Effects of two levels of counseling on acceptance , uptake and early outcomes of the post placental intrauterine contraceptive device

Abstract

Background: Contraceptive prevalence in Kenya is low at 46% (KDHS 2008/9). There is a notable steady decline in the use of Long Acting and Permanent Method's (LAPM's) especially the IUCD. Current national IUCD use rates are 1.6% compared to 2.4% in 2003( KDHS 2003). Post-placental IUCD use has been known to be safe and effective. Use of this method may increase contraceptive prevalence rates as it provides contraception at a time when the woman is highly motivated to use a method. Counseling plays a vital role in educating women, ensuring they make informed choices on the family planning method that best suits them. Improving the quality of antenatal counseling on family planning methods may increase the uptake of post-placental IUCD insertion. Objectives: To determine the effect of two levels of counseling on the acceptance, uptake and outcomes of expulsion, pelvic infection, couple satisfaction and continuation rates at 6 weeks postpartum of the post-placental intrauterine device. Study Site: The study was carried out at Embu PGH. Study Subjects: Pregnant women between the gestation of age of 36 - term, who attended ANC at Embu PGH and followed up at labour ward, pre-discharge in the wards and at 6 weeks postpartum. Study Design: A randomized "open-label" clinical trial. Study Methodology: Eligible clients were randomized to either routine or intensive FP counseling. Those who accepted were followed up intrapartum and had the IUCD inserted within 10 minutes of placental delivery. A pre-discharge review and a follow up visit at 6 weeks (exit point)were then carried out. Results: One hundred and twenty seven study participants were enrolled and randomized to intensive(64 women) or routine FP counseling (63 women). Seventy one percent of women (78% in the intensive FP counseled group and 66% in the routine FP counseled group) accepted to have the post-placental IUCD inserted. F0I1y five percent of women (63% in the intensive FP counseled Page 12 group and 64% in the routine FP counseled group) had the IUCO inserted. There was no significant difference in uptake in the two randomization arms (p-value 0.232). Complications included expulsion (3.7%), allergic reaction (1.8%), pelvic infection (1.8%) and abdominal pam (1.8%). Continuation rates, client and reported partner satisfaction were 91%, 88%, and 77% respectively at 6 weeks. The overall loss to follow up was 14 clients; six from the intensive FP counseled group and eight from the routine FP counseled group. Conclusion: The post-placental IUCO is an acceptable method among women in this region irrespective of level of counseling. Intensive counseling at Embu PGH did not significantly increase acceptance and uptake rates of post-placental IUCO insertion in comparison to routine counseling. Recommendations: Routine counseling is adequate to allow for increased uptake rates of post-placental IUCO insertion, but individualization should be considered. Widespread training on this method should be provided to health care workers and information given to pregnant women during antenatal visits.