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
Publication statusPublished - Apr 1 2019

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Keywords

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

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

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