Acceptance, safety and efficacy of postpartum intrauterine contraceptive device

Postpartum intrauterine contraceptive device (PPIUCD) is safe method of contraception, but with low acceptability rate. Factors that govern acceptability needs to be addressed for increasing its rate. This study was done to assess the acceptance, efficiency, and complications of PPIUCD in tertiary centre of Jharkhand, India.

This prospective study included antenatal women >34 weeks of gestational age who attended antenatal women in the department of Obstetrics and Gynaecology between 1st January 2020 to 1^st September 2020. Details related to age, parity, education, awareness of PPIUCD, reasons for acceptance/refusal of PPIUCD were recorded. The types of insertion were postplacental, postcaesarean, and postabortal. Postinsertion counselling was done for PPIUCD, and women were followed-up at 6 weeks and 10 weeks for assessing complications.

The overall acceptance rate was 36.23% (n = 100). The main reasons for rejecting the use of PPIUCD included fear of pain, bleeding, and other complications (59.09%) and COVID-19 (10.23%). In majority (80%), type of insertion was postplacental with postcaesarean in 18% and postabortal in 2%. Complications were present in 14% women that included abdominal pain (8%), heavy menstrual bleeding (6%), infection (4%), thread not visible (1%), and IUCD not located by USG or X-ray (1%). At 6 months, expulsion occurred in 2 women. There was no significant association of age (P = 0.312), religion (P = 1), tribal/non-tribal (P = 1), education level (P = 0.628), and type of insertion (P = 0.356) with complications. At 1 year of follow up, none of the women conceived again showing the efficacy to be 100% as a contraceptive.

In spite of limited awareness, PPIUCD proved to be an effective and safe method of long-acting reversible contraception. However, it had low rate of acceptability. PPIUCD was related to lesser complications as expulsion occurred in only 2 women at 6 months. Factors such as age, religion, tribal/non-tribal, education level, and type of insertion were not associated with acceptability rate. PPIUCD was 100% effective as a contraceptive.