|Year : 2018 | Volume
| Issue : 2 | Page : 104-107
Awareness and utilization of postpartum intrauterine contraceptive device among postnatal women in Vijayapur
Anita Nath1, Archana Kulkarni1, Shubhashree Venkatesh1, Mohan Kumar2
1 Indian Institute of Public Health, Public Health Foundation of India, Bangalore, Karnataka, India
2 Padmashree School of Public Health, Bangalore, Karnataka, India
|Date of Submission||24-Apr-2018|
|Date of Acceptance||17-Jul-2018|
|Date of Web Publication||26-Dec-2018|
Dr. Anita Nath
Indian Institute of Public Health, Bengaluru Campus, Public Health Foundation of India, 1st Cross, Magadi Road, Bengaluru - 560 023, Karnataka
Source of Support: None, Conflict of Interest: None
BACKGROUND: A fair proportion of women face an unmet need for family planning during the 1st year following childbirth. The postpartum period is an optimal time for effective contraception as the new mother is more receptive to accept family planning.
OBJECTIVE: The objective of this study is to determine the awareness and utilization of postpartum intrauterine contraceptive device (PPIUCD) among postnatal women belonging to Vijayapur district in Northern Karnataka.
MATERIALS AND METHODS: This was a cross-sectional study conducted over the duration of 1 month among postnatal women admitted at Vijayapur district hospital.
RESULTS: Only 20% of the women were aware, 6% had accepted, and 17% were willing to accept. Most of the acceptors were younger in age, better educated, and primipara and had delivered male baby, although there was no statistical significance. A significant number of acceptors were from urban areas and had undergone cesarean section.
CONCLUSION: Awareness and acceptance of PPIUCD are extremely low. Concerted effort is needed to be boost the utilization rates of this effective and safe contraceptive during the postpartum period.
Keywords: Acceptability, contraception, device, intrauterine, postnatal, utilization
|How to cite this article:|
Nath A, Kulkarni A, Venkatesh S, Kumar M. Awareness and utilization of postpartum intrauterine contraceptive device among postnatal women in Vijayapur. BLDE Univ J Health Sci 2018;3:104-7
|How to cite this URL:|
Nath A, Kulkarni A, Venkatesh S, Kumar M. Awareness and utilization of postpartum intrauterine contraceptive device among postnatal women in Vijayapur. BLDE Univ J Health Sci [serial online] 2018 [cited 2019 Jun 24];3:104-7. Available from: http://www.bldeujournalhs.in/text.asp?2018/3/2/104/248544
India was the first country in the world to launch a family planning program in 1952, now known as Reproductive and Child Health (RCH) Program. This calls for steps to stabilize the growing population. Despite this fact, India still lags behind in practicing contraception and limiting the family size.
According to the National Family Health Survey-4, although total fertility rate (TFR) of Karnataka stands at 1.8 against the national TFR value of 2.4, there appears to be a steep decline in contraceptive use, from 63.6% in 2005–2006 to 51.8% in 2015–2016. It is estimated that 40% of women have an unmet need for contraception in the 1st year following childbirth.
The postpartum period is an optimal time for effective contraception as the new mother is more receptive to accept family planning. Moreover, postnatal visits offer an ideal time and setting for contraceptive counseling. The postpartum intrauterine contraceptive device (PPIUCD) was introduced under the second phase of RCH Program in the year 2010. It is being shown to be safe, effective, and convenient. The use of PPIUCD in the state of Karnataka is dismally low, wherein PPIUCD users account for 2.5% of all contraceptive users.
The present study was a pilot study done to determine the awareness and utilization of PPIUCD among postnatal women belonging to Vijayapur district in Northern Karnataka.
| Materials and Methods|| |
The study design was cross-sectional and was conducted over the duration of 1 month. The sample size consisted of postnatal women who were admitted to the district hospital of Vijayapur during the study period of 1 month. Only those women who had opted for sterilization were excluded from the study. As this was a pilot study, a sample size of 100 consecutive postnatal women was taken.
Ethical approval for this study was granted by the Institutional Ethical Committee (IEC) of the institution. Informed consent of the women who were willing to participate was obtained after explaining about purpose of the study and study procedures. Data were collected by the study investigators. Privacy and confidentiality of data were ensured. The filled questionnaires were kept in a secured closet at the study institute. Each patient was given a unique identification number which was used as a part of data management.
A semi-structured questionnaire translated into the local language was used for data collection. The questionnaire was prepared by means of a joint consensus among the study team members. It was validated among the first ten study participants. Data were entered into SPSS Version 16 software (Manufacturer: International Business Machines Corporation (IBM), Armonk, New York, United States). Descriptive statistics and Chi-square test were employed for data analysis.
| Results|| |
Sociodemographic profile of the study participants
Majority (68%) of the postnatal women were in the age group of 18–25 years, 67% were from rural area, 75% were Hindus, over one-third had completed metric school level, and 58% were working as agriculture laborer. This has been outlined in [Table 1].
|Table 1: Sociodemographic distribution and profile of acceptors of the respondents|
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Majority (61%) of the women were multipara and 91% of them had undergone a normal delivery. Most (52%) of them had delivered a female child.
