To Determine the Frequency of Discontinuation of Post-Partum Intra Uterine Contraceptive Device (PPIUCD) within 3 Months and its Causes

Frequency of Discontinuation of PPIUCD

Authors

  • Qamar Zaman Mand Services Hospital/ Services Institute of Medical Sciences, Lahore, Pakistan
  • Madeeha Rashid Lady Willingdon Hospital/ King Edward Medical University, Lahore, Pakistan
  • Mawrah Mughal Lady Willingdon Hospital/ King Edward Medical University, Lahore, Pakistan
  • Iqra Matloob Services Hospital/ Services Institute of Medical Sciences, Lahore, Pakistan
  • Asifa Noreen Services Hospital/ Services Institute of Medical Sciences, Lahore, Pakistan
  • Kiren Khurshid Lady Willingdon Hospital/ King Edward Medical University, Lahore, Pakistan
  • Muhammad Usman Agha Khan Medical University, Karachi, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v4i06.889

Keywords:

Intrauterine Devices, Discontinuation, Side Effects

Abstract

Pakistan has a high fertility rate of 3.8 and a low contraceptive prevalence of 35%. Worldwide studies have shown that poorly spaced pregnancies have a negative impact on both the health of mothers and their children. Objective: To determine the frequency of early discontinuation of post-partum intra uterine contraceptive device within 3 months and its causes. Methods: A quantitative cross-sectional study was carried out at Services Hospital Obstetrics and Gynecology unit Lahore for a period of 6 months from 1st October 2022 to 31st March 2023. 236 pregnant women who underwent post-partum intra uterine contraceptive device insertion and agreed for a follow up were recruited after written consent. They were followed up by the researcher himself for 3 months. The data (age, parity, literacy, early discontinuation (yes/no) and factors for discontinuation i.e. side effects, discontinuation for their husband’s dislike or in-law’s opposition and desire for more children was recorded on a specially designed proforma. Results: The frequency of early discontinuation of IUCD was found in 51 (21.61%) patients. Among the causes, side effects (60.78%) was the main cause of discontinuation followed by discontinuation due to their husband’s dislike or in-law’s opposition (21.57%), desire for more children (5.88%) and myths (3.92%). Conclusions: This study concluded that about one third of the patient’s frequency of early discontinuation of IUCD was 21.61% with side effects being the main cause of discontinuation followed by discontinuation due to their family pressure

References

National Institute of population studies (Pakistan). Pakistan Demographic and Health Survey 2012-13. National Institute of population studies Pakistan. 2013. [Last Cited: 17th Jul 2023]. Available at: https://dhsprogram.com/pubs/pdf/fr290/fr290.pdf.

Shukla M and Qureshi S. Post-placental intrauterine device insertion-A five-year experience at a tertiary care centre in north India. The Indian Journal of Medical Research. 2012 Sep; 136(3): 432.

Lopez LM, Bernholc A, Hubacher D, Stuart G, Van Vliet HA. Immediate postpartum insertion of intrauterine device for contraception. The Cochrane Database Systematic Reviews. 2015 Jun; (6): CD003036. doi: 10.1002/14651858.CD003036.pub3. DOI: https://doi.org/10.1002/14651858.CD003036.pub3

Borthakur S, Sarma AK, Bhattacharjee AK, Deka N. Acceptance of post-partum intra-uterine contraceptive device (PPIUCD) among women attending Gauhati Medical College and Hospital (GMCH) for delivery between January 2011 to December 2014 and their follow up. Journal of Evolution of Medical and Dental Sciences. 2015 Nov; 4(92): 15756-9. doi: 10.14260/jemds/2015/2276. DOI: https://doi.org/10.14260/jemds/2015/2276

Deshpande S, Gadappa S, Yelikar K, Wanjare N, Andurkar S. Awareness, acceptability and clinical outcome of post-placental insertion of intrauterine contraceptive device in Marathwada region, India: Indian Journal of Obstetrics and Gynecology Research. 2017 Jun; 4(1): 77-82.

