Determinants of postpartum intrauterine contraceptive device use: a case-control study at a tertiary care center in India

Pragati Kapse; Smita Andurkar

doi:10.18203/2394-6040.ijcmph20260674

Authors

Pragati Kapse Department of Community Medicine, Government Medical College, Chhatrapati Sambhajinagar, Maharashtra, India
Smita Andurkar Department of Community Medicine, Government Medical College, Chhatrapati Sambhajinagar, Maharashtra, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20260674

Keywords:

Counseling, Family planning, India, Intrauterine contraceptive device, Postpartum contraception

Abstract

Background: Postpartum intrauterine contraceptive devices (PPIUCD) offer safe, effective, long-term contraception during the immediate postpartum period. Despite its advantages, acceptance remains low in India. Understanding the determinants of PPIUCD use is crucial for improving family planning services. This study aimed to identify determinants of PPIUCD use among postnatal women at a tertiary care center and determine their strength of association.

Methods: A hospital-based case-control study was conducted from March 2023 to February 2025. Cases included 70 postnatal women using PPIUCD, and controls included 70 age-matched postnatal women not using PPIUCD. Data were collected using predesigned questionnaires covering sociodemographic characteristics, reproductive history, and obstetric factors. Univariate and multivariate logistic regression analyses were performed.

Results: The mean age was 24.57±3.87 years among cases and 23.85±3.70 years among controls. Significant determinants in univariate analysis included education level, husband's education and occupation, age at marriage, fertility preference, planned pregnancy, PPIUCD counseling, gravidity, and parity. In multivariate analysis, joint decision-making on family size (OR: 0.043, 95% CI: 0.007-0.275), planned pregnancy (OR: 2.674, 95% CI: 1.022-6.995), PPIUCD counseling (OR: 12.674, 95% CI: 4.668-34.411), and multiparity (OR: 0.147, 95% CI: 0.055-0.393) remained significant determinants.

Conclusions: PPIUCD counseling emerged as the strongest predictor of acceptance. Comprehensive antenatal counseling involving both partners, promoting planned pregnancies, and addressing cultural barriers through community education are essential for improving PPIUCD uptake.

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References

Ministry of Health and Family Welfare, New Delhi. Postpartum IUCD Reference Manual, Family Planning Division, 2010. Available at: https://nhm.gov.in/images/pdf/programmes/familyplaning/guidelines/PPIUCD%20Reference%20Manual.pdf. Accessed on 01 March 2024.

Gonie A, Worku C, Assefa T, Bogale D, Girma A. Acceptability and factors associated with post-partum IUCD use among women who gave birth at Bale zone health facilities, Southeast-Ethiopia. Contracept Reprod Med. 2018;3(1):16. DOI: https://doi.org/10.1186/s40834-018-0071-z

Gupta S, Bansal R, Shergill HK, Sharma P, Garg P. Correlates of post-partum intra-uterine copper-T devices (PPIUCD) acceptance and retention: an observational study from North India. Int J Reprod Contracept Obstet Gynecol. 2017;6(7):2887-91.

Kant S, Archana S, Singh AK, Ahamed F, Haldar P. Acceptance rate, probability of follow-up, and expulsion of postpartum intrauterine contraceptive device offered at two primary health centers, North India. J Family Med Prim Care. 2021;10(2):780-5.

International Institute for Population Sciences (IIPS), ICF. National Family Health Survey (NFHS-5), 2019-21: India. Mumbai: IIPS; 2021. Available at: https://dhsprogram.com/pubs/pdf/FR375/FR375.pdf. Accessed 01 April 2024.

International Institute for Population Sciences (IIPS), ICF. National Family Health Survey (NFHS-5), 2019-21: Maharashtra. Mumbai: IIPS; 2021. Available from: https://dhsprogram.com/pubs/pdf/FR374/FR374_Maharashtra.pdf. Accessed 01 April 2024.

Mishra S. Evaluation of safety, efficacy, and expulsion of Post-Placental and Intra-Cesarean Insertion of Intrauterine Contraceptive Devices (PPIUCD). J South Asian Feder Obst Gyn. 2014;6(3):134-8. DOI: https://doi.org/10.1007/s13224-014-0550-3

Park K. Park’s Textbook of Preventive and Social Medicine. 28th ed. Jabalpur: Banarasidas Bhanot; 2025.

