Factors affecting uptake of the levonorgestrel-releasing intrauterine device: A mixed-method study of social franchise clients in Nigeria

Abstract

Background Despite the positive characteristics of the levonorgestrel-releasing intrauterine device (IUD)–a long-acting, highly effective contraceptive with important non-contraceptive attributes–the method has not been widely available in low- and middle-income countries. This study of hormonal IUD, copper IUD, implant and injectable users in Nigeria compares their characteristics, reasons for method choice, and experiences obtaining their method. Methods We conducted a phone survey with 888 women who received a hormonal IUD, copper IUD, contraceptive implant or injectable from 40 social franchise clinics across 18 states in Nigeria. We analyzed survey data descriptively by method and assessed factors associated with hormonal IUD use through multivariate logistic regression models. Follow-up in-depth interviews conducted with 32 women were analyzed thematically. Results There were few differences by method used in the socio-demographic profiles and contraceptive history of participants. Among users choosing a long-acting, reversible method, the top reasons for method choice included perceptions that the method was “right for my body,” long duration, recommended by provider, recommended by friends/family, few or manageable side effects, and high effectiveness. Among hormonal IUD users, 17% mentioned reduced bleeding (inclusive of lighter, shorter, or no period), and 16% mentioned treatment of heavy or painful periods. Qualitative data supported these findings. Among survey respondents, between 25% and 33% said they would have chosen no method if the method they received had not been available. Both quantitative and qualitative data indicated that partner support can affect contraceptive use, with in-depth interviews revealing that women typically needed partner permission to use contraception, but men were less influential in method choice. Conclusions Expanding access to the hormonal IUD as part of a full method mix provides an opportunity to expand contraceptive choice for women in Nigeria. Findings are timely as the government is poised to introduce the method on a wider scale.

What Have We Learned? Implementation of a Shared Learning Agenda and Access Strategy for the Hormonal Intrauterine Device

“…Satisfaction with the hormonal IUD was generally high with 80%-98% reporting being satisfied or very satisfied with method use across the time points when data were collected. [20][21][22][23][24] The study in Nigeria and Zambia that included copper IUD and implant users also documented high satisfaction rates with other LARCs (100% in Nigeria and 98% in Zambia for the 21 Brunie et al 22 Brunie et al 23 Brunie et al Cumulative continuation rates for the hormonal IUD were consistently high, ranging from 81%-95% at 12 months.…”

“…Among those who were prior contraceptive users, the majority in most studies reported using a short-acting method as their last method before uptake of the hormonal IUD (data not shown). [20][21][22][23][24] Continuation Rates…”

“…21 Positive method attributes most commonly reported by hormonal IUD users included effectiveness, long duration, convenience, reduced bleeding, and fewer side effects (data not shown). [20][21][22][23][24] Demand Generation and Marketing…”

“…We review evidence generated by research partners included in the Hormonal IUD Access Group (Table 1). [18][19][20][21][22][23][24] This article is not a systematic or scoping review of the literature but rather a review of evidence generated by the organizations that were proactively responding to questions articulated in the shared learning agenda. At the outset, Hormonal IUD Access Group members committed to harmonizing data collection approaches when feasible.…”

What are the prospects for the hormonal IUD in the public sector? A mixed-method study of the user population in Zambia

“…Given the popularity of injectables in Zambia, we also included injectable users to support a broader exploration of differences between women choosing various methods. With the exception of another study conducted in Nigeria [ 21 ], this is, to our knowledge, a rare side-to-side examination of users of these four methods in real-world conditions. Specific objectives were to describe women choosing the hormonal IUD and women choosing other methods in terms of their characteristics, reasons for method choice, and experiences getting their method.…”