Awareness about postpartum intrauterine contraceptive device
While majority (63%) of the postnatal women were aware about IUCD in general, only 20% of them were aware about PPIUCD. Among these, 80% belonged to the younger age group of 18–25 years. However, there was no statistical significance noted between age and other social characteristics such as rural/urban residence/religion, education level, occupation, and awareness level.
Postpartum intrauterine contraceptive device acceptance and willingness to accept
Only 6% of these women accepted PPIUCD insertion, while 17% were willing to accept the contraceptive device. Majority of the acceptors (83%) and those willing to accept (82%) were in the age group of 18–25 years. The proportion of acceptors was highest (50%) in those who had studied from 10th standard to PUC, but this was not statistically significant (χ2 = 0.345, d.f = 1, P > 0.05). Acceptance was significantly higher (66.7%) among women from urban areas (χ2 = 4.783, d.f = 1, P < 0.05). [Table 1] displays the profile of acceptors and those who were willing to accept. Majority of the acceptors (66.7%) had delivered a male child. The proportion of acceptors (39%) and those willing to accept (59%) was higher among primipara than multipara but not significant (χ2 = 0.846, d.f = 1, P > 0.05). The proportion of acceptors (44.5%) and those willing to accept (55.6%) was significantly higher among women who had undergone cesarean section (χ2 = 6.459, d.f = 1, P < 0.05) [Table 2].
|Table 2: Reasons for not wanting postpartum intrauterine contraceptive device and acceptability with type of delivery|
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Reasons for not wanting postpartum intrauterine contraceptive device
Among the 77 women who were not willing to accept PPIUCD, the most frequently quoted reasons were apprehension about using PPIUCD but willing for any other contraceptive method (64.5%), husband not willing (48%), and want for another child soon (42%). [Table 2] enlists the reasons cited for not wanting PPIUCD.
| Discussion|| |
While most of the studies pertaining to PPIUCD conducted in the Indian settings are clinic based and related to safety, efficacy, and acceptability among its users, there are limited data on awareness, acceptance, and reasons for nonacceptance; keeping this fact in mind, this study was conducted.
According to Census 2011, India with its population of 1210 million ranks second in the world. The last decade has seen India's population grow by 17.64%.
The present study was a pilot study conducted in a small sample of postnatal women to assess awareness and utilization of PPIUCD. While 63% of the women had a general awareness about IUCD, less than a quarter (20%) were aware about PPIUCD. This observation can be compared with study findings from a low-resource setting in Ghana, wherein a qualitative study revealed that a small number of pregnant and reproductive-aged women had ever heard about postpartum intrauterine device. A study done in India put forward the fact that only half of the women participants have ever heard about IUCD and only 7% had used one before counseling.
Acceptance profile of intrauterine contraceptive device among postpartum women
The rate of acceptability level of 6% was also extremely low when compared to a much higher acceptability rate of 24.5% among postnatal women from Kottayam and Uttar Pradesh (30.34%). This is comparable with an acceptability rate of 7% reported from a prospective cross-sectional study among 26,123 pregnant women, who were counseled for PPIUCD insertion in Hassan. The overall utilization rate of PPIUCD is 0.4% for Vijayapur district. Majority of the acceptors were young and from urban area which is in agreement with study reports from Telangana, wherein the mean age of acceptance was 23.70 ± 2.95 years and majority of them were from urban area (79.75%). In contrast to our study, findings from a study done in Udaipur, Rajasthan, observed that most of the acceptors hailed from rural area. Most (50%) of the acceptors in the present study were better educated (having completed metric to PUC). The Rajasthan study reports that a larger proportion of acceptors (40.3%) had completed primary education. Acceptability levels were higher among primiparous women and those with higher education, which is similar to the study findings from postnatal women in Kottayam. Lower acceptance among higher aged and multiparous women could be due to the widespread preference of sterilization as a family planning method in India. In a study, data collected from eight states of India reported that 87.6% women accepted PPIUCD as it was a long-acting method of contraception.
In the present study, 17% were willing to accept PPIUCD, which is comparable to another study done at an army hospital in Delhi, wherein 94 out of 500 (18.8%) pregnant women were motivated to get IUCD insertion done following delivery. However, in the Delhi study, out of the 94 women who were willing, only three (0.6%) got PPIUCD insertion done after delivery; in our study, we did not do a follow-up to determine if those who were willing to get PPIUCD inserted actually got it done. Kant et al. conducted a study in two PHCs and found that acceptance rate of PPIUCD was two times higher (48.6%) among women belonging to lower income family as compared to those from higher income families (26.1%). About 45.2% were among women with more than two children.
