Implementation Research to Improve Intrauterine Contraceptive Device (IUD) Uptake Among Women of Reproductive Age in...

Providing high-quality family planning services is one of the cornerstones for improving maternal and child health outcomes, and the intrauterine contraceptive device (IUD) is among the most cost-effective contraceptive methods available. Despite this, IUD use among women in Meghalaya remains very low. There is a strong need to understand the gaps in our system and monitor the delivery of services in order to optimize the existing services and ensure that the right impact is achieved in the community. To address this gap, a multiphase implementation research project, which included a Formative phase, Co-Implementation phase, and Iteration and Dissemination phases, was undertaken to increase IUD uptake. The formative phase of the study aimed to assess knowledge, attitudes, and practices (KAP) related to IUD use and to identify key barriers to its uptake.

This research study has been planned to facilitate the coming together of all stakeholders across the broad spectrum of health systems to ensure maximizing the beneficial impact of using the IUCD as a spacing device. The Formative phase utilized a mixed-methods design combining a quantitative method via a cross-sectional KAP survey (n = 1,064), along with the qualitative methods (49 in-depth interviews and three focus group discussions). A KAP survey assessed KAP; qualitative interviews and focus group discussions (FGDs; guided by the WHO Health Systems Framework) explored barriers and facilitators to IUD uptake. East Khasi Hills and Ri Bhoi districts were chosen, covering urban, semiurban, and rural settings across Subcenters, Primary Health Centers, Community Health Centers, and a tertiary hospital. A KAP survey assessed KAP; qualitative interviews and FGDs explored barriers and facilitators to IUD uptake.

Awareness of contraception was high (1,015 (95.4%) and 959 (90.1%) specifically for IUDs), but only 141 (13.3%) had ever used an IUD. Common barriers included fear of side effects, myths/misconceptions, spousal/family disapproval, and inadequate counseling. IUD use was more frequent among women with more than two children and an older youngest child.

Despite widespread awareness, IUD uptake remains low due to persistent sociocultural barriers and health system gaps. Targeted counseling, strengthened provider training, and male engagement are essential to overcome these barriers and improve IUD uptake. Bridging this divide requires context-specific strategies that strengthen provider competence, foster community trust, and engage both men and families in open dialogue.