Acceptability and safety of postpartum intrauterine contraceptive device among parturients at Muhimbili national hospital, Tanzania.

Abstract

Background: In Tanzania the general use of modern methods of contraception is twenty seven percent with less than two percent of the women adopting the IUCD as a method of contraception. The modern IUCD is a highly effective, safe, private, long-acting, coitus independent and rapidly reversible method of contraception with few side effects. Intrauterine contraception is the most cost-effective method of contraception today. The postpartum insertion of an IUCD provides a convenient opportunity for the woman to receive IUCD services. This is particularly important for women who have limited access to medical care. The postpartum period is potentially an ideal time to begin contraception as women are more strongly motivated to do so at this time, which also has the advantage of being convenient for both patients and health-care providers. Objectives: To assess acceptability and safety of immediate Postpartum Intrauterine Contraceptive Device (PPIUCD) among parturients at Muhimbili National Hospital (MNH). Methodology: A prospective interventional analytical study was conducted from 1st August to 31st December 2011.Contraceptive counseling was given to 369 eligible parturients after delivery during their postpartum hospitalization. A pretested structured questionnaire was administered to all participants. Women who accepted the PPIUCD during their postpartum care were inserted with the device before discharge (within 48 hours). These women were followed up at 4 weeks for complications. The acceptance rate of PPIUCD and the percentage of actual insertions were recorded. The reasons for both acceptance and decline were also recorded. Results: Of the 369 women counseled, a total of 102 (27.6%) were inserted with PPIUCD. Parturients who had a short duration from their last child birth (less than 2 years) were significantly associated with greater acceptance of the PPIUCD (p ≤ 0.05). Parturients who had previously used the interval IUCD were significantly associated with greater acceptance of PPIUCD (p = 0.005). Preference to other methods of contraception mainly short acting methods, and the need to discuss with their partners were the most common reasons for vii declining use of PPIUCD. More than half (55%) of the women whom PPIUCD was inserted did so due to its long term effect. Immediate PPIUCD was demonstrably safe due to its low rates of complications. The common complications at four weeks interval were expulsion (6.4%) and lost strings (5.3%). Conclusion: Acceptance of PPIUCD was relatively high probably because of its ‘newness’ in the community. For these women, the best opportunity to receive information about contraception is during child birth when they are in contact with healthcare providers. It is also important to emphasize and educate women on long term methods of contraception as majority of the women preferred short term methods despite their future pregnancy desires of more than three years. Couple counseling should also be promoted. The government needs to develop strategies to increase public awareness of the PPIUCD through different media sources.