Factors associated with the use of immediate postpartum intrauterine contraceptive devices among postpartum women at Muhima Hospital

Abstract

Background: In Rwanda, the unmet need for modern contraceptives is high, especially in the extended postpartum period. In Rwanda, most women would want to space the next pregnancy and yet the majority of them leave the health facility without getting any contraceptive. The use of IUD in the immediate postpartum period would reduce the unmet need for family planning; however, in Rwanda, the utilization of IUD is still low at only 0.7%. Objectives: The objective of the study was to assess the prevalence and factors associated with the use of PPIUCD among immediate postpartum women in Muhima Hospital. Methods: The study was conducted at Muhima Hospital. In this study, mixed-methods were used. The sample of 383 participants was interviewed using interviewer-administered questionnaires. Logistic binary regression was done to assess for factors associated with PPIUCD. In-depth interviews were conducted among 10 midwives to explore their experiences and perceptions regarding the provision of PPIUCD. Thematic analysis was used to analyze the qualitative data. Results: The prevalence of PPIUCD use was 28.1%. The use of PPIUCD was associated with receiving counseling for PPIUCD during antenatal (AOR 2.072, 95%CI=1.018-4.218). Women without partner approval to use PPIUCD (AOR=0.382, 95% CI (0.221-0.663). Multipara women (AOR =2.265, 95%CI=1.472-3.163). Short birth interval (AOR =2.123, CI =1.477-2.706), and women with secondary or tertiary education (AOR 2.591, 95%CI=1.329- 3.062). Fives themes emerged from the qualitative analysis: Education of the women and their partners on the use of PPIUCD; Training health care providers on PPIUCD; Midwives behaviors about PPIUCD provision; Client’s misconceptions on the use of PPIUCD; Availability and supply for the methods to provide PPIUCD influenced use of PPIUCD. Conclusion: The use of PPIUCD was high among the participants. The uptake of PPIUCD was associated with normal birth, PPIUCD counseling, spousal approval, parity, birth interval, level of education. Health education of mothers and partners on PPIUCD, training of health providers and availability of supplies to provide PPIUCD influenced use PPIUCD.