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

Somesh Kumar, Ashish Srivastava, Surendra Sharma, Vivek Yadav, Atul Mittal, Young-MI Kim, Angela Nash-Mercado, Sijmen A. Reijneveld, Bulbul Sood

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)212-216
Number of pages5
JournalContraception
Volume99
Issue number4
DOIs
StatePublished - Apr 1 2019

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Intrauterine Devices
Postpartum Period
India
Cohort Studies
Contraception
Retrospective Studies
Intrauterine Device Expulsion
Copper Intrauterine Devices
High-Volume Hospitals
Hemorrhage
Pain
District Hospitals
Family Planning Services
Telephone

Keywords

  • Family planning
  • Intrauterine contraceptive device
  • Long acting reversible contraceptives
  • Postpartum

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

Cite this

One-year continuation of postpartum intrauterine contraceptive device : findings from a retrospective cohort study in India. / Kumar, Somesh; Srivastava, Ashish; Sharma, Surendra; Yadav, Vivek; Mittal, Atul; Kim, Young-MI; Nash-Mercado, Angela; Reijneveld, Sijmen A.; Sood, Bulbul.

In: Contraception, Vol. 99, No. 4, 01.04.2019, p. 212-216.

Research output: Contribution to journalArticle

Kumar, S, Srivastava, A, Sharma, S, Yadav, V, Mittal, A, Kim, Y-MI, Nash-Mercado, A, Reijneveld, SA & Sood, B 2019, 'One-year continuation of postpartum intrauterine contraceptive device: findings from a retrospective cohort study in India', Contraception, vol. 99, no. 4, pp. 212-216. https://doi.org/10.1016/j.contraception.2018.12.003
Kumar, Somesh ; Srivastava, Ashish ; Sharma, Surendra ; Yadav, Vivek ; Mittal, Atul ; Kim, Young-MI ; Nash-Mercado, Angela ; Reijneveld, Sijmen A. ; Sood, Bulbul. / One-year continuation of postpartum intrauterine contraceptive device : findings from a retrospective cohort study in India. In: Contraception. 2019 ; Vol. 99, No. 4. pp. 212-216.
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abstract = "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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N2 - 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.

AB - 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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