Understanding factors associated with continuation of intrauterine device use in Gujarat and Rajasthan, India: a cross-sectional household study

Figures & data

Table 1. Demographic characteristics and IUD behaviours of respondents

	IIUD	PPIUD	Total
	N = 1012	N = 4012	N = 5024
Mean age	27.75	25.11	25.6
Education level
No schooling	14.9%	25.4%	23.3%
Primary	18.0%	19.0%	18.8%
Middle	20.4%	23.1%	22.5%
Higher secondary	32.7%	27.7%	28.7%
Graduate and above	14.0%	4.8%	6.6%
Mean number of living children	2.2	2.2	2.2
Occupation
Homemaker	83.1%	83.4%	83.4%
Labourer	6.8%	8.6%	13.4%
Skilled worker, service, business	6.8%	2.8%	3.6%
Ever used a contraceptive method prior to adopting an IUD	65.3%	52.6%	55.1%
Place of IUD insertion
District hospital	24.2%	23.6%	23.7%
Subdistrict hospital	13.8%	15.5%	15.2%
Community health centre	62.0%	60.8%	61.1%

Figure 1. IUD continuation rates at 3, 6, and 12 months

Table 2. Timing of and reason for IUD removal

	IIUD	PPIUD	Total
	N = 1012	N = 4012	N = 5024
% of users who removed their IUDs	14.1%	19.1%	18.1%
	N = 143	N = 766	N = 909
Timing of removal
1–2 months	44.8	48.3	47.7
3–4 months	16.1	16.4	16.4
5 or more months	39.2	35.2	35.9
Place of removal
At the facility where IUD was inserted	86.0	79.5	80.8
At another government health centre	7.0	10.6	10.0
With a private practitioner	7.0	9.7	9.2
Reasons for removal
Side effects or other problems	87.4	83.3	83.9
Spouse or family opposition	9.8	9.1	9.2
Desire to conceive	7.0	8.6	8.4
Decision to undergo sterilisation	0.7	3.6	3.2
Method failure	0.7	0.8	0.8

Table 3. Pregnancy and contraceptive use among IUD discontinuers

	IIUD	PPIUD	Total
	N = 1012	N = 4012	N = 5024
% of IUD users who discontinued	17.0% (N = 172)	24.6% (N = 988)	23.1% (N = 1160)
% of discontinuers currently pregnant	5.6%	4.1%	4.4%
% of discontinuers currently using another contraceptive method	48.8% (N = 84)	41.7% (N = 412)	42.7% (N = 496)
Type of method currently used
Condoms	44.1%	45.9%	41.7%
Female sterilisation	34.0%	39.6%	38.7%
Oral contraceptives	19.0%	10.0%	11.5%
Traditional methods	4.8%	8.5%	5.4%
Injectables	4.8%	3.9%	2.2%
Male sterilisation	0.0%	0.5%	0.4%

Table 4. Quality of care and client satisfaction

	IIUD	PPIUD	Total
	N = 1012	N = 4012	N = 5024
Quality of care
Counselled about IUD prior to insertion	93.8%	88.4%	89.5%
Timing of counselling
During antenatal period	32.8%	77.9%	68.3%
Early labour	13.0%	51.7%	43.5%
Post partum period (within 48 h)	52.4%	56.7%	55.8%
During interval period (for interval IUD clients)	66.5%		14.0%
Received information about IUD side effects	84.2%	75.0%	76.9%
Counselled about how to manage side effects	90.4%	83.4%	84.8%
Asked to return for follow-up care	89.8%	81.7%	83.3%
Client satisfaction	97.3%	96.3%	96.5%
Would use facility for other health services	98.1%	97.6%	97.7%
Would recommend this facility to others	98.4%	96.7%	97.1%
Would recommend IUDs to other women	94.8%	89.1%	90.2%
Among those satisfied with services, satisfaction with different attributes	N = 985	N = 3863	N = 4848
Counselling services	50.1%	45.4%	46.3%
Behaviour of staff	67.6%	66.6%	66.8%
Availability of medicines	51.0%	53.7%	53.1%
Timeliness of services	55.2%	54.1%	54.3%

Table 5. Adjusted odds ratio (AOR) from multivariate logistic regression analyses

	AOR	Sig.	Lower CI	Upper CI
IUD experiences
Quality of care
Counselled before insertion	2.01	<0.001**	1.24	3.26
Felt conversation would remain confidential	0.96	0.74	0.74	1.24
Counselled about side effects	0.92	0.41	0.76	1.12
Asked to return for follow-up care	1.13	0.37	0.86	1.48
Satisfied with services	2.51	<0.001**	1.67	3.76
Experiences after insertion
Experienced problem(s) after insertion	15.77	<0.001**	12.71	19.56
Attended a follow-up visit	0.92	0.41	0.76	1.12
Decision-maker for IUD adoption
Self (Ref)	–	–	–	–
Provider	1.07	0.71	0.77	1.48
Self + Provider	1.22	0.15	0.93	1.60
Spouse	1.06	0.83	0.63	1.80
Self + Spouse	1.33	0.01*	1.06	1.66
Other(s)	0.89	0.74	0.44	1.79
Timing of insertion
Postpartum (Ref)	–	–	–	–
Interval	1.36	0.01*	1.09	1.71
Facility of insertion
District hospital (ref)	–	–	–	–
Community health centre	1.22	0.04*	1.01	1.48
Subdistrict hospital	0.95	0.71	0.73	1.24
History of contraceptive use
Used other family planning method(s) before IUD	1.32	<0.001**	1.11	1.56
Sociodemographic characteristics
Age
18–24 years (ref)	–	–	–	–
25–34 years	0.90	0.28	0.75	1.09
35 and above	1.23	0.44	0.72	2.10
Parity
1 child (ref)	–	–	–	–
2 children	0.87	0.20	0.71	1.07
3 children	0.69	0.01**	0.54	0.90
4 or more children	0.69	0.03*	0.50	0.96
Occupation
Homemaker (ref)	–	–	–	–
Labourer	1.27	0.06	0.99	1.62
Skilled worker, service, business	0.86	0.49	0.56	1.32
Education and literacy
Illiterate (Ref)	–	–	–	–
Primary	1.37	0.01**	1.06	1.76
Middle	1.39	0.01**	1.08	1.79
Secondary	1.41	0.01**	1.10	1.81
Graduate and above	1.63	0.01**	1.10	2.41
State
Rajasthan (Ref)	–	–	–	–
Gujarat	1.84	<0.001**	1.53	2.20

Note: Chi-square: 1117.6 (df 27) p < 0.001; Nagelkerke R Square: 0.33.

*p-value of less than 0.05.

**p-value of less than 0.001.

Data availability

The data that support the findings in this study are available from the corresponding author upon request.