Iftikhar PM, Shaheen N, Arora E. Efficacy and satisfaction rate in postpartum intrauterine contraceptive device insertion: a prospective study. Cureus. 2020;12(5):e8033. DOI: https://doi.org/10.7759/cureus.5646

Divakar H, Bhardwaj A, Purandare CN, Sequeira T, Sanghvi P. Critical factors influencing the acceptability of post-placental insertion of intrauterine contraceptive device: a study in six public/private institutes in India. J Obstet Gynaecol India. 2019;69(4):344-9. DOI: https://doi.org/10.1007/s13224-019-01221-7

Mohammed SJ, Kelbore WG. Determinants of postpartum IUCD utilization among mothers who gave birth in gamo zone public health facilities, southern Ethiopia: a case-control study. Open Access J Contracept. 2020;11:109-20. DOI: https://doi.org/10.21203/rs.2.13077/v1

Kanakuze CA, Kaye DK, Musabirema P, Nkubito P, Mbalinda SN. Factors associated with the uptake of immediate postpartum intrauterine contraceptive devices (PPIUCD) in Rwanda: a mixed methods study. Contracept Reprod Med. 2021;6(1):28. DOI: https://doi.org/10.1186/s12884-020-03337-5

Pradhan S, Kshatri JS, Sen R, Behera AA, Tripathy RM. Determinants of uptake of post-partum intra-uterine contraceptive device among women delivering in a tertiary hospital, Odisha, India. Int J Reprod Contracept Obstet Gynecol. 2017;6(20):2017-20.

Assefaw M, Azanew G, Engida A, Tefera Z, Gashaw W. Determinants of postpartum intrauterine contraceptive device uptake among women delivering in public hospitals of South Gondar Zone, Northwest Ethiopia, 2019: An Unmatched Case-Control Study. Int J Reprod Med. 2021;2021(1):6685929. DOI: https://doi.org/10.1155/2021/1757401

Guye AH, Kanea EB, Nigussie T, Girma D, Shambi DB. Utilization of immediate postpartum intrauterine device and its associated factors among women who gave birth in public hospitals in West Wollega Zone, Oromia, Ethiopia. Contracept Reprod Med. 2020;5(1):6.

Kumar S, Sethi R, Balasubramaniam S. Women's experience with postpartum intrauterine contraceptive device use in India. BMC Public Health. 2014;14:666. DOI: https://doi.org/10.1186/1742-4755-11-32

Daba G, Deressa JT, Sinishaw W. Assessment of intention to use postpartum intrauterine contraceptive device and associated factors among pregnant women attending antenatal clinics in Ambo town public health institutions, Ethiopia, 2018. Contracept Reprod Med. 2021;6(1):9. DOI: https://doi.org/10.1186/s40834-021-00152-x

Pradhan S, Mohanty S, Mishra SS. Determinants of uptake of post-partum intra-uterine contraceptive device among women delivering in a tertiary hospital, Odisha, India. Int J Reprod Contracept Obstet Gynecol. 2017;6(5):2017-20. DOI: https://doi.org/10.18203/2320-1770.ijrcog20171968

Jairaj S, Dayyala S. A cross sectional study on acceptability and safety of IUCD among postpartum mothers at tertiary care hospital, Bangalore. J Clin Diagn Res. 2015;9(12):LC01-4. DOI: https://doi.org/10.7860/JCDR/2016/16871.7020

Nigam A, Ahmad A, Sharma A, Saith P, Batra S. Postpartum intrauterine device refusal in Delhi: reasons analyzed. J Obstet Gynaecol India. 2015;65(5):325-8.

Husain S, Gupta S. A prospective study of acceptance, safety, and efficacy of immediate postplacental insertion of intrauterine device (Cu-375) in a tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2017;6(7):3031-5.

Kant S, Archana S, Singh AK, Ahuja RC, Haldar P, Pandav CS. Acceptance rate, probability of follow-up, and expulsion of postpartum intrauterine contraceptive device offered at two primary health centers, North India. J Family Med Prim Care. 2016;5(4):775-8. DOI: https://doi.org/10.4103/2249-4863.201173

Tounkara MS, Sangho O, Maguiraga MY, Diallo AS, Seck I, Diop Y, et al. A mixed-methods study of factors influencing postpartum intrauterine device uptake after postpartum family planning counseling in Mali. PLoS One. 2022;17(11):e0278025. DOI: https://doi.org/10.1371/journal.pone.0276193

Sharma A, Gupta V, Bansal S. A prospective study to assess awareness, acceptability and satisfaction of postpartum intrauterine contraceptive device among women delivering at a tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2017;6(9):4195-201.

Chauhan R, Sharma S, Kaul P. Acceptability and continuation of immediate postpartum IUCD (PPIUCD)-a five year experience at tertiary care centre. Indian J Obstet Gynecol Res. 2016;3(4):365-9.

Chethan R, Patil SN. Acceptance, efficacy, expulsion, safety of post placental and intra-cesarean insertion of intrauterine contraceptive devices (PPIUCD). Int J Reprod Contracept Obstet Gynecol. 2015;4(6):2048-53.