Exploring reasons for discontinuing use of immediate post-partum intrauterine device in Nepal: a qualitative study

Abstract

Background: Postpartum intrauterine device (PPIUD) use remains very low in Nepal despite high levels of unmet need for postpartum family planning and the national government's efforts to promote its use. This study investigates reasons for continuing or discontinuing PPIUD use among Nepali women. Methods: We conducted in-depth interviews (IDIs) with 13 women who had discontinued PPIUD use and 12 women who were continuing to use the method 9 months or longer following the insertion. All interviews were audio recorded, transcribed, translated into English, and analyzed using a thematic approach. Results: Women discontinued PPIUD for several reasons: 1) side effects such as excessive bleeding during menstruation, nausea, back and abdominal pain; 2) poor quality of counselling and, relatedly, mismatched expectations in terms of device use; and 3) lack of family support from husbands and in-laws. In contrast, women who were continuing to use the method at the time of the study stated that they had not experienced side-effects, had received appropriate information during counselling sessions, and had the backing of their family members in terms of using PPIUD. Conclusion: Experiencing side-effects or complications following PPIUD insertion and poor quality of family planning counselling were the two main reasons for discontinuation. Family members appeared to play a major role in influencing a woman's decision to continue or discontinue PPIUD suggesting that counseling may need to be expanded to them as well. Improving quality of counselling by providing complete and balanced information of family planning methods as well as ensuring sufficient time for counselling and extending PPIUD service availability at lower level clinics/health posts will potentially increase the uptake and continued use of postpartum family planning, including PPIUD, in Nepal.

Immediate postpartum intrauterine contraceptive device utilization and influencing factors in Addis Ababa public hospitals: a cross-sectional study

“…Another clustered randomized data in Tanzania explains that giving women informational materials on PPIUCD and counseling after admission for delivery are likely to increase the proportion of women choosing PPIUCD [19]. In the same manner a study in India assures that counseling in the antenatal period was a key point in increasing acceptance of PPIUCD [37].…”

“…PPIUCD is an acceptable contraception with fewer complications [17,18]. PPIUCD inserted just after 10 min of placental delivery is a safe, effective, and efficient method of meeting women's need for long-acting but reversible method of contraception [19,20]. It can be placed after abortion, vaginal delivery and during caesarian section [21].…”

“…Intrauterine device is the least utilized modern contraceptive method in Ethiopia [22]. Reasons for low utilization range from limited provision of IUCDs to a lack of staff trained in providing family planning counseling and services to preexisting biases against IUCDs among both providers and the general public [19,[23][24][25][26].…”

Assessing knowledge, attitudes, and practice of health providers towards the provision of postpartum intrauterine devices in Nepal: a two-year follow-up

“…This in turn could result in women refusing to use an IUD due to their misguided perception of the IUDs effectiveness. Mismatched expectations of the PPIUD caused by poor quality counseling has also been shown as a main reason for PPIUD discontinuation in Nepal [ 34 ]. Enhanced and ongoing PPIUD training throughout the intervention is needed to improve and maintain providers’ knowledge around the mechanics of the IUD and increase the quality of counseling on offer.…”

Acceptability of immediate postpartum and post‐abortion long‐acting reversible contraception provision to adolescents: A systematic review

“…Other barriers to LARC use included the lack of, or inadequate, information given during contraceptive counseling, distrust of health providers or the view that consulting other women, perceived as expert users, would yield more reliable information 65,68 . Discontinuation of the Cu‐IUD in Nepal was associated with a perceived inadequate amount of information about postpartum Cu‐IUD provided during contraceptive counseling, in addition to side effects, which caused concern 64 . The long duration of action of the Cu‐IUD and lack of side effects lead to positive perceptions and was a driver of continuation of the method 64 …”