Acceptance, perception, experience and satisfaction of the couple with postpartum intrauterine contraceptive devices (PPIUCD) insertion

Abstract

Family planning can avert nearly one-third of maternal deaths and 10% of child mortality when couples space their pregnancies more than two years apart.In India 65% women in 1st year of postpartum period have unmet need for FP, but only 26% are using any contraceptive. Delivery may be the only time when they come into contact with health care providers; thereafter the chances of returning for contraceptive advice are uncertain. Insertion of intrauterine contraceptive device (IUCD) at 10 minutes after delivery is appealing. The Copper T 380A intra-uterine contraceptive device (IUCD) is a highly effective, non-hormonal method, long acting reversible and coitus independent contraceptive device that can be safely used by all women regardless of breastfeeding status during this interval. Thus increasing awareness and creating demand for postpartum intra-uterine
contraceptive devices (PPIUCD) is essential. Apart from the fact that its usage has to be increased, follow-up of the cases after insertion is an important factor since complications related to IUCD are extensive and vary with individuals. Thus routine followups and early measure is the base of PPIUCD insertion. Satisfaction related to IUCD insertion varies considerably. The studies also include the input of the husband’s opinion regarding the satisfaction related to IUCD as many problems related to interference in the sexual activity were recorded. We will conduct a study for acceptance, perception, experience and satisfaction of the couple with postpartum intrauterine contraceptive devices (PPIUCD) insertion at our institute.Objectives:1. Acceptability of postpartum intrauterine devices as a contraceptive method among women of reproductive age. 2. To record the experience
during the procedure and first six weeks after insertion of IUCD. 3. To learn about satisfaction with PPIUCD among the couple. 4. Desire to continue the service in future. Methods: Study design- This will be an open prospective and longitudinal study to
assess the acceptance, perception, experience and satisfaction of the 100 couples in the reproductive age group (19-49 years) who are willing for; with postpartum insertion of the Cu T 380 A within 10 minutes of placental expulsion. Couples will be recruited in this study after obtaining written informed consent. Institutional ethical committee clearance will be taken. Exclusion criteria will be severe anemia Hb< 8gm%, Premature rupture of membrane, Temperature >38°C during or after labor, and the patients with Postpartum Hemorrhage. Method of insertion: The Copper T model Cu T 380 A will be inserted with all aseptic
precautions within 10 minutes of placental expulsion with a sponge holder and fundal placement will be ensured. String will be cut to the level of the cervix. The string will be visible at the cervix after the insertion. Participants will be interviewed prior and after insertion of PPIUCD and then six weeks later. Data collection: Data will be collected from participants using a structured questionnaire that includes basic demographic information, questions related to acceptance and perception of pain on insertion of PPIUCD. After six weeks, PPIUCD clients will again be interviewed using a structured follow-up questionnaire that will collect information about the clients overall satisfaction, problems or any complications, and retention /expulsion of the PPIUCD. In the cases where the client fails to return to the health facility for her follow-up visit, she will be contacted by telephone for the follow-up interview. Data analysis: Continuous variables will be reported using mean (standard deviation) and categorical variables will be reported using percentages. For two group comparisons, wherever applicable a student t-test will be used to compare means of continuous variables, and chi-square tests shall be used to compare categorical variables.Results:1.Acceptance of PPIUCD was 88% after counseling than 46% before counseling. 2. 79.54% did not have any pain during insertion. 3. 17.06% had mild discomfort while insertion and only 03.40% had painful insertion. 4. After 6 weeks 83% women followed-up. Rest 17% could not be contact even through telephones. 5. Major complications encountered were abdominal pain and expulsion 13.6% each than other complications. However 54.5% women had no complications. 6. 75.3% women were willing to continue the PPIUCD, rest demanded removal either due to complications or family opposes being the major reason. 7. Overall satisfaction rate was 78% in women and 73.9% in husbands Conclusions: The study thus concludes that acceptance rate was significantly improved after proper counseling and the complication rate of the PPIUCD were less as compared to the overall benefits.