Reasons for willingness and nonwillingness for the use of intrauterine contraceptive device
A significantly higher proportion of women who had undergone cesarean section got PPIUCD insertion done which is analogous to the results from the Delhi study. This could be attributed to the quick and convenient intracesarean administration of IUCD which is mutually beneficial for both patient and health provider.
It is interesting to note that over two-third of acceptors had delivered a male child. While we cannot come to a definite conclusion that the nonacceptors who had delivered a female child might avoid contraceptive spacing in want for a male baby, nevertheless want for a male child has been frequently cited as a reason for not adopting contraception for spacing.,
The most common reasons given for not wanting PPIUCD included fear and apprehension about the method, husband not being willing, and want for another baby soon which is similar to those expressed in different studies., Nearly 22% of women said that the reason for acceptance was free-of-charge services for choosing IUCD.
| Conclusion|| |
The findings from this study indicate low levels of awareness and utilization of PPIUCD in the district.
Important highlights of the study
The present study highlights the need to strengthen information, education, and communication (IEC) activities and scale-up family planning services during the immediate postpartum period before discharge of women from the hospital to ensure contraceptive acceptance and its use among them. While majority of the acceptors in the present study were from urban area, better educated, and had undergone cesarean section, focus should be given to design specific motivational strategies for rural women and those who undergo normal deliveries. The rise of institutional deliveries in India provides an ideal platform to promote acceptance of PPIUCD. This would curb unwanted pregnancies which lead to unsafe abortion and contribute to maternal mortality. We recommend sustained efforts to increase awareness and motivation for contraceptive use.
The present study was a pilot study conducted on a small sample of women during a limited period of time without any follow-up, wherein nonprobability sampling method was used to include study participants. Subsequent to this, it is proposed to conduct a prospective study with a larger sample selected using stratified random sampling.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
New Delhi: Registrar General and Census Commissioner of India, Census of India; 2011. Available from: http://www.censusindia.gov.in/
. [Last accessed on 2017 Feb 04].
International Institute for Population Sciences. National Family Health Survey (NFHS-3) 2005-06. India, Mumbai: International Institute for Population Sciences; 2007.
Rossier C, Bradley SE, Ross J, Winfrey W. Reassessing unmet need for family planning in the postpartum period. Stud Fam Plann 2015;46:355-67.
Kapp N, Curtis KM. Intrauterine device insertion during the postpartum period: A systematic review. Contraception 2009;80:327-36.
Robinson N, Moshabela M, Owusu-Ansah L, Kapungu C, Geller S. Barriers to intrauterine device uptake in a rural setting in Ghana. Health Care Women Int 2016;37:197-215.
Kumar S, Sethi R, Balasubramaniam S, Charurat E, Lalchandani K, Semba R, et al.
Women's experience with postpartum intrauterine contraceptive device use in India. Reprod Health 2014;11:32.
Nisha S, Sathi MS, Vijayan CP. Post-placental insertion of IUCD in a tertiary care centre – Acceptance and safety. J Evol Med Dent Sci 2016;5:5933-8.
Tyagi S, Aditya V, Srivastava S, Gupta G. Changing trends in intrauterine contraceptive device: From interval intrauterine contraceptive device to postpartum intrauterine contraceptive device: A prospective observational study in a tertiary care hospital in Eastern Uttar Pradesh. Int J Reprod Contracept Obstet Gynecol 2016;5:2104-8.
Banapurmath ST, Dotard GB, Doreswamy N, Shymala. Feasibility of post partum insertion of intrauterine contraceptive device-expanding the use of intrauterine contraceptive device in post partum period – A cross sectional study in developing country, India. Int J Curr Res Rev 2014;6:38-48.
Jairaj S, Dayyala S. A cross sectional study on acceptability and safety of IUCD among postpartum mothers at tertiary care hospital, Telangana. J Clin Diagn Res 2016;10:LC01-4.
Barala S, Maheshwari S, Sharma P. Analysis of awareness, acceptance, safety and continuation rate of post placental and intra-caesarean insertion of intrauterine contraceptive device. Int J Rep Contracept Obstet Gynecol 2016;5:1974-80.
Kathpalia SK, Mustafa MS. Awareness about postpartum insertion of intrauterine device among antenatal cases. Med J Armed Forces India 2015;71:221-4.
Kant S, Archana S, Singh AK, Ahamed F, Haldar P. Acceptance rate, probability of follow-up, and expulsion of postpartum intrauterine contraceptive device offered at two primary health centers, North India. J Family Med Prim Care 2016;5:770-6.
] [Full text]
Khokhar A, Mehra M. Contraceptive use in women from a resettlement area in Delhi. Indian J Community Med 2005;30:21-3. [Full text]
Sambath S, Balasubramaniam T, Ilangovan S, Aravazhi M, Shanmuganathan S. Awareness of contraception and the reasons for having more than two children: A survey among antenatal women. Int J Reprod Contracept Obstet Gynecol 2016;5:959-61.
[Table 1], [Table 2]