An exploratory analysis of factors associated with interest in postpartum intrauterine device (IUD) uptake among pregnant women and couples in Kigali, Rwanda Open Access

Da Costa, Vanessa (Spring 2018)

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Background: The desire to space or prevent future pregnancies is high among postpartum women in Rwanda. However, the use of long-acting reversible contraception (LARC), especially the highly effective and cost-effective copper intrauterine device (IUD), is very low, while the rates of unintended pregnancy are high. This study aims to identify factors associated with pregnant women’s and couple’s interest in receiving a postpartum IUD within 6 weeks after delivery.

Methods: Pregnant women or couples attending antenatal care (ANC) in Kigali, Rwanda were consented and enrolled in this cross-sectional study from August-September, 2017. After participating in a postpartum LARC counseling session, surveys assessed participants’ demographics; pregnancy experiences and desires; and postpartum LARC knowledge, attitudes, practices, and interest. Multivariable logistic regression was used to model factors associated with interest in receiving a postpartum IUD within 6 weeks after delivery.

Results: 150 pregnant women (103 women alone and 47 couples) consented to participate. Though only 3% of women had ever used an IUD previously, 124 (83%) women were interested in receiving a postpartum IUD. Self-reporting physical side effects as a disadvantage to the IUD (adjusted odds ratio, aOR 0.21 95% CI 0.06-0.75) and self-reporting infection as a disadvantage to the IUD (aOR 0.19 95% CI 0.04-0.85) were significantly associated with less interest in receiving a postpartum IUD. Demographic factors did not predict postpartum IUD interest, and interest did not differ by male involvement.

Conclusion: Recommendations to increase postpartum IUD uptake include educating pregnant women and couples about the method during antenatal care and addressing client myths and misconceptions about the IUD. This strategy provides allows pregnant women and couples to make informed decisions about their future contraception use, reduce unmet need for family planning, and reduce unintended pregnancy.

Table of Contents

List of Figure and Tables i


Chapter I: Literature Review

Background 1


Chapter II: Manuscript

Introduction 7

Methods 10

Results 15

Discussion 18

Conclusion 23

References 24

Figure and Tables 29


Chapter III: Conclusion

Summary 38

Public Health Implications 38

Current LARC Intervention 38

Future Directions 39



Appendix 1: Survey Instrument 40

Appendix 2: SAS Code 58

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