A one-year cohort study of complications, continuation, and failure rates of postpartum TCu380A in Tanzania

Abstract

Background Less than 1% of married women in Tanzania use an Intrauterine Contraceptive Device (IUD) for contraception. An initiative by the International Federation of Gynecology and Obstetrics (FIGO) has been in progress since 2015 resulting in escalated method uptake in implementing hospitals. This study investigates failure rate, complications, and risk factors for one-year continuation of TCu380A IUD when used for immediate postpartum contraception under the initiative in Tanzania. Methodology A prospective cohort study of women who had TCu380A insertion within 48 h of delivery in 6 hospitals in Tanzania between 1st December 2017 and 18th April 2018 was conducted. Face to face post insertion interviews were made with 1114 clients before discharge and later through phone calls up to the beginning of 13th month postpartum. Postpartum Intrauterine Device (PPIUD) continuation status, complications, duration of time they stayed with the IUD and the currently used method if PPIUD was discontinued were enquired. The outcome variable was PPIUD continuation at one year of IUD insertion. Data were analyzed using Statistical Product and Service Solutions software (SPSS) for Windows version 20 (IBM SPSS Statistics, Chicago, IL, USA). Results In total 511(45.8%)clients had consented and availed to complete the one-year follow-up. Out of these, 440 still had IUD, giving a one-year continuation rate of 86.1%. Most (63%) IUD discontinuations occurred in the period between 7th week and 6 months of insertion. One-year method expulsion rate was 2.1%. There was one reported pregnancy that gives a method failure rate of about 2 per 1000. The independent risk factors in favor of method continuation at one year were absence of medical or social problem, being a youth (16–24 years), and delivery by Cesarean section. Conclusions The continuation rate when CuT380A is used for immediate postpartum contraception is high, with low complication and failure rates. Some medical and social factors are important for method continuation, hence the need to consider in training, counselling and advocacy.

Determinants and perception of postpartum intrauterine contraceptive device services in Maharashtra, India

“…In the present study, only three women had removed CuT; hence we did not compile the reasons by asking the women; instead, we asked the reasons for removal to the HCWs. However, the removal rate is concordant with other studies showing the range of 2.9 to 13.89% of cases, including the present study [10], [12], [13], [20], [24]- [26], [29]. The reasons for removal among more than 50% of women may not be related to the complications [15].…”

Discharge instructions given to women following delivery by cesarean section in Sub-Saharan Africa: A scoping review

“…reported and encouraged patients to use intrauterine devices (IUDs) [48][49][50][51][52][53], with 1 study describing a government family planning program that provided a wider range of contraceptives that also included oral contraceptives, condoms and other barrier methods [49]. Of the 5 studies on IUDs, 3 encouraged placement of IUD immediately postpartum with the option of IUD placement at 6 weeks for those who declined immediate placement [50,51,54]. Two studies raised concerns about patients asking their husbands for permission to place IUD, leading to delayed placement [49,54].…”

Acceptance, utilization, and factors associated with immediate postpartum intrauterine contraceptive device among mothers delivered at public health facilities in Hawassa city, Ethiopia: Institution-based study

“…Immediate post-partum intrauterine contraceptive device (IPPIUCD) placement within 10 min after the expulsion of the placenta up to 48 h after delivery is a prevailing strategy that prevents unintended pregnancy with a high continuation rate [6]. Placement of the IPPIUCD is preferred because it does not interfere with breastfeeding and in addition breastfeeding can reduce early removal of IUCD as it reduces bleeding and pain [7,8].…”