Factors affecting the behavior outcomes on post-partum intrauterine contraceptive device uptake and continuation in Nepal: a qualitative study

Abstract

Background The use of post-partum family planning (PPFP) methods such as post-partum intrauterine device (PPIUD) in general remains low despite its benefits for the women. The reasons or factors affecting the uptake and continuation of such PPFP methods in developing countries such as Nepal remains unclear. This qualitative research aims to explore the factors affecting PPIUD uptake and continuation related behaviors among post-partum mothers within 6 weeks of childbirth in Nepal. Methods This qualitative study was conducted through 43 in-depth interviews among post-partum mothers who delivered in 3 selected hospitals in Nepal. Data were analyzed through content analysis using the theory of planned behavior (TPB) as the theoretical framework. Results The themes and categories were structured around the three major components of the TPB on attitude, subjective norms, and behavioral control. Majority of the women in this study, irrespective of their behavioral outcome expressed a positive attitude towards PPIUD use. However, the women who expressed an unfavorable attitude towards PPIUD influenced their behavior to not choose or discontinue PPIUD. Subjective norms such as the family, peer, and societal influences against PPIUD negatively affected the women’s intention and behavior related to PPIUD. Whereas, the positive influence of the health providers positively affected their behavior. Regarding the behavior control, women who had their own control over decisions tended to use PPIUD. However, external factors such as their husband’s preference or medical conditions also played a prominent role in preventing many to use PPIUD despite their positive intentions. Conclusion As suggested in TPB, this study shows that multiple factors that are interlinked affected the behaviors related to uptake and continuation of PPIUD. The attitude helped in s`haping intention but did not always lead to the behavioral outcome of PPIUD uptake and continuation. Subjective norms had a strong influence on both intention and behavior. Behavior control belief also had an important role in the outcome with respect to PPIUD uptake and continuation. Thus, a more layered, multidimensional and interlinked intervention is necessary to bring positive behavior changes related to PPIUD. Electronic supplementary material The online version of this article (10.1186/s12884-019-2310-y) contains supplementary material, which is available to authorized users.

Knowledge and predictors of retention of postpartum intrauterine contraceptive device among users in rural areas of Nadia district, West Bengal, India

“…19,20 A qualitative study from Nepal also found that factors related to subjective norms of family, peer, society or husband's preference negatively affected the women's behavior and attitude towards PPIUCD. 21 The present study revealed a finding similar with Mishra S, that retention of PPIUCD did not affected by complication related to its use. 20 Hence, the gap lies in knowledge and attitude of the acceptors.…”

Prevalence of Postpartum Family Planning Service Coverage in Selected Referral Facilities of Nepal

“…Nepal Society of Obstetricians and Gynecologists (NESOG) jointly with the Nepalese government and with the support from International Federation of Obstetrics and Gynecology (FIGO) had implemented the initiative of institutionalizing immediate postpartum family planning (PPFP) services in selected major referral facilities of Nepal between 2015 and 2019. [1][2][3] The initiative had focused on PPFP services that could be incorporated as a routine part of maternity care in the selected hospitals. The outcome of institutionalization was to improve the coverage of PPFP counseling and uptake of immediate PPFP methods.…”

“…The outcome of institutionalization was to improve the coverage of PPFP counseling and uptake of immediate PPFP methods. [1][2][3] The increasing institutional deliveries in Nepal provides a one-stop approach to provide maternity and PPFP service at the same time. 4 However, the data on postpartum family planning service coverage from the health facilities in Nepal remains limited.…”

Evaluating the long-term impact of Female Community Health Volunteer involvement in a postpartum family planning intervention in Nepal: a mixed-method study at 1 year post-intervention

“…PPIUD can be used immediately after childbirth, with minimal side effects for up to 10 years [7,8]. However, its uptake in Nepal is lower than in many other countries, which has largely been attributed to societal barriers and a lack of knowledge and skills among health providers [1,9]. A previous study has identi ed female community health volunteers (FCHVs) in Nepal to play a key role in in uencing a woman's decision to choose a PPFP method.…”

“…Based on key ndings and recommendations from earlier studies [6,9,10], the Nepal Society of Obstetricians and Gynecologists (NESOG) and the International Federation of Gynecology and Obstetrics (FIGO) jointly implemented an intervention to orientate FCHVs on PPFP, including PPIUD. FCHVs are community health workers (CHW), and are considered a special cadre of health workforce in Nepal as they are the rst point of contact for people in the communities in need of healthcare [6].…”