Factors influencing the likelihood of acceptance of postpartum intrauterine devices across four countries: India, Nepal, Sri Lanka, and Tanzania

Int J Gynaecol Obstet. 2018 Sep;143 Suppl 1:13-19. doi: 10.1002/ijgo.12599.

Abstract

Objective: To examine the factors that positively influenced the likelihood of accepting provision of postpartum intrauterine devices (PPIUDs) across four countries: Sri Lanka, Nepal, Tanzania, and India.

Methods: Healthcare providers were trained across 24 facilities in counselling and insertion of PPIUDs as part of a large multicountry study. Women delivered were asked to take part in a 15-minute face-to-face structured interview conducted by in-country data collection officers prior to discharge. Univariate analysis was performed to investigate factors associated with acceptance.

Results: From January 2016 to November 2017, 6477 health providers were trained, 239 033 deliveries occurred, and 219 242 interviews were conducted. Of those interviewed, 68% were counselled on family planning and 56% on PPIUD, with 20% consenting to PPIUD. Multiple counselling sessions was the only factor resulting in higher consent rates (OR 1.30-1.39) across all countries. Odds ratios for women's age, parity, and cadre of provider counselling varied between countries.

Conclusion: Consent for contraception, specifically PPIUD, is such a culturally specific topic and generalization across countries is not possible. When planning contraceptive policy changes, it is important to have an understanding of the sociocultural factors at play.

Keywords: Counselling; FIGO initiative; Family planning; LMICs; PPIUD; Postpartum contraception; Postpartum intrauterine device.

MeSH terms

  • Adult
  • Contraception / methods
  • Contraception / statistics & numerical data*
  • Contraceptive Agents / therapeutic use*
  • Counseling / statistics & numerical data
  • Family Planning Services / statistics & numerical data*
  • Female
  • Humans
  • India
  • Intrauterine Devices / statistics & numerical data*
  • Nepal
  • Postpartum Period / psychology*
  • Pregnancy
  • Sri Lanka
  • Tanzania
  • Young Adult

Substances

  • Contraceptive Agents