Understanding factors associated with continuation of intrauterine device use in Gujarat and Rajasthan, India: a cross-sectional household study

Abstract

The Government of India has promoted the expansion of access to and uptake of intrauterine devices (IUDs), during both the interval (IIUD) and postpartum (PPIUD) periods, as part of its Family Planning 2020 initiative. This study, conducted by EngenderHealth as part of the Expanding Access to IUD Services in India project, examines IIUD and PPIUD continuation rates over time and investigates factors associated with IUD continuation. We recruited respondents (N = 5024) through a repeated cross-sectional household study between February and December 2019. We identified respondents using IUD client data from public health facility registers in 20 districts of Gujarat and Rajasthan. We compared continuation rates for IIUD and PPIUD adopters and used regression analyses to measure the association between continuation and demographic, quality of care, and counselling variables. IIUD continuation rates decreased from 85.6% to 78.3% and PPIUD rates decreased from 78.5% to 70.7% between month 3 and month 12. Clients experiencing side effects or other problems were 15 times more likely to discontinue IUD use than clients who did not. Clients who received IUD counselling prior to insertion were more likely to continue than those who did not. IUD continuation increased significantly in cases where both partners jointly selected the method compared to situations where women decided alone. Several sociodemographic factors were associated with continuation. Our study demonstrates the value and benefits of programmes offering IUD services emphasising quality counselling and client-centred care to increase access, uptake, and continuation.

Using machine learning to understand determinants of IUD use in India: Analyses of the National Family Health Surveys (NFHS-4)

“…We used ML models with iterative thematic analysis to explore potential predictors of IUD use among currently married women in India and found that the strongest predictor of this outcome was shared marital family planning goals in terms of both contraceptive decision-making and fertility goals. This finding corresponds with a smaller study from Rajasthan, India, that indicates that joint marital decision-making regarding contraceptive use among IUD users is associated with IUD continuation ( Singal et al, 2022 ). However, it is not in line with research from younger married women from Maharashtra, India, which found a trend in the association between IPV and IUD use, or with a state-representative sample of married women aged 15–49 in Uttar Pradesh that found an association between reproductive coercion and IUD use ( Chen et al, 2020 ; Tomar et al, 2020 ).…”

“…Findings from our study are aligned with prior research that documents higher IUD use among wealthier and more educated women as well as those with greater contraceptive knowledge ( Bhat & Halli, 1998 ; Kumar et al, 2018 ; Singal et al, 2022 ). This underscores that community-level support may be particularly important for lower-resource communities to increase their IUD uptake.…”

“…Research on factors affecting IUD use in India and elsewhere focuses largely on supply-side aspects such as low availability, training of providers, and quality of service provision ( Agha et al, 2011 ; Bhat & Halli, 1998 ; Prasad et al, 2018 ; Sharma et al, 2014 ), but efforts made to affect these factors have been implemented with no change in IUD uptake at scale ( Government of India, Ministry of Health and Family Welfare & International Institute for Population Studies, 2022b , 2017 ). Studies also identify several demand-side factors that influence the uptake and use of IUDs, including concerns regarding side effects and opposition from spouses and family ( Agha et al, 2011 ; Mishra et al, 2017 ; Payne et al, 2016 ; Robinson et al, 2016 ; Singal et al, 2022 ; Weston et al, 2012 ). Additionally, there is growing evidence in family planning that recognizes the importance of demand-side factors related to women's agency and male engagement in family planning ( Bankole & Singh, 1998 ; Bhan & Raj, 2021 ).…”

Tools for patient-centred family planning counselling: A scoping review

“…The 33 full-text documents retained for this scoping review included three theoretical and/or conceptual articles [1,3,6] and three systematic reviews [7,23,25]. Eight studies focused on women's experiences with family planning counselling and counselling preferences [2,4,9,[26][27][28][29][30], one study discussed the process of contraceptive decision-making [5], and five studies focused on measurement of patient-centred family planning care [10,[31][32][33][34]. Only 13 studies discussed a tool for patient-centred family planning care.…”

Analisis Faktor-Faktor Yang Berhubungan Dengan Minat Penggunaan IUD Pada Akseptor KB Di Desa Kodaka Wilayah Kerja Puskesmas Puuweri Kabupaten Sumba Barat Provinsi Nusa Tenggara Timur

“…Adanya peran tenaga kesehatan melalui konseling, penyuluhan, pemberian informasi kesehatan terkait mitos-mitos negatif kontrasepsi IUD melalui pemanfaatan berbagai media akan membantu meningkatkan kesadaran wawasan serta kesadaran ibu dalam penggunaan kontrasepsi yang lebih efektif (Woldeyohannes et al, 2022). Pemberian konseling yang berkualitas sangat penting untuk memenuhi hak reproduksi akseptor termasuk penggunaan kontrasepsi IUD (Singal et al, 2022).…”