Postplacental Placement of Intrauterine Devices: Acceptability, Reasons for Refusal and Proposals to Increase its Use

Why women refuse Postpartum IUCD?

Background

Women are highly motivated and receptive to accepting family planning methods during the antenatal period. Hence, we conducted this study to evaluate the refusal rate and reasons for the refusal of postpartum Intrauterine Contraceptive Devices (PPIUCD).

Material and Methods

The present cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, at a tertiary Care Centre, on 400 antenatal women from November 2023 for 2 months.

Results

In present study, 331 (82.8%) subjects were knowing condom as contraceptive, followed by 310 (77.5%) subjects knowing about copper T. 282 (70.5%) subjects were knowing tubectomy, 264 (68.5%) were knowing oral contraceptives, 264 (66%) were knowing vasectomy, 205 (51.2%) were knowing natural methods, 179 (44.8%) were knowing injectable contraceptive, 83 (20.8%) were knowing Saheli, and 27 (6.8%) subjects were not knowing any contraceptive method. In total, 185 (46.5%) subjects knew that Copper T could be inserted immediately after delivery followed by 83 (20.9%) who knew that copper T could be inserted after menses. Sixty-nine (17.3%) knew that copper T could be inserted during a cesarean section. A total of 352 (88%) subjects refused postpartum copper T as a method of contraception. Only 48 (12%) subjects were willing to insert postpartum copper T. After counseling, the rate of acceptance of copper T insertion increased from 48 (12%) to 102 (25.5%).

Conclusion

Knowledge of PPIUCD in the present study was good, but the refusal rate was high. The commonest reason was fear of side effects.

Barriers to accessing post-pregnancy contraception in Brazil: The impact of COVID-19

The aim of our article is to discuss barriers associated with post-pregnancy contraception in Brazil during the SARS-CoV-2 (COVID-19) pandemic. Socioeconomic differences in gaining access to long-acting reversible contraceptive (LARC) methods became greater during the COVID-19 pandemic. The inadequate distribution of existing resources and the reduced capacity for elective care meant that healthcare providers in family planning had to be reallocated to respond to COVID-19 emergencies. In Brazil, 74% of the population depends on the national health service (Sistema Unico de Saúde) including for the provision of free contraception. However, the only LARC method available at the public service is the copper-intrauterine device (IUD); implants and hormonal-IUDs are not available, except at some teaching hospitals. Contraceptive sales remained unmodified during the pandemic, which shows that the majority of the population used less effective or no contraceptive methods during this time. However, sales of implants and the hormonal-IUD increased significantly, indicating the inequity of the low-income portion of the society as only the wealthy can afford these. On the other hand, there was an increase in sales of emergency contraception. The uptake of postpartum IUDs and contraceptive implants at the selected teaching hospitals in which they were available was high during the COVID-19 pandemic as they were the only methods immediately available. In conclusion, the COVID-19 pandemic increased both inequality and social differences in gaining access to contraceptives. Postpartum and immediate post abortion methods were also good strategies during the pandemic and were well accepted by the population. However, they were not offered by most services.

Women's experiences with the post-placental intrauterine device: a qualitative study

Objective

To explore women's experiences with postpartum intrauterine device (PPIUD) insertion and the decision-making process in the postpartum period.

Methods

A qualitative design was employed with face-to-face interviews using a semi-structured script of open questions. The sample was intentionally selected using the concept of theoretical information saturation.

Results

Interviews were conducted (1) in the immediate postpartum period, and (2) in the postpartum appointment. 25 women (N = 25) over 18 years old who had a birth followed by PPIUD insertion were interviewed between October 2021 and June 2022. Three categories were constructed: (1) Choice process, (2) Relationship with the health team at the time of birth and the postpartum period, and (3) To know or not to know about contraception, that is the question.

Conclusion

Professionals' communication management, popular knowledge, advantages of the PPIUD and the moment PPIUD is offered play a fundamental role in the construction of knowledge about the IUD. Choice process did not end in the insertion.

Knowledge, Attitude, and Practice of Brazilian Physicians about Immediate Postpartum and Postabortion Intrauterine Device Insertion

OBJECTIVE

 To assess the knowledge, attitude, and practice of Brazilian physicians about immediate postpartum and postabortion intrauterine device insertion.

METHODS

 Cross-sectional online survey involving physicians on duty in public Brazilian hospitals. Participants answered an anonymous questionnaire with close-ended questions to assess their knowledge, attitude, and experience on the immediate postpartum and postabortion insertion of copper intrauterine devices.

