Severe pain at interval IUD insertion: a case-control analysis of patient risk factors.

This investigation, using a case-control analysis approach on an IUD data set from a less-developed country center, delineated four risk factors in patient characteristics that are associated with severe pain at interval IUD insertion. They are: higher education (greater than or equal to seven years), low-parity (1-2 live births), longer open interval (greater than or equal to 13 months) between the end of the last pregnancy and insertion, and non-breastfeeding at the time of insertion. Adjusted relative risks estimated by odds ratios are 2.1, 2.7, 2.7 and 5.0, respectively. For women with a combination of the above risk factors, they have a further increased (additive in nature) risk of suffering severe insertion pain. Similar analysis was also performed on a developed country center data set for which only the effect of education and parity could be studied; an odds ratio of 5.0 for nulliparity was obtained. The plausibility of these findings as well as their clinical and programmatic implications are discussed.

PIP: This investigation, using a case-control analysis approach on an intrauterine device (IUD) data set from a less-developed country center, delineated 4 risk factors in patient characteristics that are associated with severe pain at interval IUD insertion. They are: higher education ( or = 7 years) low parity (1-2 live births), longer open interval ( or = 13 months) between the end of the last pregnancy and insertion, and non-breast feeding at the time of insertion. Adjusted relative risks estimated by odds ratios are 2.1, 2.7, 2.7, and 5.0 respectively. For women with a combination of the above risk factors, they have a further increased (additive in nature) risk of suffering severe insertion pain. Similar analysis was also performed on a developed country center data set for which only the effect of education and parity could be studied; an odds ratio of 5.0 for nulliparity was obtained. Better educated women are probably less inhibited to complain of pain than less-educated women. A tighter uterine cervix and a smaller uterine cavity in women of low parity may account for IUD insertion pain. Postpartum involution of the uterus could explain pain upon insertion for women with a long open interval. These findings support the hypothesis that cervical stretching and direct endometrial pressure are probably the most important factors for IUD insertion pain.

IUD use effectiveness in an urban Guatemalan clinic.

Contraceptive continuation rates-the rates at which people continue to use a particular contraceptive method-can be a great help in determining whether a family planning program is effective or whether new contraceptive methods should be introduced. Until now, very little systematic work has been done to study contraceptive continuation rates in Latin America. The present article reports the results of one of the few existing studies on this subject, which examined the IUD experiences of women admitted to a large family planning clinic in Guatemala City. The study showed that these experiences compared favorably with the IUD experience of groups previously studied in Costa Rica, Taiwan, and the United States.

PIP: Contraceptive continuation rates were determined for 366 women admitted to a large urban family planning clinic in Guatemala city for their 1st IUD insertion between July 1, 1969-June 30, 1970. Data were recorded and analyzed using multiple decrement life table techniques. 75% of the women were between 20-34 years of age; over 90% had had 2 or more pregnancies. 63% of patients wanted no more children, while 37% wanted to space their children. 87.4% received Size D Lippes Loops and 6.8% Size C Lippes Loops. The cumulative continuation rate at the end of the first 12 ordinal months was 72.1/100 1st insertions; after 2 years, an estimated 56% were continuing IUD use. The median length of use was 27 months. 2.2% of women became pregnant during the 1st year, 3.2% within 2 years. 10% expelled the IUD during the 1st year, 13% during the first 2 years of use. 11% of the women had the IUD removed for medical reasons within 1 year and 19% within 2 years. Except for the 1st month, the cumulative continuation rates for women 15-24 years of age were consistently lower than other age groups. The cumulative continuation rates for women with 2 or more living sons were consistently higher than those with fewer sons; the difference of 14.4/100 1st insertions is the most substantial demographic difference. This study showed results which compare favorably with experience in Costa Rica, Taiwan, and the U.S.

IUD use effectiveness in an urban Guatemalan clinic

Contraceptive continuation rates-the rates at which people continue to use a particular contraceptive method-can be a great help in determining whether a family planning program is effective or whether new contraceptive methods should be introduced. Until now, very little systematic work has been done to study contraceptive continuation rates in Latin America. The present article reports the results of one of the few existing studies on this subject, which examined the IUD experiences of women admitted to a large family planning clinic in Guatemala City. The study showed that these experiences compared favorably with the IUD experience of groups previously studied in Costa Rica, Taiwan, and the United States (Au)

IUD use effectiveness in an urban Guatemalan clinic

Contraceptive continuation rates-the rates at which people continue to use a particular contraceptive method-can be a great help in determining whether a family planning program is effective or whether new contraceptive methods should be introduced. Until now, very little systematic work has been done to study contraceptive continuation rates in Latin America. The present article reports the results of one of the few existing studies on this subject, which examined the IUD experiences of women admitted to a large family planning clinic in Guatemala City. The study showed that these experiences compared favorably with the IUD experience of groups previously studied in Costa Rica, Taiwan, and the United States (Au)