Rates of IUCD discontinuation and its associated factors among the clients of a social franchising network in Pakistan

Abstract

BackgroundModern Intrauterine contraceptive device (IUCD) is very safe, highly effective reversible and inexpensive family planning method which offers 5-10 years of protection against pregnancy. The contraceptive use in Pakistan has been merely 30% for over a decade with IUCD being the least used method. Higher discontinuation rates are documented in developing countries; however no such data is available for Pakistan. Marie Stopes Society (MSS) established a social franchise outlets network branded as 'SURAJ' (Sun) in Pakistan to provide quality family planning services. This study attempts to determine IUCD discontinuation rates and its associated risk factors. Using a semi-structured questionnaire, a cross-sectional study was conducted with 3000 clients who availed IUCD services from Suraj provider 6, 12 and 24 month back,. Data were analyzed in SPSS 17.0; adjusted prevalence ratios were calculated to see associations between discontinuation and its risk factors.Case presentationWe found that 22.7% of the IUCD acceptors experienced some health problem; while the overall discontinuation rate was 18.9% with average time of usage of 7.4 (SD ± 5.8) months before discontinuation. Half of them showed health concerns (49.8%); of which a majority (70.2%) returned to Suraj provider for IUCD removal. Women living in Punjab, residing at a travelling time of 30-60 minutes and no previous use of contraceptive are more likely to discontinue IUCD. However, among total women 81.7% still expressed willingness to avail IUCD services from Suraj provider in future, if needed.ConclusionThe findings suggest a need for training the providers and field workers to prevent early discontinuation of IUCD among the Suraj clients and by addressing the health concerns through proper counseling, continued follow-up and immediate medical aid/referral in case of complications.

Determinants of Intrauterine Contraceptive Device Discontinuation Among Indian Women

“…62.5 % of the females using contraception in any form discontinued IUCD use as against 83 % among those who had not used the contraception in the past, indicating the motivated women's desire to have a safe and long-lasting contraceptive method (Table 3). This was in accordance with the results obtained in Pakistan by Azmat et al [8].…”

Evaluation of Factors for Discontinuation of Intrauterine Contraceptive Device Among Women in a Tertiary Care Center in Jammu, India

“…[8] 66.66% of the females using contraception in any form discontinued IUCD as against 85.08% among those who had not used the contraception in any past. This is in accordance with the results obtained in Pakistan by Azmat et al [9] The result also corroborated well with the study by Sharma Megha et al [4] It indicates that the motivated women desire to have a safe and long-lasting contraceptive method. In our study, type of insertion has no significant effect as discontinuation rate as in accordance with study by Sharma Megha et al [4] CONCLUSION The average duration of IUD use in a majority of the females was about 36 months, thereby fulfilling its objective of spacing between the children as laid down by WHO (2 years spacing between pregnancies).…”

Determinants of Intrauterine Contraceptive Device Use Among the Women of Urban Areas of Nepal

“…Their role in improving the maternal health status of the country has been well appreciated by the international community as well. 12 Similarly, this study also highlighted that the FCHVs as the source of information has a positive significant association with IUCD use. This association might have been attributed due to the fact that the Government of Nepal has provided incentive for FCHVs for tracking the client to increase the use of IUCD.…”

“…[4][5][6][7] Several studies done in other countries revealed that factors like education, place of residence, culture, religion, literacy, occupation, income, reproductive intention, spousal communication and service related factors influence women's behavior to use IUCD. [8][9][10][11][12][13][14][15][16] Studies had shown that the reason for non-use is the fear of side effects. 17,18 However, studies from Nepal did not provide adequate reliable information about the factors for use and non-use of the device.…”