RESULTS

 One hundred twenty-seven physicians working in 23 hospitals in the 5 geographic regions of Brazil completed the questionnaire. Most were female (68.5%) and worked in teaching hospitals (95.3%). The mean (standard deviation) knowledge score (0-10 scale) was 5.3 (1.3); only 27.6% of the participants had overall scores ≥ 7.0. Most physicians (73.2%) would insert a postpartum intrauterine device in themselves/family members. About 42% of respondents stated that they had not received any training on postpartum or postabortion intrauterine device insertion. In the past 12 months, 19.7%, 22.8%, and 53.5% of respondents stated they had not inserted any intrauterine device during a cesarean section, immediately after a vaginal delivery, or after an abortion, respectively.

CONCLUSION

 Most study participants have a positive attitude toward the insertion of intrauterine devices in the immediate postpartum period, but they have limited knowledge about the use of this contraceptive method. A large percentage of respondents did not have previous training on postpartum and postabortion intrauterine device insertion and had not performed any such insertions in the last 12 months. Strategies are needed to improve the knowledge, training, and experience of Brazilian physicians on immediate postpartum and postabortion intrauterine device insertion.

Acceptance rate of post-placental plac ement of intrauterine devices during the SARS-CoV-2 (COVID-19) pandemic

OBJECTIVE

To evaluate the acceptance rate of post-placental intrauterine device (PPIUD) placement during the SARS-CoV-2 (COVID-19) pandemic and to to assess factors associated with PPIUD acceptance.

METHODS

A cross-sectional study was conducted between August 2020 and August 2021. PPIUDs were offered to women scheduled for caesarean delivery or admitted in labour at the Women's Hospital of the University of Campinas. The study compared women according to whether they accepted or did not accept the IUD placement. The factors associated with PPIUD acceptance were analysed through bivariate and multiple logistic regression analyses.

RESULTS

We enrolled 299 women (15.9% of the deliveries that occurred during study period), aged 26.8 ± 6.5 years; 41.8% were White, almost one third were primiparous, and 155/299 (51.8%) had a vaginal delivery. The PPIUD acceptance rate was 65.6%. The principal reason for refusal was the desire for another contraceptive (41.8%). Women with the highest likelihood of accepting a PPIUD were younger (<30 years old has 1.7 more likely or 74% greater), those without a partner (3.4 times more likely) and those after vaginal delivery (1.7 times more likely or 69% greater).

CONCLUSION

The COVID-19 does not affected the PPIUD placement. PPIUD is a viable alternative during crisis in which women has difficult to access health services. Younger women, those without a partner and after vaginal delivery were more likely to accept a PPIUD during the COVID-19 pandemic.

Immediate Postpartum Insertion of Copper Intrauterine Device in a Brazilian University Hospital: Expulsion and Continuation Rates

OBJECTIVE

 To evaluate the expulsion and continuation rates of the copper intrauterine device (IUD) inserted in the immediate postpartum period in a Brazilian public university hospital.

MATERIALS AND METHODS

 In the present cohort study, we included women who received immediate postpartum IUD at vaginal delivery or cesarean s March 2018 to December 2019. Clinical data and the findings of transvaginal ultrasound (US) scans performed 6-weeks postpartum were collected. The expulsion and continuation rates were assessed 6-months postpartum using data from the electronic medical records or by telephone contact. The primary outcome was the proportion of IUDs expelled at 6 months. For the statistical analysis, we used the Student t-test, the Poisson distribution, and the Chi-squared test.

RESULTS

 There were 3,728 births in the period, and 352 IUD insertions were performed, totaling a rate of 9.4%. At 6 weeks postpartum, the IUD was properly positioned in 65.1% of the cases, in 10.8% there was partial expulsion, and in 8.5% it had been completely expelled. At 6 months postpartum, information was obtained from 234 women, 74.4% of whom used IUD, with an overall expulsion rate of 25.6%. The expulsion rate was higher after vaginal delivery when compared with cesarean section (68.4% versus 31.6% respectively; p = 0.031). There were no differences in terms of age, parity, gestational age, final body mass index, and newborn weight.

CONCLUSION

 Despite the low insertion rate of copper IUDs in the postpartum period and a higher expulsion rate, the rate of long-term continuation of intrauterine contraception was high, indicating that it is a useful intervention to prevent unwanted pregnancies and to reduce short-interval birth.