Women's Perspectives on Postpartum Intrauterine Devices in Tanzania

Abstract

Despite the numerous benefits of the postpartum copper intrauterine device (PPIUD), which is inserted within 48 hours after giving birth, it is underutilized in many resource-constrained settings, including Tanzania. We conducted in-depth interviews with 20 pregnant women who received contraceptive counseling during routine antenatal care in 2016-2017 and 27 postpartum women who had a PPIUD inserted in 2018 to understand reasons for use versus nonuse and continuation versus discontinuation. Primary motivators for using a PPIUD included: convenience, effectiveness, perceived lack of side effects, and duration of pregnancy protection. Barriers to use included: fear of insertion, concerns related to sexual experiences post-insertion, and limited knowledge. Women who had a PPIUD inserted continued use when their expectations matched their experience, while discontinuation resulted from unexpected expulsion and experience of unanticipated side effects. Frequent followup and guidance on side-effect management influenced women's decisions to continue use. To support uptake and continued utilization of the PPIUD, postpartum contraceptive counseling should explicitly address side effects and risk of expulsion.

‘I haven’t heard much about other methods’: quality of care and person-centredness in a programme to promote the postpartum intrauterine device in Tanzania

“…48 A detailed description of the cluster-randomised trial and evaluation is described by Canning et al 48 The qualitative portion of this study included in-depth interviews with women after their antenatal counselling, follow-up interviews with women 20 months postpartum, as well as interviews with providers who were trained by the PPIUD Project. Previous qualitative analyses from this study have focused on women's reasons for PPIUD use/non-use, 49 as well as provider and patient perspectives broadly on the programmatic implementation. 28 Here, we focus specifically on perceptions of quality of care, with an emphasis on the impact of the PPIUD intervention on person-centred contraceptive counselling at the time of antenatal care.…”

Barriers and Enablers Influencing Women's Adoption and Continuation of Vaginally Inserted Contraceptive Methods: A Literature Review

“…2014; Huber‐Krum et al. 2019). According to the literature reviewed, effective counseling includes a provider reviewing a method's advantages and disadvantages, including potential risks and side effects, and instructions on how to use the method correctly.…”

“…Many women saw the ability to use a method while breastfeeding as a positive factor (Huber‐Krum et al. 2019; Eva et al. 2018; Routes2Results et al.…”

Evaluating the Implementation of an Intervention to Improve Postpartum Contraception in Tanzania: A Qualitative Study of Provider and Client Perspectives

“…Many individual-level factors influenced women's decisions to use PPIUD, which we have reported elsewhere in depth. 29 These included fear of insertion, concerns related to sexual experiences postinsertion, unexpected expulsion, and experience of unanticipated side effects.…”