Postplacental Placement of Intrauterine Devices: Acceptability, Reasons for Refusal and Proposals to Increase its Use

Abstract

Objective To evaluate the acceptability of postplacental placement of intrauterine devices (PPIUD), reasons for refusal and suggested policies to increase its use. Methods Cross-sectional study conducted at the Women Hospital of the Universidade de Campinas, Campinas, SP, Brazil. Postplacental placement of intrauterine devices was offered to women admitted in labor who did not present infections, uterine malformation, twin pregnancy, preterm birth, and were at least 18 years old. In case of refusal, the parturient was asked to give their reasons and the answers were classified as misinformation about contraception or other reasons. The following were considered misinformation: fear of pain, bleeding, contraception failure and future infertility. Bivariate analysis was performed. Results Amongst 241 invited women, the refusal rate was of 41.9%. Misinformation corresponded to 50.5% of all refusals, and the reasons were: fear of pain (39.9%); fear of contraception failure (4.9%); fear of bleeding (3.9%); fear of future infertility (1.9%); other reasons for refusal were 49.5%. Parturients aged between 18 and 27 years old refused the PPIUD more frequently due to misinformation (67.4%), and older parturients (between 28 and 43 years old) refused frequently due to other reasons (63.6%) (p = 0.002). The mean age of those who declined the PPIUD due to misinformation was 27.3 ± 6.4 years old, while those who declined for other reasons had a mean age of 29.9 ± 5.9 years old (p = 0.017). Conclusion The refusal of the PPIUD was high, especially amongst young women and due to misinformation. It is necessary to develop educative measures during antenatal care to counsel women about contraception, reproductive health and consequences of unintended pregnancy.

Knowledge, Attitude, and Practice of Brazilian Physicians about Immediate Postpartum and Postabortion Intrauterine Device Insertion

“… 29 According to a Brazilian study conducted in a public hospital in Campinas, 42% of 242 women refused the offer for free IPP-IUD insertion, and the most important reason was misinformation related to fear of pain, method failure, increased menstrual bleeding, and effects of IUDs on future fertility. 30 Education about the method during prenatal care can significantly increase women's decision to insert IPP-IUD. 31 On the other hand, research indicates that physicians are the greatest source of influence on women's attitude about and choice of contraceptive methods.…”

Immediate Postpartum Insertion of Copper Intrauterine Device in a Brazilian University Hospital: Expulsion and Continuation Rates

“… 5 On the other hand, in view of the available scientific evidence, the postpartum insertion of an IUD is a safe practice with few contraindications and many benefits that can be routinely offered to women, including adolescents. 8 9 However, few studies 15 16 17 18 19 have evaluated the results of this practice in Brazilian public maternities. Thus, our objective was to evaluate the expulsion and continuation rates of copper IUDs inserted in the immediate postpartum period in a Brazilian public university hospital.…”