long-term, highly efficacious, safe and reversible contraception like Intrauterine Device (IUD) in these women. Copper T 380A (CuT 380A) as a Postpartum Intrauterine Contraceptive Device (PPIUCD) can reduce maternal and perinatal mortality by decreasing unintended and closely spaced pregnancies in the postpartum period. Despite many advantages, the acceptability and utilisation of PPIUCD still remain very low due to lack of information about it. Aim: To determine the acceptance, safety, and efficacy of Copper T 380A; its association with socio-demographic factors and to compare the clinical outcomes between vaginal and intracaesarean insertions of this device. Materials and Methods: A hospital-based prospective cohort study was conducted in the Department of Obstetrics and Gynaecology, RG Kar Medical College and Hospital, Kolkata, India, from February 2021 to July 2021 among the cohort of 210 consecutive eligible postpartum mothers delivered either vaginally or by caesarean section. Primarily, acceptance rate was assessed. Postinsertion follow-up was done till six months after delivery to note various clinical outcomes and complications measuring safety of the device in terms of cramping pain abdomen, irregular vaginal bleeding, abnormal vaginal discharge, string problems, and perforation; compliance in terms of pregnancy and expulsion; and continuation of the device. All the follow-up results were compared between two modes of insertions. Comparison between categorical variables was done by Chi-square test. Results: Out of 210 counselled mothers, Copper T 380A insertions were done in 178 (84.8%) postpartum mothers. The acceptance rate was slightly higher in intracaesarean group (n=87, 85.3%). The mean±Standard Deviation (SD) age of acceptance of IUCD in partcipants was 25.59±4.06 years with the highest rate observed in the age group of 21-25 years (n=82, 46.1%). Acceptance of the device was significantly associated with multipara and the clients completed primary education (p-value <0.05). On follow-up, overall complications are low. No case of perforation was reported. Significantly higher incidences of abnormal vaginal bleeding, foul smelling vaginal discharge, string problems, and expulsions were observed in the vaginal group (p-value <0.05). Pregnancy was recorded in five (5.5%) clients and all of them were in the vaginal group. Out of 178 acceptors, compliance-continuation of the device was shown by 151 (84.8%), with significantly higher in the caesarean group (p-value <0.000051). A significantly higher continuation rate was observed among the clients of low socio-economic status (p-value <0.000207). Abdominal pain (33.33%) was reported to be the most common reason for discontinuation of Copper T 380A. Conclusion: Regardless of the mode of delivery, Copper T 380A is quite an acceptable, safe, effective, and convenient contraceptive method with a good continuation rate in the immediate postpartum period.