Programmatic experience of post-partum IUD use in Zambia: an observational study on continuation and satisfaction

Abstract

Objectives: The aim of the study was to assess continuation rates and satisfaction among post-partum intrauterine device (PPIUD) accepters.

Methods: This prospective observational study comprised 591 Zambian women who underwent PPIUD insertion at sites of the Society for Family Health, Lusaka, Zambia. The women were contacted 6–12 months after PPIUD insertion and asked to return to the clinic for interview and examination. If the IUD strings were not visible, an ultrasound was performed. Participants were asked about their satisfaction with the PPIUD. Main outcome measures were short-term PPIUD continuation and reported complications according to time of insertion.

Results: Of 591 women enrolled, 305 women attended the follow-up appointment for interview and examination, giving a power of 80% to estimate an expulsion rate of 10 ± 5%. The IUD was inserted within 10 min of placental delivery (post-placental insertion) in 24.3% of participants (n = 74) and within 48 h (immediate post-partum insertion) in 71.1% of participants (n = 217). The total expulsion rate was 5.6%. Expulsion rates for post-placental and immediate post-partum insertions were 10.8% and 4.1%, respectively. No significant difference in expulsion rates was found (p = 0.10). Of those with an expulsion, 76.5% (n = 13) recognised that it had occurred. There were no reported complications, and 94.1% of women reported being satisfied or very satisfied with their PPIUD (n = 287).

Conclusions: Overall, expulsion rates were lower than previously reported, particularly for immediate post-partum insertions. Attention to high fundal placement at insertion is a likely explanation for the low expulsion rates. Contrary to conventional wisdom, these low expulsion rates indicate that previous notions regarding insertion timing may not be accurate. Satisfaction levels were also favourable. PPIUD can be safe, acceptable and feasible in an African setting.

Chinese abstract

目的: 本研究的目的是评估产后宫内节育器（PPIUD）接受者的持续率及满意度。

方法: 本次前瞻性的观察研究包括591名在赞比亚首都卢萨卡的家庭健康协会网点进行过PPIUD植入的赞比亚妇女。在PPIUD放置之后的6-12个月与这些妇女取得联系并请她们回到诊所进行面谈和检查。如果看不到宫内节育器的尾丝, 就行超声检查。参与者会被问及对PPIUD的满意度。根据植入时间, 主要测量短期PPIUD的持续情况和报道的并发症。

结果: 招募的591名妇女中, 305名妇女接受了后续约定的访谈和检查, 其中占80%的大比例评估出了10 ± 5%的排异率。24.3%的参与者（n=74）在胎盘娩出后10分钟内就放入IUD（胎盘娩出后植入）, 71.1%的参与者（n=217）是在产后48小时内植入（产后立即植入）。总排异率是5.6%。胎盘娩出后植入及产后立即植入的排异率分别是10.8%和4.1%。排异率并未发现明显区别（p=0.10）。那些有排异反应的女性中有76.5%（n=13）意识到排异反应已经发生。没有记录到并发症, 且记录到94.1%的妇女对她们的PPIUD满意或者非常满意（n=287）。

结论: 总之, 排异率比之前的报道低, 尤其是对于产后立即植入。注意到植入子宫较高的位置是排异率低的一个可能解释。与传统的观点相反, 这些排异率降低表明之前关于放置时间选择的观念或许是不精确的。满意度也受到了肯定。PPIUD在非洲的环境中可以是安全、可接受以及可行的。

Keywords:

• Contraception
• intrauterine device
• post-partum IUD

Acknowledgements

Authors acknowledge the assistance of Jully Chilambwe, Josselyn Neukom and Nicholas Shiliya from SFH Zambia in overseeing clinical sites, training and analysis.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Funding

Authors acknowledge an anonymous donor to the Women’s Health Project of PSI.