An all time low utilization of intrauterine contraceptive device as a birth spacing method- a qualitative descriptive study in district Rawalpindi, Pakistan

Abstract

BackgroundPakistan was among the leading countries in south Asia which started the family planning program in late 50s, forecasting the need to control the population. Despite this early intervention, fertility rate has declined but slower in Pakistan as compared to most other Asian countries. Pakistan has almost a stagnant contraceptive prevalence rate for more than a decade now, perhaps owing to the inadequate performance of the family planning programs. The provision and use of long term contraceptives such as IUCD has always been low (around 2%) and associated with numerous issues. Married women who want to wait before having another child, or end childbearing altogether, are not using any long term method of contraception.MethodologyA descriptive qualitative study was conducted from May to July 2012, to explore and understand the perceptions of women regarding the use of IUCDs and to understand the challenges/issues at the service provider’s end. Six FGDs with community women and 12 in-depth interviews were conducted with family planning providers. The data was analyzed using the Qualitative Content Analysis approach.ResultsThe study revealed that the family planning clients are reluctant to use IUCDs because of a number of myths and misconceptions associated with the method. They have reservations about the provider’s capability and quality of care at the facility. Private health providers are not motivated and are reluctant to provide the IUCDs because of inadequate counseling skills, lack of competence and improper supporting infrastructure. Government programs either do not have enough supplies or trained staff to promote the IUCD utilization.ConclusionBesides a well-designed community awareness campaign, providers’ communication and counseling skills have to be enhanced, as these are major contributing factors in IUCD acceptance. Ongoing training of all family planning service providers in IUCD insertion is very important, along with strengthening of their services.

Acceptance and Positive Attitude Increased Utilization of Long Acting and Permanent Family Planning Methods Among Reproductive Age Group Women from Debre Berhan District, Ethiopia: Quantitative and Qualitative Analysis

“…Furthermore, they stated IUD could cause uterine cancer; these situations were hindering the utilization of long acting and permanent family planning methods. This is in line with qualitative research done in Pakistan and Nigeria [18,20].…”

“…IUD were the most extensively used LAPMs around the world but in this study it was the reverse and very low. Even if, IUD can provide effective protection for up to 10 years and might be used as alternative to sterilization for women who may regret after tubal ligation, it was low with this study [16][17][18]. The reasons for not to use IUD in the town were fear of side effect, loss of privacy during insertion and thought that IUD reduces daily activities which was supported from qualitative finding.…”

Factors associated with intrauterine contraceptive device use among women of reproductive age group in Addis Ababa, Ethiopia: A case control study

“…Therefore, increasing the uptake of modern contraception is one of the solutions in order to decrease the fertility rate and to reduce the unmet need for family planning [4,6,9,10]. The IUCD) is one of the most reliable and the most widely used reversible modern contraceptive method worldwide and has the potential to reduce the overall number of unintended pregnancies more than any other contraceptive method [11,12]. Despite the fact that the copper-bearing IUCD brand TCu-380A is widely available in Ethiopia and is provided free of charge in government healthcare facilities, it is still very much underutilized [3].…”

Evaluating Quality of Contraceptive Counseling: An Analysis of the Method Information Index

“…As a consequence, Pakistan was among the few middle‐income countries that failed by 2015 to achieve Millennium Development Goal (MDG) 5 that aimed to reduce the maternal mortality ratio by 75 percent and to achieve universal access to reproductive health (Countdown to 2015 ). Information given to clients about benefits and potential side effects of modern methods of contraception may not be sufficient, potentially leading to low contraceptive uptake and discontinued use (Khan and Shaikh ; NIPS Pakistan and ICF International ). The most recent DHS survey indicates that two‐thirds of current contraceptive users report not being informed about potential side effects, whereas 70 percent said they were not informed about the wide range of contraceptive methods, and even more (72 percent) said they were not informed about what to do in case they experienced side effects (NIPS Pakistan and ICF International ).…”