Jairaj S and Dayyala S. A cross sectional study on acceptability and safety of IUCD among postpartum mothers at tertiary care hospital, Telangana. Journal of Clinical and Diagnostic Research: JCDR. 2016 Jan; 10(1): LC01. doi: 10.7860/JCDR/2016/16871.7020. DOI: https://doi.org/10.7860/JCDR/2016/16871.7020

Tomar B, Saini V, Gupta M. Post-partum intrauterine contraceptive device: acceptability and safety. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2018 May; 7(5): 2011-8. doi: 10.18203/2320-1770.ijrcog20181948. DOI: https://doi.org/10.18203/2320-1770.ijrcog20181948

Goldstuck ND and Wildemeersch D. Prevention of intrauterine contraceptive device expulsion and intolerance: determination of the anchor mechanism. Clinical Obstetric Gynecology Reproductive Medicine. 2017; 3(1): 1–8. doi: 10.15761/COGRM.1000173. DOI: https://doi.org/10.15761/COGRM.1000173

Fekadu GA, Omigbodun AO, Roberts OA, Yalew AW. Factors associated with early long-acting reversible contraceptives discontinuation in Ethiopia: evidence from the 2016 Ethiopian demographic and health survey. Archives of Public Health. 2020 Dec; 78: 1-0. doi: 10.1186/s13690-020-00419-w. DOI: https://doi.org/10.1186/s13690-020-00419-w

Bryant AG, Gottert A, Stuart GS, Hamela G, Kamanga G. Reasons for intrauterine device use, discontinuation and non-use in Malawi: a qualitative study of women and their partners. African Journal of Reproductive Health. 2015 Dec; 19(4): 50-7.

Azmat SK, Shaikh BT, Hameed W, Bilgrami M, Mustafa G, Ali M, et al Rates of IUCD discontinuation and its associated factors among the clients of a social franchising network in Pakistan. BMC Women's Health. 2012 Dec; 12(1): 1-8. doi: 10.1186/1472-6874-12-8. DOI: https://doi.org/10.1186/1472-6874-12-8

Thapa S. Early discontinuation of intrauterine device in Nepal–a retrospective study. WHO South-East Asia Journal of Public Health. 2012 Jul; 1(3): 309-19. doi: 10.4103/2224-3151.207027. DOI: https://doi.org/10.4103/2224-3151.207027

Rasheed SM and Abdelmonem AM. Complications among adolescents using copper intrauterine contraceptive devices. International Journal of Gynecology & Obstetrics. 2011 Dec; 115(3): 269-72. doi: 10.1016/j.ijgo.2011.07.014. DOI: https://doi.org/10.1016/j.ijgo.2011.07.014

Eber M. Comprehensive Approach to IUD Promotion in Pakistan. USAID. 2006. [Last Cited: 26th Oct 2012]. Available at: http://www.k4health.org/sites/default/files/Comprehensive%20approach%20to%20iud%20prom%20in%20pakistan.pdf.

United Nations Department of Economic and Social Affairs. World Contraceptive Use 2011. United Nations. Population Division. 2011. [Last Cited: 27th Oct 2012]. Available at:http://www.un.org/esa/population/publications/contraceptive2011/contraceptive2011.htm.

National Institute of Population Studies Pakistan, Macro International Inc. Pakistan Demographic and Health Survey 2006–07. Islamabad: 2008. [Last Cited: 26th Oct 2012]. Available at: http://www.measuredhs.com/pubs/pdf/FR200/FR200.pdf.

Ali MM, Sadler RK, Cleland J, Ngo TD, Shah IH. Long-term Contraceptive Protection, Discontinuation and Switching Behaviour: Intrauterine Device (IUD) Use Dynamics in 14 Developing Countries. London, UK: World Health Organization and Marie Stopes International; 2011. [Last Cited: 26th Oct 2012]. Available at: http://www.who.int/reproductivehealth/publications/family_planning/Long_term_contraceptive_protection_behaviour.pdf.

Khan SA, Amin ZU, Fouzia F, Jadoon S. A comparative trial of copper T 380 and Cu 375 IUCD. Journal of Ayub Medical College Abbottabad. 2010 Sep; 22(3): 185-7.

Azmat SK, Hameed W, Mustafa G, Hussain W, Ahmed A, Bilgrami M. IUD discontinuation rates, switching behavior, and user satisfaction: findings from a retrospective analysis of a mobile outreach service program in Pakistan. International Journal of Women's Health. 2013 Jan; 5: 19-27. doi: 10.2147/IJWH.S36785. DOI: https://doi.org/10.2147/IJWH.S36785

Rivera R, Chen-Mok M, McMullen S. Analysis of client characteristics that may affect early discontinuation of the TCu-380A IUD. Contraception. 1999 Sep; 60(3): 155-60. doi: 10.1016/S0010-7824(99)00077-3. DOI: https://doi.org/10.1016/S0010-7824(99)00077-3

Petta CA, Amatya R, Farr G, Chi IC. An analysis of the personal reasons for discontinuing IUD use. Contraception. 1994 Oct; 50(4): 339-47. doi: 10.1016/0010-7824(94)90021-3. DOI: https://doi.org/10.1016/0010-7824(94)90021-3

Youssef RM. Contraception use and probability of continuation: community-based survey of women in southern Jordan. EMHJ-Eastern Mediterranean Health Journal. 2006 Jan; 11 (4), 545-558.

