Perceptions of Intra-Uterine Device Users in Mirebalais, Haiti: A Mixed Methods Study

Abstract

Introduction:IUDs are safe, effective, and used worldwide to prevent unintended pregnancy. However, uptake in Haiti is low. There are limited data on IUD choice and experience in low resource settings; anecdotal reports from providers in Haiti have suggested that Haitian women are unlikely to choose to use or be satisfied with the IUD. The objective of this study is to explore the perceptions of a cohort of IUD users in Mirebalais, Haiti.Methods:In June and July 2015, an IRB-approved mixed methods study of women over age eighteen with hormonal or copper IUDs inserted at Hôpital Universitaire de Mirebalais (HUM) was performed in Mirebalais, Haiti.Results:Twenty-one eligible women participated, out of 58 women identified as eligible. Most women (81%) reported using the copper IUD; most (86%) had used the IUD for 6 months or more. Over half were under 30 years old (62%) and most had completed primary school or less (76%). Almost all (91%) reported prior pregnancies; 65% did not desire more children. The majority of participants were satisfied with the IUD, with 70% being very satisfied and 25% somewhat satisfied. Most women (71%) reported no very bothersome side effects, and would recommend the IUD to others (86%). Qualitative data highlighted positive perceptions of the IUD among users, as well as misperceptions and lack of knowledge regarding the IUD among members of their communities.Conclusion/Implications:Understanding of culture-specific perceptions is critical in addressing barriers to IUD uptake. Our findings indicate that IUDs can be an acceptable contraceptive method for women in Haiti, and suggest the possibility that increased access to the IUD may lead to increased acceptance of this method.

Barriers and Enablers Influencing Women's Adoption and Continuation of Vaginally Inserted Contraceptive Methods: A Literature Review

“…Alignment between a method's duration of use and women's preferences facilitated the adoption and continued use of all methods except the female condom, which is a single-use, on demand method (Shapiro 2016;Machado et al 2013;Shapiro et al 2014;Somesh Kumar et al 2014;Das et al 2015;Minnis et al 2018;Shapley-Quinn et al 2019;Sheriar et al 2014;Van Der Straten et al 2018;Callahan et al 2019;Van Der Westhuizen and Hanekom 2016;Ndegwa et al 2014;Jairaj and Dayyala 2016;Eva et al 2018;Kakaire et al 2016;FHI360 and Family Health Options Kenya 2016, 360;FHI 360, SFH Nigeria, and PSI 2020b;USAID 2019;PSI et al 2019;Population Council 2016c;FHI 360 2012;Routes2Results et al 2019b;Danna et al 2019;FHI 360 2017;Van Der Straten et al 2010;Todd et al 2012;Bryant et al 2015;Gutin et al 2011;Ho and Wheeler 2018;Hubacher et al 2013;Da Costa et al 2019;Priyanka, Kaushik, and Paras 2015). For example, many studies found that women appreciated the long-acting nature of copper and hormonal IUDs because they saw this duration as convenient and low maintenance (Nanda et al 2018;Gottert et al 2015;Huber-Krum et al 2019;Mukamuyango et al 2020;Azmat et al 2012;Boller et al 2018;…”

“…An acceptable side effect profile was influential for the adoption of three methods: the diaphragm and copper and hormonal IUDs (Shapiro 2016;Harris and Angel 2020;Nanda et al 2018;Shapiro et al 2014;Huber-Krum et al 2019;Callahan et al 2019;Eva et al 2018;FHI360 and Family Health Options Kenya 2016;FHI 360, SFH Nigeria, and PSI 2020b;USAID 2019;PSI et al 2019;2019b;Danna et al 2019;FHI 360 2017;Bryant et al 2015;Hubacher et al 2013;Priyanka, Kaushik, and Paras 2015;Boller et al 2018;Marston et al 2016;A. Kumar et al 2018;Hayes and Kilbourne-Brook 2016b;Kyamwanga et al 2014;S.…”

“…For hormonal IUDs, the method's treatment of heavy or painful periods and tendency to reduce menstrual bleeding were positive factors for adoption (Nanda et al 2018;Boller et al 2018;Callahan et al 2019;Eva et al 2018;FHI360 and Family Health Options Kenya 2016;FHI 360, SFH Nigeria, and PSI 2020b;USAID 2019;FHI 360, SFH Nigeria, and PSI 2020a, 2019a, 2019bDanna et al 2019;FHI 360 2017;Hubacher et al 2013). In addition, women often adopted the diaphragm, female condom, and copper IUD due to a preference for nonhormonal methods (Harris and Angel 2020;Miller et al 2018;Somesh Kumar et al 2014;Huber-Krum et al 2019;Boller et al 2018;Tilahun et al 2016;Bryant et al 2015;Callahan et al 2019;Da Costa et al 2019;Blumenthal et al 2016;Marston et al 2016;Scavuzzi, Souza, and Amorim 2016;Mahlalela and Maharaj 2015;Jairaj and Dayyala 2016;Hayes and Kilbourne-Brook 2016b;Kyamwanga et al 2014;Mathenjwa and Maharaj 2012;Van Der Westhuizen and Hanekom 2016). Many women saw the ability to use a method while breastfeeding as a positive factor (Huber-Krum et al 2019;Eva et al 2018;Routes2Results et al 2019b;Danna et al 2019).…”

“…Receiving a recommendation from a provider, friend, or family member was an important enabler for method adoption, particularly for the female condom, copper IUD, and hormonal IUD (Harris and Angel 2020;Nanda et al 2018;Gottert et al 2015;Azmat et al 2012;Boller et al 2018;Gedeon et al 2015;Eva et al 2018;FHI360 and Family Health Options Kenya 2016, 360;Danna et al 2019;POW PDP 2015). As expected, user satisfaction with a chosen method was linked to the continuation of most methods (RamaRao et al 2018;Miller et al 2018;Nanda et al 2018;Somesh Kumar et al 2014;Ting, Wong, and Tnay 2018;Agot et al 2019;Minnis et al 2018;Ndegwa et al 2014;Eva et al 2018;Kakaire et al 2016;Azmat et al 2012;FHI 360, SFH Nigeria, and PSI 2020a;Blumenthal et al 2016;Scavuzzi, Souza, and Amorim 2016;Van Dijk et al 2013;Santibenchakul and Jaisamrarn 2016;Sodje et al 2016;Wanyenze et al 2011;Bharadwaj 2015;Pandit et al 2014;Joanis et al 2011;Dam et al 2015;Radwan et al 2019;Park, Nguyen, and Ngo 2011;Ezegwui et al 2013;Wu et al 2019;Moagi, Snyman, and Makin 2019;Das et al 2016).…”

“…For the copper IUD, the 10 years of protection provided many women with "freedom from worry" since they did not have to remember to use contraception more frequently (Gottert et al 2015). Compared to hormonal methods, the nonhormonal nature of the copper IUD was a benefit to many women (Somesh Kumar et al 2014;Huber-Krum et al 2019;Boller et al 2018;Tilahun et al 2016;Bryant et al 2015;Callahan et al 2019;Van Der Westhuizen and Hanekom 2016;Jairaj and Dayyala 2016;Blumenthal et al 2016;Da Costa et al 2019;Marston et al 2016;Scavuzzi, Souza, and Amorim 2016), who perceive nonhormonal methods to have fewer side effects (Huber-Krum et al 2019;Boller et al 2018;Bryant et al 2015;S. Castle et al 2019;A.…”