Usage of postpartum intrauterine contraceptive device (postpartum-IUD) after an increase in the institutional delivery rate in India: time to re-visit the effect of timing of counselling on its acceptance

Abstract

Purpose

While increase in institutional deliveries brings an opportunity to counsel women for postpartum family planning (PPFP), its uptake remains low. Reasons for poor acceptance of postpartum intrauterine contraceptive device (postpartum-IUD), and its relation with the timing of counselling need to be investigated.

Methods

Women attending the antenatal clinic, reporting in labour, and within 48 h of delivery respectively were invited to participate. Eligible women were asked about awareness and choice for PPFP. After counselling, acceptance for PPFP was compared with the baseline. Acceptance and continuation of postpartum-IUD were compared between women counselled in the antenatal, intrapartum, and postpartum periods.

Results

Only 23% of 360 women were aware of postpartum-IUD. After counselling, acceptance for PPFP increased from 14% to 97% and for postpartum-IUD, from 0.5% to 33.9%. Acceptance of postpartum-IUD among women counselled in the antenatal, intrapartum and postpartum period was 45%, 35% and 21.7% respectively. Acceptance was higher among the antenatal-counselling group than the postpartum-counselling group (OR 0.45; CI 0.22–0.94; p = 0.03).

Conclusion

Counselling, irrespective of its timing, improves acceptance for PPFP. Acceptance and continuation of postpartum-IUD are higher following counselling in antenatal period. All eligible women should be counselled irrespective of ‘when’ they approach the facility.

Short Condensation

Acceptance for postpartum-IUD is maximum when women are counselled in the antenatal period. With a surge in institutional deliveries, the opportunity to counsel women in the intrapartum and postpartum period should not be missed as this also increases acceptance for PPFP and postpartum-IUD.

摘要

目的：虽然医疗机构分娩率增加为产妇提供了产后计划生育（postpartum family planning, PPFP）咨询的机会, 但其接受率仍很低。需要调查产后宫内节育（Postpartum Intrauterine Contraceptive, Postpartum-IUD）的低接受度与咨询时间的关系。

方法：分别邀请产前、产时和产后48小时内的妇女参加, 符合条件的妇女被问及对PPFP的认识和选择。咨询后, 将PPFP接受率与基线进行比较。比较了产前、产时和产后接受咨询的妇女对产后宫内节育器的接受程度和继续使用情况。

结果：360名妇女中, 仅有23%知道产后宫内节育器。咨询后, PPFP的接受率充14%提高到97%, 产后宫内节育器的接受率从0.5%提高到33.9%。产前、产时和产后接受咨询的妇女, 产后宫内避孕器的接受度分别为45%、35%和21.7%, 产前咨询组的接受率高于产后咨询组（OR 0.45；CI 0.22-0.94；p=0.03）。

结论：PPFP咨询能够提高PPFP的接受度, 与咨询的时间无关。产前咨询后, 产后宫内节育器的接受率和持续率较高。不管孕产妇何时进入医疗机构, 都推荐为她们提高PPFP咨询。

Keywords:

• Postpartum-IUD
• awareness
• acceptance
• continuation
• counselling
• PPFP

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Institute’s own Research Grant Cell.