A twenty year experience with the use of intrauterine contraceptive device (IUCD) in a university teaching hospital in South- south Nigeria

Context: Contraceptive prevalence in Nigeria is low at 17%. Amongst Nigerian women and couples who accept to use contraception, the IUCD is the most commonly used contraceptive method with variation in rates of use between geographical areas and among Health Institutions. Factors that determine decision making on IUCD use are not well understood. Aims: To study the use, effectiveness, complications and discontinuation rates for intrauterine contraceptive device received at the University of Benin Teaching Hospital from 1997 to 2016 and analyzed in January, 2019. Study Design: This was a retrospective cross sectional study. Methodology: The case notes of all 3326 new clients who accepted Copper T intrauterine contraceptive device at the UBTH Family Planning Clinic during the review period were retrieved and analyzed. Data regarding acceptors socio-demographic characteristics, side effects, effectiveness, complications, duration of use and reasons for discontinuation were extracted and entered into SPSS for windows version 22.0 and analyzed. Results: Out of the 8203 clients that accepted to commence a family planning method, 3326 (40.55%) accepted to use IUCD. The mean age of IUCD acceptors at commencement was 33.4±5.60 and the mean age of their husbands was 39.85±6.91. The mean parity was 3.73±1.87 (range 0-12), while the mean number of living children was 3.56±1.66 (range 0-10). The mean duration of use (in months) was 40.43±40.13. Women with 5 or more children (P Value 0.000) and at least a minimum of secondary education (P Value 0.000), were significantly associated with IUCD use duration of > or more than 2 years. Also, women who reported satisfaction with IUCD (P Value 0.000) and no complications (P Value 0.000) were also associated with longer duration of use. Conclusion: IUCD is a common family planning method used by women at UBTH. Its duration of use is higher among clients with more children, at least a minimum of secondary school education and no complications from its use. This information is relevant for family planning service providers to increase contraceptive uptake by women in Nigeria

Intraoperative insertion of intrauterine contraceptive device at cesarean section: A survey on the experiences of trainee and practicing obstetricians

Background: Intrauterine contraceptive device (IUCD) placement during cesarean section has been shown to be a safe and effective method of contraception with very low complication and disuse following insertion. Its practice can be of immense benefit, especially in developing countries like Nigeria where high unmet needs for contraception and increasing cesarean section rates are prevalent. Objective: The objective of this study is to evaluate the practice of obstetricians and trainees on counseling and insertion of IUCD during cesarean section. Materials and Methods: A questionnaire­based cross­sectional study was conducted among obstetricians and trainees at the 49th Annual Scientific Conference of the Society of Gynecology and Obstetrics of Nigeria held in November 2015. The data were analyzed using the SPSS version 20. Results: Of 150 respondents, 134 returned completed questionnaires, giving a response rate of 89.3%, 130 of these were adjudged to be correctly filled and were analyzed. Majority of the respondents, 97 (74.6%), were consultants. The mean age of the respondents was 42.01 years ± 7.00. About 95% (125) of the respondents admitted performing cesarean sections, but only 13 (10%) had ever inserted IUCD during cesarean operations. Counseling for the procedure was also low, as only 35 (26.9%) of the respondents had ever counseled the clients toward IUCD placement at cesarean section. Conclusion: For counseling and practice of insertion of IUCD at cesarean section is very low among Nigerian obstetricians, revealing a major barrier to clients' access to this effective and safe method of contraception. Advocacy, education, and training of this category of health­care providers are necessary for improved contraceptive access to cesarean section clients

Factors responsible for discontinuation of long-term reversible contraceptives in a tertiary facility in Northeastern Nigeria

