One year continuation of post-partum intrauterine contraceptive device: findings from a retrospective cohort study in India

OBJECTIVE: To evaluate outcomes of a national post-partum (within 48h of delivery) copper intrauterine device placement (PPCuIUD) program in six "high focus states" with high-unmet family planning need in India. STUDY DESIGN: We identified high volume district hospitals that provided PPCuIUD in six (Bihar, Jharkhand, Uttar Pradesh, Uttarakhand, Madhya Pradesh and Chhattisgarh) Indian states (2 per state). Each selected hospital maintained a list of PPCuIUD acceptors with contact phone numbers. We randomly selected 100 women at each site for inclusion in a telephone survey of IUD outcomes at one year. Questions regarded IUD expulsion, discontinuation because of symptoms (e.g. pain, bleeding, discharge), discontinuation for other reasons, and use of alternative contraception if discontinuation reported. RESULTS: We could contact 844 of the 1200 randomly selected women of whom 673 (79.7%) had post-placental insertion (within 10min of delivery) while 171 (20.3%) had an early post-partum insertion (between 10min to 48h after delivery). Of those contacted, 530 women (62.8%) reported continuing with the method beyond one year, 63 (7.5%) reported having an expulsion, 163 (19.3%) reported having removals for associated side effects (bleeding, pain, and discharge) and 88(10.4%) reported having removals for other reasons. After removal or expulsion, almost half of the women (46.5%) did not switch to any other modern contraceptive method. CONCLUSION: PPCuIUD continuation rate at 1year was 62.8%. Most removals within one year were due to associated side effects. Almost half of the women discontinuing PPCuIUD did not switch to an alternative modern contraceptive method. IMPLICATIONS: The 1-year continuation rate of PPCuIUD achieved through a large-scale national program in India is satisfactory. The program though needs to address the low uptake of other modern contraceptive methods after discontinuation