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Exploring barriers and facilitators to immediate postpartum intrauterine device uptake within the strengthening Egypt
Mireille M Hanna1, Omaima El Gibaly2, Mohamed M F Fathalla3
1Public Health and Community Medicine Department, Faculty of Medicine, Assiut University, Assiut City, 71515, Egypt. miray.maged222@med.aun.edu.eg.
Background:
Egypt faces significant economic and healthcare challenges due to overpopulation. The Strengthening Egypt Family Planning Program tackles the rapid population growth by improving access to family planning services. Given Egypt's high cesarean section rates, the program leverages this opportunity to facilitate immediate postpartum IUD (IPPIUD) insertion as a safe and efficient method. This study identifies barriers and predictors of IPPIUD uptake, providing valuable insights to enhance family planning services in Egypt and other low- and middle-income countries facing overpopulation, such as Kenya, India, and Ethiopia, which have implemented similar initiatives.
Methods:
A case-control study was conducted on women who underwent cesarean sections in three public hospitals in Assiut City, Egypt. The study included two groups: 210 cases (women who used IPPIUD), and 210 controls (women who did not). Data was collected using a semi-structured questionnaire covering sociodemographic data, obstetric history, reproductive history, and barriers to IPPIUD uptake. Statistical analyses employed Chi-square tests, t-tests, and logistic regression to identify predictors of IPPIUD use.
Results:
The study found that the main barriers to IPPIUD use were disapproval from husbands (73.3%), desire for more children (71.9%), lack of knowledge about IPPIUD (67.6%), preference for female providers (64.3%), and negative provider attitudes (20.0%), fear of side effects (27.6%), and misconceptions (22.4%). The significant predictors of IPPIUD use were receiving IPPIUD counseling during antenatal care (AOR = 11.42, 95% CI: 4.58-28.49), having husband's support for family planning (AOR = 9.43, 95% CI: 3.44-25.83), receiving IPPIUD counseling during labor (AOR = 5.63, 95% CI: 2.56-12.33), and having sons (AOR = 4.24, 95% CI:1.37-13.14), their source of knowledge about FP is from ANC (AOR = 2.39, 95% CI: 1.89-5.83), high socioeconomic status (AOR = 1.54, 95% CI: 1.23-1.95), increased women's age (AOR = 1.13, 95% CI: 1.06-1.21).
Conclusions:
Barriers to IPPIUD use include husbands' disapproval, desire for more children, lack of knowledge, preference for female providers, provider negativity, and fear of side effects. Key predictors of uptake are counseling during antenatal care and labor, husband's support, and having sons. Policymakers should enhance family planning education targeting men and address gender norms, while providers must leverage every opportunity during antenatal, labor, and postpartum care to provide counseling.
Trial Registration:
Number: NCT05471362.
