Postpartum intrauterine contraceptive device: effect of antenatal versus postpartum counselling in acceptance of postpartum intrauterine contraceptive device

ABSTRACT

Background: The acceptance for PPIUCD in our country, especially in rural areas is very low despite all the efforts. Counselling during the antenatal visits may play a vital role in improving the acceptance of PPIUCD. Objective of this study was to assess the factors associated with the acceptability of immediate PPIUCD insertion in women; counselled during antenatal and postpartum period; according to their sociodemographic and obstetric characteristics, and future pregnancy desires.Methods: One-year prospective study carried out in the department of obstetrics and gynecology, S. S. Medical College Rewa, Madhya Pradesh, India. a total of 4850 women were counselled for PPIUCD insertion; 2540 during their antenatal visits, and 2310 during postpartum period who visited in study centre for first time and their follow up was done. Chi square tests were applied to compare proportions.Results: After antenatal counselling in 2540 women, (with multiple counselling sessions) about half of the women gave verbal acceptance for PPIUCD. However, during postpartum counselling in 2310 women, (where only single short session of counselling could be done) majority of the women declined (80.9%) for PPIUCD insertion with only about a fifth (19.1%) of the women giving verbal acceptance. Women who had antenatal counselling one third of them had PPIUCD insertion. In the postpartum counselling group, a meagre 15.1% women had PPIUCD insertion.Conclusions: Counselling during antenatal and postpartum period is the key to improve the awareness and acceptance of PPIUCD in our community. Multiple counselling sessions during antenatal visits make it easier for the women to slowly understand the process and accept PPIUCD as compared to the short counseling during postpartum period.