Programmatic experience of post-partum IUD use in Zambia: an observational study on continuation and satisfaction

Blumenthal, Paul D.; Chakraborty, Nirali M.; Prager, Sarah; Gupta, Pratima; Lerma, Klaira; Vwalika, Bellington

doi:10.1080/13625187.2016.1201655

Cited by 23 publications

(39 citation statements)

References 20 publications

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“…A study limitation is the small proportion of women who received postplacental IUD insertion among the whole sample, resulting in an imbalance in the two groups. The expulsion rate observed for postplacental insertion was lower than the previously reported average (10% in a recent meta‐analysis), but consistent with data from low‐ and middle‐income countries, a potential consideration when reviewing PPIUD studies. In addition, the IUD‐to‐fundus distance was smaller than previously reported in the literature; however, no difference in expulsion was observed between the two groups in this study.…”

Section: Discussionsupporting

confidence: 84%

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Importance of the delivery‐to‐insertion interval in immediate postpartum intrauterine device insertion: A secondary analysis

Lerma

Bhamrah

Singh

et al. 2020

Intl J Gynecology & Obste

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Objective: To evaluate the delivery-to-insertion interval for copper postpartum intrauterine devices (PPIUDs). Methods: Secondary analysis of two related studies at five academic sites in India from March 2015 to July 2016. IUDs were inserted within 48 hours of vaginal delivery. Women (n=560) were grouped by whether they underwent postplacental (≤10 minutes) or immediate (>10 minutes) insertion. Outcomes were complete expulsion at the 6-8-week follow-up (primary), and IUD-to-fundus distance, as assessed by postinsertion ultrasound (secondary). Results: Overall, 93 (16.6%) women received a postplacental PPIUD and 467 (83.4%) received an immediate PPIUD. Complete expulsion at follow-up was 3.2% (n=3) in the postplacental and 7.5% (n=35) in the immediate postpartum group (P=0.176; difference in proportions, 4.3%; 95% confidence interval, −2.0 to 8.1). Distance from the fundus did not differ between the two groups (P=0.107); high fundal placement (≤10 mm from the internal endometrial verge) was achieved for most women. Conclusion: The present data challenge previous guidance on the timing of PPIUD insertion. The 10-minute insertion window is a barrier to uptake and should be reassessed for inclusion in service delivery guidelines. A flexible interval would accommodate the multiple post-delivery tasks of providers and increase access to PPIUD. K E Y W O R D S Copper IUD; Intrauterine contraceptive device; Intrauterine device; IUCD; Postpartum IUD; Postplacental IUD SUPPORTING INFORMATION Additional supporting information may be found online in the Supporting Information section at the end of the article. File S1. STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist.

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Section: Discussionsupporting

confidence: 84%

“…Reducing this unmet need has the potential to decrease maternal and child morbidity and mortality . Decades of clinical research and demonstration projects have provided evidence that postpartum intrauterine devices (PPIUDs) are convenient and safe, and their utilization continues to increase globally …”

Section: Introductionmentioning

confidence: 99%

Importance of the delivery‐to‐insertion interval in immediate postpartum intrauterine device insertion: A secondary analysis

Lerma

Bhamrah

Singh

et al. 2020

Intl J Gynecology & Obste

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“…While global evidence on continuation rates is available for interval intrauterine contraceptive device (IUCD) insertions [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , it is limited for PPCuIUDs. The few studies on PPCuIUD continuation rates are restricted to hospital settings [18] , [19] , [20] , but there is little evidence from any program implemented at scale [21] . Considering the complexities in scale-up of any new intervention in resource-constrained health systems, this lack of program level evidence is a barrier to informed decision making for scale-up of these services globally.…”

Section: Introductionmentioning

confidence: 99%

One-year continuation of postpartum intrauterine contraceptive device: findings from a retrospective cohort study in India

et al. 2019

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Objective To evaluate outcomes of a national postpartum (within 48 h of delivery) copper intrauterine device placement (PPCuIUD) program in six “high-focus states” with high unmet family planning need in India. Study design We identified high-volume district hospitals that provided PPCuIUD in six (Bihar, Jharkhand, Uttar Pradesh, Uttarakhand, Madhya Pradesh and Chhattisgarh) Indian states (two per state). Each selected hospital maintained a list of PPCuIUD acceptors with contact phone numbers. We randomly selected 100 women at each site for inclusion in a telephone survey of IUD outcomes at 1 year. Questions regarded IUD expulsion, discontinuation because of symptoms (e.g., pain, bleeding, discharge), discontinuation for other reasons and use of alternative contraception if discontinuation reported. Results We could contact 844 of the 1200 randomly selected women, of whom 673 (79.7%) had postplacental insertion (within 10 min of delivery), while 171 (20.3%) had an early postpartum insertion (between 10 min to 48 h after delivery). Of those contacted, 530 women (62.8%) reported continuing with the method beyond 1 year, 63 (7.5%) reported having an expulsion, 163 (19.3%) reported having removals for associated side effects (bleeding, pain and discharge), and 88 (10.4%) reported having removals for other reasons. After removal or expulsion, almost half of the women (46.5%) did not switch to any other modern contraceptive method. Conclusion PPCuIUD continuation rate at 1 year was 62.8%. Most removals within 1 year were due to associated side effects. Almost half of the women discontinuing PPCuIUD did not switch to an alternative modern contraceptive method. Implications The 1-year continuation rate of PPCuIUD achieved through a large-scale national program in India is satisfactory. The program though needs to address the low uptake of other modern contraceptive methods after discontinuation.

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“…Moreover, although evidence is limited, women have reported high levels of satisfaction with the PPIUD in African settings, such as Zambia (Blumenthal et al. ) and Malawi (Bryant et al. ).…”

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confidence: 99%

Women's Perspectives on Postpartum Intrauterine Devices in Tanzania

Huber‐Krum¹,

Hackett²,

Senderowicz³

et al. 2019

Studies in Family Planning

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Despite the numerous benefits of the postpartum copper intrauterine device (PPIUD), which is inserted within 48 hours after giving birth, it is underutilized in many resource-constrained settings, including Tanzania. We conducted in-depth interviews with 20 pregnant women who received contraceptive counseling during routine antenatal care in 2016-2017 and 27 postpartum women who had a PPIUD inserted in 2018 to understand reasons for use versus nonuse and continuation versus discontinuation. Primary motivators for using a PPIUD included: convenience, effectiveness, perceived lack of side effects, and duration of pregnancy protection. Barriers to use included: fear of insertion, concerns related to sexual experiences post-insertion, and limited knowledge. Women who had a PPIUD inserted continued use when their expectations matched their experience, while discontinuation resulted from unexpected expulsion and experience of unanticipated side effects. Frequent followup and guidance on side-effect management influenced women's decisions to continue use. To support uptake and continued utilization of the PPIUD, postpartum contraceptive counseling should explicitly address side effects and risk of expulsion.

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Programmatic experience of post-partum IUD use in Zambia: an observational study on continuation and satisfaction

Cited by 23 publications

References 20 publications

Importance of the delivery‐to‐insertion interval in immediate postpartum intrauterine device insertion: A secondary analysis

Importance of the delivery‐to‐insertion interval in immediate postpartum intrauterine device insertion: A secondary analysis

One-year continuation of postpartum intrauterine contraceptive device: findings from a retrospective cohort study in India

Women's Perspectives on Postpartum Intrauterine Devices in Tanzania

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