Successful programmatic approaches to facilitating IUD uptake: CARE's experience in DRC

Area of Science:

• Sexual and Reproductive Health
• Family Planning Programs
• Contraceptive Uptake

Background:

• Sub-Saharan Africa faces challenges in contraceptive uptake, particularly for the Intrauterine Device (IUD).
• Addressing barriers to method-specific contraceptive use is crucial for achieving sexual and reproductive health and rights.
• A CARE project in the Democratic Republic of Congo (DRC) observed comparatively high IUD use, necessitating an investigation into its drivers.

Purpose of the Study:

• To identify reasons for high IUD utilization within a specific project in the DRC.
• To determine programmatic characteristics that facilitated increased IUD uptake.
• To understand factors influencing method choice in family planning services.

Main Methods:

• Qualitative data collection through 15 focus group discussions and 18 in-depth interviews in 2015.
• Participants included IUD users, other method users, non-users, male partners, health providers, project staff, and community health workers.
• Data analysis employed a content theory approach, supplemented by routine monitoring data.

Main Results:

• Over 10,000 IUDs were chosen, representing 30% of 31,569 long-acting/permanent method users in an area with prior low IUD use.
• Positive perceptions of IUDs and service quality were reported, with some concerns about insertion intimacy/shame.
• High uptake was linked to effective supply chains, provider training, supervision, male-targeted communication, and community engagement.

Conclusions:

• Involving local stakeholders in overcoming structural and socio-cultural barriers enhances family planning (FP) service quality and method mix.
• Improved knowledge and attitudes surrounding FP use, particularly for IUDs, can be achieved through community engagement.
• Programs can significantly improve FP and IUD uptake, even in conflict-affected settings, by addressing access barriers and fostering local participation.