Asari VG. Determinants of contraceptive use in Kerala: the case of son/daughter preference. Journal of Family Welfare. 1994 Sep; 40(3): 19-25.

Salhan S and Tripathi V. Factors influencing discontinuation of intrauterine contraceptive devices: an assessment in the Indian Context. The European Journal of Contraception & Reproductive Health Care. 2004 Jan; 9(4): 245-59. doi: 10.1080/13625180400017495. DOI: https://doi.org/10.1080/13625180400017495

Kenya National Bureau of Statistics (KNBS) and ICF Macro. 2010. Kenya Demographic and Health Survey 2008-09. Calverton, Maryland: KNBS and ICF Macro. [Last Cited: 17th Jul 2023]. Available at: https://dhsprogram.com/pubs/pdf/fr229/fr229.pdf.

Bhat PM and Halli SS. Factors influencing continuation of IUD use in South India: Evidence from a multivariate analysis. Journal of Biosocial Science. 1998 Jun; 30(3): 297-319. doi: 10.1017/S0021932098002971. DOI: https://doi.org/10.1017/S0021932098002971

Kurz KH, Tadesse E, Haspels, AA. In vivo measurements of uterinecavitiesing 795 women of fertile age. Contraception, 1984 Jun; 29: 495–510. doi: 10.1016/S0010-7824(84)80011-6. DOI: https://doi.org/10.1016/S0010-7824(84)80011-6

Ahmed NM, Mostafa RH, Abuelghar W, Elbishry G. Discontinuation Rates among Copper Intrauterine Device Users in Primary Healthcare Unit and University Clinic. Is There a Difference? The Egyptian Journal of Hospital Medicine. 2018 Jul; 72(11): 5658-65. doi: 10.21608/ejhm.2018.11543. DOI: https://doi.org/10.21608/ejhm.2018.11543

Mutihir JT, Uduagbamen PF, Ujah IA, Iranloye T. Indications for removal of intrauterine contraceptive devices in Jos, north-central Nigeria. Nigerian Journal of Clinical Practice. 2006 Sep; 9(2):105-8.

Okunlola MA, Owonikoko KM, Roberts OA, Morhason-Bello IO. Discontinuation pattern among IUCD users at the family planning clinic, University College Hospital, Ibadan. Journal of Obstetrics and Gynaecology. 2006 Jan; 26(2): 152-6. doi: 10.1080/01443610500443667. DOI: https://doi.org/10.1080/01443610500443667

Khader YS, El-Qaderi S, Khader AM. Intrauterine contraceptive device discontinuation among Jordanian women: rate, causes and determinants. BMJ Sexual & Reproductive Health. 2006 Jul; 32(3): 161-4. doi: 10.1783/147118906777888279. DOI: https://doi.org/10.1783/147118906777888279

Shah NM, Shah MA, Chowdhury RI, Menon I. Reasons and correlates of contraceptive discontinuation in Kuwait. The European Journal of Contraception & Reproductive Health Care. 2007 Jan; 12(3): 260-8. doi: 10.1080/13625180701440560. DOI: https://doi.org/10.1080/13625180701440560

Tinelli A, Tinelli R, Malvasi A, Cavallotti C, Tinelli FG. The intrauterine device in modern contraception: still an actuality? The European Journal of Contraception & Reproductive Health Care. 2006 Jan; 11(3): 197-201. doi: 10.1080/13625180600759755. DOI: https://doi.org/10.1080/13625180600759755

Petta CA, McPheeters M, Chi IC. Intrauterine devices: learning from the past and looking to the future. Journal of Biosocial Science. 1996 Apr; 28(2): 241-52. doi: 10.1017/S0021932000022276. DOI: https://doi.org/10.1017/S0021932000022276

Downloads

Published

2023-06-30
CITATION
DOI: 10.54393/pjhs.v4i06.889
Published: 2023-06-30

How to Cite

Mand, Q. Z. ., Rashid, M. ., Mughal, M. ., Matloob, I. ., Noreen, A. ., Khurshid, K. ., & Usman, M. (2023). To Determine the Frequency of Discontinuation of Post-Partum Intra Uterine Contraceptive Device (PPIUCD) within 3 Months and its Causes: Frequency of Discontinuation of PPIUCD. Pakistan Journal of Health Sciences, 4(06), 248–252. https://doi.org/10.54393/pjhs.v4i06.889

Issue

Section

Original Article

Plaudit