Use of Mother's Class in Promoting IUD Acceptance and Its Effectiveness

This paper is a result of experimental studies on family planning in Koyang county, a rural setting of Korea. The Koyang experience has shown that the acceptance of IUD is heavily dependent on two factors: the distance from the village to the IUD service clinic and the extent of side reactions: and unfavorable rumors about its use in the community. While the problem of distance was solved by sending out mobile teams or by establishing new clinics in the villages, the problem of side reaction and unfavorable rumors still remained. This study was set up to see whether the organization of mothers' classes could be a means to promote the acceptance and retention of IUDs. The mothers' class was organized in each village (hamlet), and the membership was opened to every women in the village. It was hypothesized that the mothers, class with the proper educational materials will work as an adequate educational program to offset rumors and to make a favorable social climate for accepting and retaining the IUD. The field experiment was conducted according to the "before-after" design with a control group. It was found that the educational program in the mothers' class was effective in promoting the acceptance and retention of contraceptive practice, particularly the IUD.

Field Study of an Oral Contraceptive Among IUD Drop-Outs in Rural Korea

During a period of about one year (November' 66 to December' 67), the Yonsei University College of Medicine conducted a field trial of the oral contraceptive (Ovulen) in order to study its acceptability and use-effectiveness among IUD drop-outs in Koyang County. We can summarize the outstanding findings from this investigation as follows: 1. 61.4% of the IUD drop-outs interviewed (911 women) wanted to use the pill. Most of the reasons for not wanting to use it (352 women)pertained to either use of other contraceptive methods (98) or subfecundity (150) following IUD terminations. Only 83 out of 911 women gave reasons related to the difficulty of obtaining pills. Therefore, we can state that most IUD dropouts if still in need of a contraceptive methods are in favor of trying the pill, and especially so if this method is conveniently available. 2. The 467 women or 37% of those who terminated IUD use actually visited the clinic for medical screening, and only 11 of them or 2.4% were rejected because of pregnancy and other medical reasons such as cervical erosion, myoma, breast mass, etc. 5.5% or 25 of the 456 women who received the first cycle did not take a single pill during the study period. 3. When we defined those 431 women who took one or more tablets as acceptors we found that women over 30 years with 4 or more children, and/or with a higher educational level were the best prospects for recruitment. 4. In accuracy of use, about two thirds of the users started taking the pi1l on the 5th day as directed for the first thee cycles, but the percentages rose sharply to about 80% in later cycles. Tardiness in starting pill use in the first cycle may have occurred partly because they had to return to the clinic month1y to get each new cycle. Among acceptors who did not quit between cycles, 80 to 90% were regular users, missing two or less tablets in each cycle. 5. More than 60% of the users felt well and sometimes lost their pre-acceptance symptoms, especially dysmenorrhea. However, 27.4% (58 women) had side effects attributable to the pill compound such as nausea, vomiting, indigestion, breast tenderness, decreased lactation or breakthrough bleeding. 25.0% (53 women) also complained of medical diseases or symptoms not related to the pill, especially during the first three cycles. However as the confidence and experience of the client and the field workers grew, the incidence of unrelated medical complaints quickly fell to a lower level in the later cycles. 6. As of the end of this study, on December 31, 1967, 49.2% (212 women) had discontinued the use of the pill for medical reasons as well as for the non-medical reasons. Only one case terminated use due to a pregnancy after taking pills. The cumulative continuation rates (by the life table method) were 58.9%, 51.9%, 41.0% at the end of 3 months, 6 months and 12 months respectively. These rates are 1ower than in the U.S. studies. Even when we add the retaking group to the first segment, the continuation rate goes up only about 5% above the first segment rates mentioned above. Possible explanations are: different dosages, the newerness of the method, and the use of only one point for pill distribution in the county together with a monthly return for cycles 1,2,3, and 4-6, etc. 7. Based on the experiences gained by this field study, the action implications for adding up the pill service to the on-going IUD program were also discussed in connection with the cost, follow-up method, educative and inforamtional methods, record forms and the critieria of eligible population for the pill program.

Improving Access to the IUD: Experiments in Koyang

The experimental study has been conducted in six townships of Koyang County, Kyonggi Province to identify more efficient methods of carrying the Intra-Uterine Device (IUD) into rural areas since May 1965, covering in all 76,810 inhabitants with 10,073 eligible women in 13,947 households. IUD acceptance rates are improved remarkably in two townships with activities of the mobile service and stationary clinic, impling that the IUD program could be intensified if IUD services are extended to the village either by mobile service or stationary services. The most of the eligible women wanting IUD in the future preferred to have IUD insertion by female physician on the before survey, but the results of the study shows no difference in IUD insertions by female and male physicians. Reasons to choose a clinic for IUD insertion are most likely to be accessibility or availability and reliability of the service with a little shyness problem. It indicates that the sex of physician inserter is not important in Korea. IUD termination rates are least for postpartum, and are trivially different between those inserted within ten days after onset of menstruation and those inserted later. IUD termination rates in terms of the qualification of inserter show that Ob-Gyn specialist is with the lowest termination rates, but it is interesting that nurse working alone with the postpartum cases did best of all and suggested that nurses can potentially insert IUD's as efficiently as do physicians if the proper training is given to them.