Increasing the accessibility, acceptability and use of the IUD in Gujarat, India

Abstract

Despite the many advantages of the IUD as a method of family planning, it generally suffers from unpopularity worldwide, with the exception of a few countries like China, Egypt, Mexico and Turkey. The scenario in India is the same, with less than two percent of currently women adopting the IUD as a method of contraception. The USAID-funded FRONTIERS Program of the Population Council, in collaboration with the Department of Health & Family Welfare, Government of Gujarat and the Center for Operations Research and Training, Vadodara, conducted an operations research study to test the hypothesis that improving the demand for the IUD and simultaneously strengthening the technical competencies and counseling skills of the providers, use of the IUD use would increase. A pre and post intervention design with no control group was used. The study was carried out in both rural and urban areas with a population of 300,000 in Vadodara District, Gujarat. The package of interventions included: (a) strengthening counseling and technical skills of providers; (b) an educational campaign using field-tested behavior change communication (BCC) educational materials; (c) strengthening provision of IUD services in selected sub-centers and PHC; and (d) making the programmatic environment more supportive of spacing methods. The impact of the intervention was evaluated nine months after introduction of the interventions. Knowledge of providers on the critical steps for providing IUD services increased significantly, from 5 percent to 40 percent, and the proportion of women having poor knowledge (score of <7 out of 29) decreased significantly from 81 to 47 percent. Though the proportion believing in myths decreased significantly from the baseline, their prevalence was still high at endline. The proportion of IUD users who reported the quality of IUD services received to be good (score of ≥ 25 out of 34) increased from 26 percent to 73 percent. A majority (92 percent) of providers used the IEC materials developed during the project when counseling clients and 95 percent of them stated that their performance improved because of the IEC materials. Due to continuous monitoring and supportive supervision by the medical officers, over-reporting of IUD cases decreased significantly from 42 percent to 2 percent. Comparison of month-wise IUD insertion rates during the intervention period (2007), compared with 2006 showed significant improvement after adjusting for over reporting. A cost analysis shows that the additional cost of carrying out educational activities and strengthening provision using this model is approximately $3.37 per IUD user and to strengthen IUD services in one facility is approximately $74 per facility. These costs are for the pilot project; if the model is scaled up the per-site cost will be lower because of the scale of expansion. These are affordable costs and need serious consideration by the Family Welfare Department.

Acceptance of Long Acting Contraceptive Methods and Associated Factors among Women in Mekelle City, Northern Ethiopia

“…Though the current studies finding revealed that a higher percentage of women were aware of LARC, in comparison with other studies the awareness on IUCD was lower than a study which reported in Nigeria Copper T (70.8%), India (77%), and USA (79%) [15,24,25]. Women in Mekelle City, Northern Ethiopia…”

“…This study is Consistent with a study done in Ethiopia, India, Nigeria, Bangladesh, Benin and USA [15,19,21,[25][26][27] The limitation of this could be that it didn't include the qualitative part; due to this it was not possible to capture detail reasons from different angles for not accepting LARC. But, the attempt was made to make the questionnaire more comprehensive to capture detail variables.…”

Awareness and Practice of Contraceptive Methods Among Men- A Study

“…The scenario in India is the same with less than two percent of currently women adopting the IUD as a method of contraception. (8) An integrated approach to male involvement is needed. Some studies supported school-based clinics as a venue to involve male adolescents in contraceptive decision making.…”

Aligning product development and user perspectives: social–behavioural dimensions of multipurpose prevention technologies

“…One example is the intrauterine device (IUD), one of the most highly effective and long‐acting temporary contraceptive methods available . The method is considered highly acceptable to both users and providers and is available in several geographic settings, including Egypt, China, Mexico and Turkey . However, a recent survey in the USA revealed that many women have misperceptions about the device's safety and effectiveness; only one in five had accurate knowledge that the IUD was more effective than the pill .…”

“…16 The method is considered highly acceptable to both users and providers and is available in several geographic settings, including Egypt, China, Mexico and Turkey. 13,17 However, a recent survey in the USA revealed that many women have misperceptions about the device's safety and effectiveness; only one in five had accurate knowledge that the IUD was more effective than the pill. 18 Providers themselves had misperceptions about the method.…”