An Exploratory Analysis of Factors Associated With Interest in Postpartum Intrauterine Device Uptake Among Pregnant Women and Couples in Kigali, Rwanda.

• Type of Material: Article
• Authors: Vanessa Da Costa, Rwanda Zambia HIV Research Group; Rosine Ingabire, Rwanda Zambia HIV Research Group; Robertine Sinabamenye, Rwanda Zambia HIV Research Group; Etienne Karita, Rwanda Zambia HIV Research Group; Victoria Umutoni, Emory University; Alexandra Hoagland, Rwanda Zambia HIV Research Group; Susan Allen, Emory University; Ellen Mork, University of Michigan; Rachel Parker, Rwanda Zambia HIV Research Group; Jeannine Mukamuyango, Rwanda Zambia HIV Research Group; Lisa Haddad, Emory University; Julien Nyombayire, Rwanda Zambia HIV Research Group; Kristin M. Wall, Emory University
• Language: English
• Date: 2019-12-03
• Publisher: SAGE Publications (UK and US)
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2019
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1177/1179558119886843
• Title of Journal or Parent Work: Clinical Medicine Insights: Reproductive Health
• ISSN: 1179-5581
• Volume: 13
• Start Page: 1179558119886843
• End Page: 1179558119886843
• Grant/Funding Information: Bill & Melinda Gates Foundation (OPP1160661), the Emory University Research Council Grant (URCGA16872456), the O.C. Hubert Fellowship in International Health through the Global Field Experience Award program at the Rollins School of Public Health at Emory University, the Emory Center for AIDS Research (P30 AI050409), the National Institutes of Health (NIAID R01 AI51231, NIAID R01 AI64060, and NIAID R37 AI51231), Emory AITRP Fogarty (5D43TW001042), and the International AIDS Vaccine Initiative (IAVI) (SOW2166).
• Keywords: Antenatal Care; Postpartum IUD; Long-Acting Reversible Contraception; Intrauterine Device; Family Planning
• Research Categories: Health Sciences, Obstetrics and Gynecology; Health Sciences, Public Health

Abstract

Background: The desire to space or prevent future pregnancies is high among postpartum women in Rwanda. However, the use of long-acting reversible contraception (LARC), especially the highly effective and cost-effective copper intrauterine device (IUD), is very low, whereas the rates of unintended pregnancy are high. This study aims to identify factors associated with pregnant women's and couple's interest in receiving a postpartum intrauterine device (PPIUD) within 6 weeks after delivery. Methods: A total of 150 pregnant women or couples attending antenatal care (ANC) in Kigali, Rwanda participated in this cross-sectional study. After participating in a postpartum LARC counseling session, surveys assessed participants' demographics, pregnancy experiences and desires, and PPIUD knowledge, attitudes, practices, and interest. Multivariable logistic regression was used to model factors associated PPIUD interest within 6 weeks postpartum. Results: Although only 3% of women had ever used an IUD previously, 124 (83%) women were interested in receiving a PPIUD after counseling. Self-reporting physical side effects (adjusted odds ratio [aOR], 0.21; 95% confidence interval [CI], 0.06-0.75) and infection (aOR, 0.19; 95% CI, 0.04-0.85) as disadvantages to the IUD were significantly associated with no interest in receiving a PPIUD. Interest did not differ by male involvement. Conclusion: Recommendations to increase PPIUD uptake include educating pregnant women and couples about the method during ANC and addressing client myths and misconceptions about the IUD. This strategy allows pregnant women and couples to make informed decisions about their future contraception use, reduce unmet need for family planning, and reduce unintended pregnancy.