ABSTRACT
Background: India accounts for world's 17.5 percent population and is the second most populous country in the world next only to China (19.4%). Birth control pills, condoms, sterilization, IUD (intrauterine device) etc. are most commonly practiced family planning methods in India. The latest NFHS shows that 77% of sterilized women did not use a family planning method. Despite of family welfare program having a target free approach, the program has not been successful in educating people about the concept and advantages of contraceptive methods for spacing births.Methods: This randomized controlled trial was carried out in the department of obstetrics and gynecology of Pondicherry Institute of Medical Sciences (PIMS), Puducherry. All antenatal mothers >28 weeks of gestational age were enrolled and given a semi-structured questionnaire. After randomization intervention was done in the form of counselling and distribution of pamphlets for future use. The women were followed in the postnatal period and 6 weeks later.Results: A total of 280 subjects were enrolled in this study. Socio-demographic characteristics were similar in both the study groups. Majority of women in both the comparison and intervention group were in the age group 20-25 years (43.6%). Very few participants (20.0%) had used some form of contraception to delay pregnancy. However, the postpartum follow-up of the study participants revealed significant increase in the knowledge on the various contraceptive methods in the intervention group compared with the comparison group.Conclusions: The implementation of behaviour change communication strategy to communicate the benefits of uptake of postpartum contraception to antenatal mothers, is vital in improving the acceptability of family planning programs in India.
ABSTRACT
Background: The safety and efficacy of the Post-Partum Intra Uterine Contraceptive Device (PPIUCD) has been documented worldwide. With increasing institutional deliveries and greater sensitization, the aim is to increase PPIUCD insertions. Many areas still report poor acceptance. Objectives of this study to determine the proportion of antenatal women willing to accept PPIUCD insertion and the reasons behind refusal to accept this method.Methods: A prospective questionnaire study was done between January 2019 to June 2019 of 200 women. Inclusion criteria were antenatal women in the 2nd/3rd trimester. Exclusion criteria were those opting for a permanent method of contraception and those with a contra-indication.Results: Eighty-four women (42%) had never used any method of contraception. Earlier Intrauterine device (IUD) use (including both interval and PPIUCD) was in only 18.9% of all contraceptive users. Only 2 women in the group had ever used PPIUCD. 79% of women were aware of IUDs. Those unaware were mainly nulliparous. Amongst those aware of an IUD, 88 (56%) were aware it could be inserted postpartum. Only 18% were aware it could be inserted intra-cesarean. All women who participated were offered the option for a PPIUCD. Fifty-nine (29.5%) of all women expressed their willingness but on follow up till delivery only 18 of these women got a PPIUCD inserted. Amongst those not willing for the PPIUCD insertion the commonest reason was general apprehension (39%) followed by partner refusal (33%) and fear of complications (31%). Six women (4.2%) gave history of complications following earlier use and were unwilling for its repeat use. Conclusion: The large unmet need for contraception in India can be solved through repeated counselling and discussions with the woman during her antenatal visits. Alleviating apprehension and addressing concerns of the couple will increase PPIUCD acceptance.
ABSTRACT
Background: This study was conducted to evaluate the acceptance, safety, efficacy, complications and expulsion rate of post-partum intrauterine contraceptive device (PPIUCD) insertion among post-partum pregnant women in a rural tertiary care center. Objective of this study was assessment of the efficacy and safety of post-partum IUCD insertion. Comparing the complications and client satisfaction in both groups (intra caesarean insertion versus vaginal route of insertion).Methods: This is a prospective study conducted at one of the rural tertiary care teaching institution. A total of 150 patients with caesarean or vaginal deliveries had PPIUCD insertions and they were followed up for a period of one year. The outcome measures analyzed were menstrual irregularities, vaginal discharge, pelvic infection and perforation and efficacy measures - failure, expulsion and removal. Data are expressed in frequency and percentage. Chi square test was used for comparison and P value <0.05 was considered significant.Results: The study shows that PPIUCD is an effective intervention in both caesarean and vaginal delivery with non-significant differences in safety and efficacy depending on the route of insertion. There was no case of perforation and no significant risk of infection in either caesareans or delivery. Spontaneous expulsion occurred in two cases inserted by vaginal route. Missing string incidence is high in the caesarean group compared to vaginal insertion.Conclusions: PPIUCD is a safe, effective and long term reversible method of contraception and should be encouraged by public awareness and community acceptance.