Rates of IUCD discontinuation and its associated factors among the clients of a social franchising network in Pakistan

BMC Womens Health. 2012 Mar 29;12:8. doi: 10.1186/1472-6874-12-8.

Abstract

Background: Modern Intrauterine contraceptive device (IUCD) is very safe, highly effective reversible and inexpensive family planning method which offers 5-10 years of protection against pregnancy. The contraceptive use in Pakistan has been merely 30% for over a decade with IUCD being the least used method. Higher discontinuation rates are documented in developing countries; however no such data is available for Pakistan. Marie Stopes Society (MSS) established a social franchise outlets network branded as 'SURAJ' (Sun) in Pakistan to provide quality family planning services. This study attempts to determine IUCD discontinuation rates and its associated risk factors. Using a semi-structured questionnaire, a cross-sectional study was conducted with 3000 clients who availed IUCD services from Suraj provider 6, 12 and 24 month back,. Data were analyzed in SPSS 17.0; adjusted prevalence ratios were calculated to see associations between discontinuation and its risk factors.

Case presentation: We found that 22.7% of the IUCD acceptors experienced some health problem; while the overall discontinuation rate was 18.9% with average time of usage of 7.4 (SD ± 5.8) months before discontinuation. Half of them showed health concerns (49.8%); of which a majority (70.2%) returned to Suraj provider for IUCD removal. Women living in Punjab, residing at a travelling time of 30-60 minutes and no previous use of contraceptive are more likely to discontinue IUCD. However, among total women 81.7% still expressed willingness to avail IUCD services from Suraj provider in future, if needed.

Conclusion: The findings suggest a need for training the providers and field workers to prevent early discontinuation of IUCD among the Suraj clients and by addressing the health concerns through proper counseling, continued follow-up and immediate medical aid/referral in case of complications.

MeSH terms

  • Adolescent
  • Adult
  • Cross-Sectional Studies
  • Device Removal / psychology
  • Device Removal / statistics & numerical data*
  • Family Planning Services / organization & administration*
  • Family Planning Services / trends
  • Female
  • Humans
  • Intrauterine Devices / adverse effects
  • Intrauterine Devices / statistics & numerical data*
  • Middle Aged
  • Organizational Case Studies
  • Pakistan
  • Patient Acceptance of Health Care / psychology
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Patient Satisfaction
  • Social Support
  • Surveys and Questionnaires
  • Time Factors
  • Young Adult