Background: The emergence of long-term reversible contraceptives (LARC) has helped in reaffirming the concept of Family Planning (FP) 2020. LARC is one of the safest and most effective methods covering both hormonal implants and intrauterine devices (IUDs). However, despite their acceptability and wide usage, they are associated with undesired effects limiting their use ranging from personal to device-related or both.Aim: This study is aimed at determining the reasons for the discontinuation of LARCs among women accessing FP services in Bauchi.Methods: The study was for 1-year period. It was a retrospective survey of 335 clients that presented to the FP unit of a tertiary institution in Northeastern Nigeria for removal of implants. Data were inputted into and analysed using SPSS version 21 and results presented in tables and charts.Results: A total of 1069 clients had one method of contraception or the other over the study periods. About 335 (31.3%) clients had removal of LARCs (53.4%, 18.2% and 28.4%, for Implanon, Jadelle and IUDs, respectively). The mean parities of the clients were 3 +_ 0.55. The most common indications for removal of implants observed in the study included, the desire for pregnancy (38.5%), expired implants and untolerable side effects (24.5%) each.Conclusions: LARCs were the most common form of contraceptives used by women during the study period. The most common reason for removal of LARCs implants discovered was for feature pregnancy, undesired effects and implants expiry

Attitudes towards and Knowledge about Intrauterine Contraceptive Devices among Women in the Reproductive Age Group in a Resource-Constrained Setting

Background. One of the strategies to reduce maternal mortality includes accessible and appropriate contraceptive services to all women. The intrauterine contraceptive device (IUCD) has been identified as a cheap and effective means of contraception by the South African National Department of Health.Objective. To explore knowledge about the IUCD among women using the public health sector and identify any misconceptions.Methods. A sample of 150 women attending antenatal/postnatal clinics were interviewed using a structured questionnaire.Results. Forty-six percent (n=69) had some experience with the injectable form of contraception; and 2.7 (n=4) had used the IUCD; 70.7 (n=106) knew that the device does not prevent HIV transmission; 40.7 (n=61) knew that HIV-positive women can use the IUCD; 75.3 (n=113) believed that the IUCD causes heavy bleeding; 36.7 (n=55) knew that the device does not stop fertility indefinitely; 33.3 (n=50) knew that the IUCD can be inserted in the immediate postpartum period; and 26.7 (n=40) knew that the duration of use is 10 years. In terms of attitudes; 40.0 (n=60) expressed concern about the pain during insertion; 33.3 (n=50) believed the IUCD can cause cancer; and 32.0 (n=48) believed that the device interferes with normal sexual activities. Most participants 77.3 (n=116) acquired the information they had about the IUCD from the clinic during teaching and counselling sessions.Conclusion. This survey documented poor knowledge about the IUCD among women using the public health sector. However; the fact that there are few misconceptions and that clients rely on the clinic information should be seen as an opportunity to improve the situation

Profile of intrauterine contraceptive device acceptors at the University of Uyo Teaching Hospital, Uyo, Nigeria

Background: Use of modern contraceptive methods has been shown to reduce unwanted pregnancy; high parity and maternal mortality. Intrauterine contraceptive devices which are among the safest and most effective reversible contraceptives available; are particularly suitable for women in developing countries as they are affordable; convenient to use; do not require re-supply visits and are very cost-effective. The aim of this study is to determine the socio-demographic characteristics of intrauterine contraceptive device acceptors; the pattern of insertions and complications at the University of Uyo Teaching hospital; Uyo. Method: The record cards of all clients who had intrauterine contra- ceptive device inserted at the family planning clinic over a six-year period were reviewed. Results: During the study period; there were 852 new contraceptive acceptors out of which 39.7accepted the intrauterine contraceptive device. The modal age group of the clients was 25-29 years (32.5). Acceptance of intrauterine contraceptive device was most common among multiparous clients (65.1). Majority of the acceptors were married (90.0); Christians (98.8) and 72.8had at least secondary school education. Clinic personnel (65.7) and friends/relatives (21.3) were the most common sources of information on contraception. Most (93.5) of the clients had their intrauterine contraceptive devices inserted within 7 days of menstruation. Lower abdominal pain (5.5) and vulval/vaginal itching (5.3) were the most common complications. Conclusion: The acceptors of intrauterine contraceptive devices in our center were young; multiparous and educated women. Increasing mass media involvement in the dissemination of accurate information about intrauterine contraceptive devices to the general populace; the introduction of postpartum and post-abortal intrauterine contraceptive device insertions and the encouragement of our grandmultiparous women to accept intrauterine contraceptive device would lead to an increase in its acceptance and use