Intrauterine contraceptive device discontinuation among Jordanian women: rate, causes and determinants

Abstract

Objective To determine the intrauterine contraceptive device (IUD) discontinuation rate and its causes and related factors among women attending UNRWA health centres in Jordan. MethodsThe study cohort comprised 371 women who had an IUD inserted during 1997 and who were interviewed during their visits to the health centres in the period January-March 2003. The main outcome measure was IUD discontinuation. ResultsThe incidence of IUD discontinuation in the first year following insertion was 17.5%. Approximately 32% of the study sample continued using their devices after 5 years. The average duration of IUD use was 36 months. Of the 371 women, 39.6% discontinued IUD use because of a desire to conceive, 18.6% because of side effects, 4.9% because they were sexually inactive and 1.6% because of opposition from the woman's family. The most common side effects reported as reasons for discontinuation were bleeding, infection and pain. Discontinuation was inversely related to current age, marital age and number of living children. Outside camp residents, previous contraceptive users and women with obstetric complications were significantly less likely to discontinue IUD use. ConclusionsThe crude cumulative rate of IUD discontinuation was 17.5% during the first year, suggesting a need to tackle the problem of discontinuation through effective educational strategies on the process of fertility and contraception. The most common reason for voluntary IUD removal was the women's desire to conceive. This suggests that improved counselling and good selection of candidates before IUD insertion is required. G A desire to conceive and side effects are the main reasons for IUD discontinuation.

Discontinuation Pattern Among Intrauterine Contraceptive Device Users at Jos University Teaching Hospital, Jos, Nigeria

“…Discontinuation of IUCD was also noted to be influenced by the number of living children in this study with 72.5% of clients who discontinued having 4 or fewer children. This finding is in keeping with the observed reports that the fewer a woman's children are at the time of IUCD insertion, the more likely she is to discontinue it [12,13,17]. Therefore women of low parity in particular need extensive motivation to continue contraceptive for a longer period of time for effective demographic impact.…”

“…This is the leading indication reported by other authors in Jos [8], Ibadan [9], Irbid Jordan [13] and Kuwait [20]. This is because the intrauterine device is a contraceptive method largely used as an effective, safe, reversible and it is an economic method of contraception [1,7].…”

“…The desire for pregnancy, excessive menstrual bleeding and medical indications are among the leading reasons for discontinuation of the method amongst its users [8][9][10][11][12][13][14][15]. They are also removed at other times when the client makes such a request [1,2,7].…”

Evaluation of Family Planning Counselling in North Jordan

“…Moreover, in the private JAFPP clinics, all of the other steps of the GATHER framework (Tell, Help, Explain and Return) were deemed to be adequate; however, in the governmental clinics, these steps were assessed as either semiadequate or inadequate. The mean evaluation score was 12.88 (range: [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

“…4,5 Evidence indicates that structured counselling both protects women's rights to an informed and voluntary decision regarding their reproductive choices and improves the use of modern contraception methods. [5][6][7][8][9][10][11][12] Ideally, counselling sessions should be acceptable to the patient, provide high-quality information and offer enough time and motivation to apply any recommendations. 13 According to the World Health Organization (WHO), a successful counsellor should understand women's beliefs, needs and concerns and be respectful, honest, highly competent and an effective communicator.…”