Assessment of knowledge and attitude regarding intrauterine devices among auxiliary nurse midwife in two districts of North Bengal

Romy Biswas, Sharmistha Bhattacherjee, Kuntala Ray, Jayanta K. Roy, Tapas K. Sarkar, Manasi Chakraborty


Background: Despite being one of the most easily available and reversible methods of family planning, IUD utilization continue to remain low, as evident in the nationwide surveys. One of the reasons was poor knowledge and skills on IUD provision among health care providers. This study examined factors related to providers, by examining their IUD-related knowledge, and their attitudes toward recommending or inserting the IUD.

Methods: A descriptive cross sectional study was conducted among 503 ANMs from Uttar Dinajpur and Darjeeling Districts using a semi-structured questionnaire exploring the service providers’ knowledge, current practices and experience with IUD insertion. Attitudes regarding IUDs were assessed by asking how much they agreed with a number of hypothetical statements about the IUD.

Results: The proportion of good knowledge and favourable attitude was 57.5% and 60% respectively. The knowledge was found to be significantly higher among ANMs aged less than 30 years and who had graduate education than their counterparts. Better knowledge and favourable attitude was found among the ANMs posted in Darjeeling and had service experience of more than 5 years.

Conclusions: The knowledge and attitude of the ANMs were found to be less than satisfactory. Addressing IUDs and other newer contraceptives in pre-service curriculum, within job training and peer group education in both public and private areas may help the situation.


IUD, Knowledge, Attitude, ANM, Districts

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Committee on Adolescent Health Care Long-Acting Reversible Contraception Working Group, The American College of Obstetricians and Gynecologists. Committee opinion no. 539: adolescents and long-acting reversible contraception: implants and intrauterine devices. Obstet Gynecol. 2012;120:983–8.

National Family Welfare Programme. Available at Accessed on 10th August 2018.

International Institute for Population Sciences. India National Family Health Survey (NFHS-4), 2017. International Institute for Population Sciences; 2017

Luchowski A, Anderson B, Poer M, et al. Obstetrician-gynecologists and contraception: practice and opinions about the use of IUDs in nulliparous women, adolescents and other patient populations. Contraception. 2014;89:572–577.

IUCD Reference Manual for. Medical Officers and. Nursing Personnel. September 2013. Family Planning Division. Ministry of Health and Family Welfare. Available at: modules/IUCD_Reference_Manual_for_MOs_and_Nursing_Personne_-Final-Sept_2013.pdf. Accessed on 10th August 2018.

Chokshi M, Patil B, Khanna R, et al. Health systems in India. J Perinatol. 2016;36(3):9-12.

Eren N, Ramos R, Gray RH. Physicians vs. auxiliary nurse-midwives as providers of IUD services: a study in Turkey and the Philippines. Studies in family planning. 1983: 43-47.

Pachauri S. Priority strategies for India's family planning programme. The Indian journal of medical research. 2014;140(1):137.

Shoupe D. LARC methods: entering a new age of contraception and reproductive health. Contraception Reprod Med. 2016;1:4.

Robinson N, Moshabela M, Owusu-Ansah L, Kapungu C, Geller S. Barriers to intrauterine device uptake in a rural setting in Ghana. Health care for women international. 2016;37(2):197-215.

Ehsanpour S, Mohammadifard M, Shahidi S, Nekouyi NS. A comparative study on attitude of contraceptive methods users towards common contraceptive methods. Iranian J Nursing Midwifery Res. 2010;15(1):363.

Chakraborty NM, Murphy C, Paudel M, Sharma S. Knowledge and perceptions of the intrauterine device among family planning providers in Nepal: a cross-sectional analysis by cadre and sector. BMC Health Services Res. 2015;15:39.

Gutin SA, Mlobeli R, Moss M, Buga G, Morroni C. Survey of knowledge, attitudes and practices surrounding the intrauterine device in South Africa. Contraception. 2011;83(2):145-50.

Othman AE, Suleiman W. An analysis of causes of poor attitude to work. Procedia-Social Behavioral Sci. 2013;97:194-200.

Espey E, Ogburn T, Espey D, Etsitty V. IUD-related knowledge, attitudes and practices among Navajo Area Indian Health Service providers. Perspect Sex Reprod Health. 2003;35:169–73.

Tyler TR, Schuller RA. Aging and attitude change. Journal of Personality and Social Psychology. 1991;61(5):689.

Diaz-Quijano FA, Martínez-Vega RA, Rodriguez-Morales AJ, Rojas-Calero RA, Luna-González ML, Díaz-Quijano RG. Association between the level of education and knowledge, attitudes and practices regarding dengue in the Caribbean region of Colombia. BMC Public Health. 2018;18(1):143.

Dhimal M, Aryal KK, Dhimal ML, Gautam I, Singh SP, Bhusal CL, et al. Knowledge, attitude and practice regarding dengue fever among the healthy population of highland and lowland communities in Central Nepal. PLoS One. 2014;9(7).