Provider and lay perspectives on intra-uterine contraception: a global review

Abstract

BackgroundIntra-uterine contraception (IUC) involves the use of an intra-uterine device (IUD), a highly effective, long-acting, reversible contraceptive method. Historically, the popularity of IUC has waxed and waned across different world regions, due to policy choices and shifts in public opinion. However, despite its advantages and cost-effectiveness for programmes, IUC’s contribution to contraceptive prevalence is currently negligible in many countries.This paper presents the results of a systematic review of the global literature on provider and lay perspectives on IUC. It aims to shed light on the reasons for low use of IUC and reflect on potential opportunities for the method’s promotion.MethodsA systematic search of the literature was conducted in four peer-reviewed journals and four electronic databases (MEDLINE, EMBASE, POPLINE, and Global Health). Screening resulted in the inclusion of 68 relevant publications.ResultsMost included studies were conducted in areas where IUD use is moderate or low. Findings are similar across these areas. Many providers have low or uneven levels of knowledge on IUC and limited training. Many wrongly believe that IUC entails serious side effects such as pelvic inflammatory disease (PID), and are reluctant to provide it to entire eligible categories, such as HIV-positive women. There is particular resistance to providing IUC to teenagers and nulliparae. Provider opinions may be more favourable towards the hormonal IUD. Some health-care providers choose IUC for themselves.Many members of the public have low knowledge and unfounded misconceptions about IUC, such as the fear of infertility. Some are concerned about the insertion and removal processes, and about its effect on menses. However, users of IUC are generally satisfied and report a number of benefits. Peers and providers exert a strong influence on women’s attitudes.ConclusionBoth providers and lay people have inaccurate knowledge and misconceptions about IUC, which contribute to explaining its low use. However, many reported concerns and fears could be alleviated through correct information. Concerted efforts to train providers, combined with demand creation initiatives, could therefore boost the method’s popularity. Further research is needed on provider and lay perspectives on IUDs in low- and middle-income countries.Electronic supplementary materialThe online version of this article (10.1186/s12978-017-0380-8) contains supplementary material, which is available to authorized users.

Expanding Method Choice in Africa with Long-Acting Methods: IUDs, Implants or Both?

“…This analysis is based on data from Demographic and Health Surveys (DHSs), health facility surveys and telephone interviews with key international family planning stakeholders, as well as findings from recently published literature reviews on enablers and barriers to IUD uptake in low-and middle-income countries. 9,10 Unless otherwise stated, our IUD analyses refer to copper devices and our implant analyses refer to the generic method (including levonorgestrel-and etonogestrel-based implants) rather than to specific brands.…”

Causes of Visiting Teenagers in the Pediatric and Adolescence Examining Room

“…The use of IUD can cause tempοrarily edema, headache, tenderness, depression and breast tenderness, acne or other skin lesions. There are may also be appeared: abdominal pain in the lower part of the abdomen, vaginal discharge, nausea, functional ovarian cysts and rarely spotting, especially in the first months [69].…”

Investigating the quality of family planning counselling as part of routine antenatal care and its effect on intended postpartum contraceptive method choice among women in Nepal

“…Previous studies have documented many barriers that have prevented the use of family planning methods resulting in unplanned pregnancies [4].. Many families overlook post-partum contraception due to sociocultural issues such as lack of communication on family planning methods, the pervasive mistrust and fear that IUD can cause infertility, and methods not being suitable for women who still want to have children [7,8]. Additional factors such as geographical and financial access, provider bias, poor method choice availability, lower status of women, medico legal restrictions, and fear of side effects act as barriers to postpartum family planning use [9].…”