A mixed-methods study of factors influencing postpartum intrauterine device uptake after family planning counseling among women in Kigali, Rwanda

• Type of Material: Article
• Authors: Mariama S Tounkara, Emory University; Rosine Ingabire, Emory University, Kigali, Rwanda; Dawn Comeau, Emory University; Etienne Karita, Emory University, Kigali, Rwanda; Susan Allen, Emory University; Julien Nyombayire, Emory University, Kigali, Rwanda; Rachel Parker, Emory University; Lisa B Haddad, Center for Biomedical Research, Population Council, New York; Vanessa Da Costa, Emory University; Amanda Tichacek, Emory University; Amelia Mazzei, Emory University, Kigali, Rwanda; Jeannine Mukamuyango, Emory University, Kigali, Rwanda; Kristin Wall, Emory University
• Language: English
• Date: 2022-11-03
• Publisher: PUBLIC LIBRARY SCIENCE
• Publication Version: Final Published Version
• Copyright Statement: © 2022 Tounkara et al
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0276193
• Title of Journal or Parent Work: PLOS ONE
• Volume: 17
• Issue: 11
• Start Page: e0276193
• End Page: e0276193
• Keywords: COUPLES; Multidisciplinary Sciences; Science & Technology; Science & Technology - Other Topics; HIV
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Pathology

Abstract

Introduction Rwanda has high unmet need for family planning (FP), especially in the postpartum period when women are advised to space pregnancies at least two years for improved maternal-child health. Despite interest in the copper intrauterine device (IUD), a highly cost-effective method, access and uptake remain low. This study aimed to determine factors associated with postpartum IUD (PPIUD) uptake after postpartum family planning (PPFP) counseling as well as provider perceptions of facilitators and barriers to clients’ PPIUD uptake. Methods Postpartum women who received PPFP counseling and were less than 6 weeks postpartum were recruited for a case-control study in Kigali, Rwanda in 2018. We recruited n = 74 women who had accepted and n = 91 women who had declined the PPIUD. Multivariate logistic regression analyses evaluated associations between women’s socio-demographics, FP knowledge and decision-making, and the outcome of PPIUD uptake. Six focus groups (FGs) were conducted with FP providers (n = 24) and community health workers (n = 17) trained to deliver PPFP counseling to assess perceptions of PPFP counseling and facilitators and barriers to PPIUD uptake. FG discussions were recorded, translated, and analyzed for themes. Results Factors associated (P<0.1) with PPIUD uptake included citing its non-hormonal nature, effectiveness, and duration of protection against pregnancy as advantages. Exclusive male partner control over FP decisions (relative to women’s control or joint decision-making) was associated with non-use. Overall, limited knowledge about some aspects of the PPIUD persisted among clients even after counseling. Provider FGs highlighted client concerns, inconsistent FP messaging, and lack of male partner involvement as factors influencing non-use. Conclusions Knowledge of the IUD and its benefits was associated with PPIUD uptake. There is need to refine PPFP counseling messages to address remaining knowledge gaps and concerns. Additionally, male partner involvement in FP counseling and decisions with their partners could be a key strategy to increase both PPIUD and FP uptake in Rwanda.