A retrospective analysis on acceptability and complications of PPIUCD insertion

Abstract

Background: In India, 65% of women in the first year postpartum have an unmet need for family planning but only 26% of women are using any method of family planning during the first year postpartum. This leaves a huge gap which needs to be addressed if maternal health is to be optimized. This calls for a method which is both effective and acceptable immediately post-partum. This is where the role of PPIUCD needs to be studied.Methods: This study was a retrospective observational study conducted in a tertiary care hospital. All deliveries during the time period from September 2016 to August 2017 were included in the study and the women accepting PPIUCD were studied for analysed for their age, parity, booking status and complaints during the follow up visit.Results: A total of 13,039 deliveries took place in one year between Sept 2016 to Aug 2017 out of which, 1118 (8.6%) accepted PPIUCD as a method of contraception. 44.3% PPIUCD users were in the age group of 21-25 years. 57% of PPIUCD users were primigravidas. 84% of PPIUCD users were booked cases. Missing threads was the most common complication, with 8.4% patients reporting it at follow up. There were no major complications noted in the study.Conclusions: PPIUCD is a safe and effective long acting reversible contraception method. Is particularly beneficial in a setting where women do not return for contraceptive advice. With low expulsion rates and high continuation rate, authors can conclude that PPIUCD can be the solution to a country like India currently facing population crisis and high unmet need.

Facilitators and barriers in acceptance of postpartum intrauterine contraceptive devices in Bihar

“…One-third of maternal mortality and 10% of child mortality can be decreased if the spacing between the two pregnancies is more than 2 years 1 and PPIUCD is the way to go for achieving spacing in a reversible fashion. Women preferred this method due to sufficiently long duration 4,13,16,18,19,26 of action for meant for spacing between births as per some studies. Many studies suggested that women being motivated and being aware with the use of proper counselling was a major reason for acceptance of this method.…”

“…Many studies suggested that women being motivated and being aware with the use of proper counselling was a major reason for acceptance of this method. [4][5][6][7][8][9][10][11][12][13][14]28 A few other studies showed that women were more accepting of this method because of its safety and efficacy, 7,[13][14][15][16][17][18][19][20][21][22] and some preferred it due to availability of trained service providers. 6,11,12,23 In this study, women who were currently using PPIUCD were satisfied with the method due to its safety, efficacy, reversibility, husband's approval, long duration of action, awareness, incentivization and proper training to ASHAs/ANMs.…”

“…In 2018-19, out of total PPIUCD users, two-third users were reported in 6 states-West Bengal (16.9%), Uttar Pradesh (13.5%), Rajasthan (10.3%), Madhya Pradesh (10.1%), Tamil Nadu (8.1%) and Bihar (7.9%) whereas one-third reported in remaining 23 states and 7 UT. 3 Studies conducted suggest that reasons for acceptance as appropriate and detailed counseling, 4,5 motivation, 6,7 awareness, 4,[8][9][10][11][12][13] safety and effectiveness 7,[13][14][15][16][17][18][19][20][21][22] and availability of trained service providers. 6,11,12,23 Some studies concentrated on counselling during ANC visits 10,13,24,25 and counselling of spouse and family members 9,13,16 whereas, others preferred this method due to sufficiently long duration 4,13,16,18,19,26 of action for meant for spacing between births.…”

“…3 Studies conducted suggest that reasons for acceptance as appropriate and detailed counseling, 4,5 motivation, 6,7 awareness, 4,[8][9][10][11][12][13] safety and effectiveness 7,[13][14][15][16][17][18][19][20][21][22] and availability of trained service providers. 6,11,12,23 Some studies concentrated on counselling during ANC visits 10,13,24,25 and counselling of spouse and family members 9,13,16 whereas, others preferred this method due to sufficiently long duration 4,13,16,18,19,26 of action for meant for spacing between births. Few studies also suggested that PPIUCD being cost effective 7,18 is another reason for its acceptance while one of the studies said that incentivization to motivator 10 is a reason for acceptance.…”

Factors Affecting Post Placental Intra-Uterine Contraceptive Device Insertion Rate

“…Different studies have recorded rates as low as 8% to as high as 50%. [14][15][16][17][18] A low acceptance rate (8.2%) has been recorded by Prabha et al 14 In a study conducted by Kachan Rani, 15 high rate (51.6%) of acceptance of PPIUCD was found. An acceptance rate ranging between 43.8 -50% has been mentioned in a research work done by Rajuan Doley et al 18 The rate (24.36%) of PPIUCD insertion recorded in our study lies midway between above mentioned studies.…”