Usage of postpartum intrauterine contraceptive device (postpartum-IUD) after an increase in the institutional delivery rate in India: time to re-visit the effect of timing of counselling on its acceptance: The European Journal of Contraception & Reproductive Health Care: Vol 0, No 0

Purpose

While the increase in institutional deliveries provides an opportunity to counsel women for postpartum family planning (PPFP), its uptake remains low. The reasons for poor acceptance of the postpartum intrauterine contraceptive device (postpartum-IUD), and its relationship to the timing of counseling need to be investigated.

Method

Women attending the antenatal clinic, reporting delivery, and within 48 hours of delivery were invited to participate. Eligible women were asked about awareness and choice for PPFP. After counseling, acceptance for PPFP was compared to baseline. Postpartum-IUD acceptance and persistence were compared between women counseled in the antenatal, intrapartum, and postpartum periods.

Results

Only 23% of the 360 ​​women were aware of the postpartum-IUD. After counseling, acceptance increased for PPFP from 14% to 97% and for postpartum-IUD, from 0.5% to 33.9%. Acceptance of postpartum-IUD among women counseled in the antenatal, intrapartum and postpartum period was 45%, 35% and 21.7% respectively. Acceptance was higher in the antenatal-counseling group than in the postpartum-counseling group (OR 0.45; CI 0.22–0.94; p= 0.03).

Conclusion

Counseling, regardless of its timing, improves acceptance for PPFP. Postpartum-IUD acceptance and persistence is higher after counseling in the antenatal period. All eligible women must be counseled regardless of ‘when’ they approach the facility.

• Short condensation

• Acceptance for the postpartum-IUD is highest when women are counseled in the antenatal period. With the increase in institutional deliveries, the opportunity to counsel women during the intrapartum and postpartum period should not be missed as it also increases acceptance for PPFP and postpartum-IUD.