Postpartum intrauterine contraception device, a method of contraception: A study from rural north India

Abstract

Background: PPIUCD is not commonly used in developing countries because of lack of awareness, social taboos and fear of complications of IUCD devices. Low acceptance of immediate PPIUCD usage results in high unmet needs and low utilization of the contraceptive method. Therefore we planned this study to see the acceptability and safety of PPIUCD in our local population. Material & Methods: A cross sectional, prospective study was conducted on 2540 women attending antenatal clinic at District hospital Samba, Jammu; Jammu and Kashmir from March 2016 to February 2018. All women attending antenatal clinic and in labour room were counseled for immediate PPIUCD and after written consent were included in the study. All these women were called for follow up visit after 6 weeks of insertion of PPIUCD. Results: A total of 2540 women were counseled for PPIUCD during their antenatal visits in third trimester and in early labour. Out of which 811 (31.9%) PP IUCD insertions were done. Most common age group was 26-30 year. Most of PPIUCD insertions were done in vaginal deliveries i.e. 678(83.6%) out of 811 and intracesarean PPIUCD insertions were only 133(16.40%) out of 811. Most of the women were either Para 2 or Para 1. 396 (48.82%) women came for follow-up after 6 weeks. There was no case of uterine perforation or any unplanned pregnancy. Unusual vaginal discharge were reported by 76(19.19%) women at follow-up. In 32 women IUCD was removed because of heavy menstrual loss, PID and personal reasons. IUCD strings were not seen on per vaginum examination in 40(10.10%) cases. All women with undescended strings underwent ultrasonographic confirmation of intrauterine placement of the device and women were assured for continuation of PPIUCD. Conclusion: To achieve the goal of Health Services for all, all women should have access to family planning services. If family planning services are provided to all women then only we will be able to decrease maternal and infant mortality. Acceptance of PPIUCD as method of contraception is low, though PPIUCD is an effective, safe, rapidly reversible and convenient contraceptive method. PPIUCD should be encouraged considering the advantages that come along, although there is a relatively higher incidence of expulsions. Introduction India's population of over 1.2 billion is stated to overtake China as the world's most populous country in less than one and a half decade. This population size is more than the population size of USA, Brazil, Bangladesh, Pakistan, Indonesia and Japan put together. Family planning is important not only for population stabilization, but it has been increasingly realised that family planning is central to improve maternal and newborn survival and health. Even though India has made considerable progress in reducing maternal mortality ratio, it still contributes 20% of maternal deaths worldwide according to 2012 report of World Bank, UNFPA and WHO. Family planning can avert more than 30% maternal deaths 10% child mortality if couples spaced their pregnancies more than 2 years apart [1]. India was world's first nation to start Family Planning Programme in 1952. Most women do not desire a pregnancy immediately after delivery but are unclear about contraceptive usage in postpartum period. In recent study of postpartum unintended pregnancies 86% resulted from nonuse of contraceptive and 88% ended in abortion [2]. In India 65% of women in first year of postpartum have an unmet need of family planning [3]. Hence providing contraception in this sensitive period is very important. Post partum period is one of the critical time when women need an integrated package of health services including contraceptive devices. At this time women are highly motivated and receptive to accept Family Planning methods [3] .