Immediate Postpartum Copper IUD: A Comparative Analysis between Profiles of Women who Accept and who Refuse it

Abstract

Objective To analyze the profiles of women who accepted and who refused the insertion of the copper intrauterine device (IUD) postpartum and to learn the motivations related to the refusal of the method.

Methods Cross-sectional study with 299 pregnant women. The women were informed about the possibility of inserting a copper IUD postpartum and were questioned about their interest in adopting or not this contraceptive. All participants answered a questionnaire with information relevant to the proposals of the present study. The sample size was limited to the number of devices available for the present study.

Results A total of 560 women were invited to join the present study and 299 accepted. Out of the 299 women included in the present study, 175 accepted the copper IUD and 124 refused. As the number of pregnancies increased, the IUD acceptance rate raised (p = 0.002), especially between the groups with 1 and with ≥ 4 pregnancies (p = 0.013). Regarding the desire to have more children, the women who planned to have more children were more likely to refuse the method than the ones who did not (p < 0,001).

Conclusion Women with multiple pregnancies and desire to not have more children were more likely to accept the copper IUD. The profile of those who refused was first pregnancy and desire to have more children. Among the three most frequent reasons reported for copper IUD rejection, two responses stood out: no specific justification and desire to have more children.

Resumo

Objetivo Analisar o perfil das mulheres que aceitaram e recusaram a inserção do dispositivo intrauterino (DIU) de cobre no pós-parto imediato e conhecer as motivações relacionadas à recusa ao método.

Métodos Estudo transversal com 299 gestantes, as quais foram informadas sobre a possibilidade de inserir o DIU de cobre imediatamente após o parto e questionadas sobre o interesse em adotar ou não este contraceptivo. Todas as participantes responderam a um questionário com informações pertinentes às propostas do presente estudo. O tamanho da amostra foi limitado ao número de dispositivos disponíveis para o presente estudo.

Resultados Um total de 560 mulheres foram convidadas a participar do estudo, dentre as quais 299 aceitaram. Das 299 participantes, 175 aceitaram o DIU e 124 recusaram. Conforme aumentou o número de gestações, maior foi a taxa de aceitação do DIU (p = 0,002), principalmente quando comparados os grupos de mulheres com 1 e ≥ 4 gestações (p = 0,013). Quanto ao desejo de ter mais filhos, as mulheres que planejavam ter mais filhos tiveram maior chance de recusar o dispositivo do que as que não planejavam (p < 0,001).

Conclusão Mulheres com múltiplas gestações e sem desejo de ter mais filhos apresentaram maior probabilidade de aceitar o DIU. O perfil das que recusaram foi primeira gravidez e desejo de ter mais filhos. Dentre os três motivos mais frequentes de rejeição do DIU relatados, duas respostas se destacaram: a falta de justificativa específica e o desejo de ter mais filhos.

Keywords

intrauterine devices - contraception - postpartum period - family planning services - copper intrauterine device

Palavras-chave

dispositivos intrauterinos - anticoncepção - período pós-parto - planejamento familiar - dispositivo intrauterino de cobre

Contributions

All authors contributed to the design of the present study, were involved in the data collection, data analysis and/or interpretation. Also, all authors contributed to the writing/substantive editing and review of the manuscript and approved the final draft of the manuscript.

Publication History

Received: 13 October 2020

Accepted: 05 October 2021

Article published online:
25 February 2022

• References

• 1 Kaneshiro B, Aeby T. Long-term safety, efficacy, and patient acceptability of the intrauterine Copper T-380A contraceptive device. Int J Womens Health 2010; 2: 211-220
• 2 Gonie A, Worku C, Assefa T, Bogale D, Girma A. Acceptability and factors associated with post-partum IUCD use among women who gave birth at bale zone health facilities, Southeast-Ethiopia. Contracept Reprod Med 2018; 3: 16
• 3 Whitaker AK, Chen BA. Society of Family Planning Guidelines: Postplacental insertion of intrauterine devices. Contraception 2018; 97 (01) 2-13
• 4 Wildemeersch D, Goldstuck ND, Hasskamp T. Current status of frameless anchored IUD for immediate intracesarean insertion. Dev Period Med 2016; 20 (01) 7-15
• 5 Gonçalves CS, Cesar JA, Marmitt LP, Gonçalves CV. Frequency and associated factors with failure to perform the puerperal consultation in a cohort study. Rev Bras Saúde Mater Infant 2019; 19 (01) 63-70
• 6 Liberty A, Yee K, Darney BG, Lopez-Defede A, Rodriguez MI. Coverage of immediate postpartum long-acting reversible contraception has improved birth intervals for at-risk populations. Am J Obstet Gynecol 2020; 222 (4S, Suppl): 886.e1-886.e9
• 7 Hubacher D, Kavanaugh M. Historical record-setting trends in IUD use in the United States. Contraception 2018; 98 (06) 467-470
• 8 Machado RB. Uso de dispositivos intrauterinos (DIU) em nulíparas. São Paulo: FEBRASGO. 2018. . (Série Orientações e Recomendações FEBRASGO; no. 1/Comissão Nacional Especializada em Anticoncepção).
• 9 Prefeitura Municipal de São Paulo. Secretaria Municipal da Saúde. Relação municipal de medicamentos: REMUNE-SP [Internet]. São Paulo: Secretaria Municipal da Saúde; 2016 [cited 2020 Jul 10]. Available from: https://www.prefeitura.sp.gov.br/cidade/secretarias/upload/remune2016.pdf
• 10 Lopez LM, Bernholc A, Hubacher D, Stuart G, Van Vliet HA. Immediate postpartum insertion of intrauterine device for contraception. Cochrane Database Syst Rev 2015; (06) CD003036
• 11 Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO). Manual de orientação assistência ao abortamento, parto e puerpério;. São Paulo: FEBRASGO; 2010
• 12 Kirk E, Bottomley C, Bourne T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Hum Reprod Update 2014; 20 (02) 250-261
• 13 Brandão ER, Cabral CD. Da gravidez imprevista à contracepção: aportes para um debate. Cad Saude Publica 2017; 33 (02) e00211216  × 00211216
• 14 O'Hanley K, Huber DH. Postpartum IUDS: keys for success. Contraception 1992; 45 (04) 351-361
• 15 Zerden ML, Tang JH, Stuart GS, Norton DR, Verbiest SB, Brody S. Barriers to receiving long-acting reversible contraception in the postpartum period. Womens Health Issues 2015; 25 (06) 616-621
• 16 World Health Organization. Comparing typical effectiveness of contraceptive methods. Geneva: WHO; 2006
• 17 Stoddard A, McNicholas C, Peipert JF. Efficacy and safety of long-acting reversible contraception. Drugs 2011; 71 (08) 969-980
• 18 Zaconeta AM, Oliveira AC, Estrela FS, Vasconcelos TM, França PS, Wanderley MS. et al. Intrauterine device insertion during cesarean section in women without prenatal contraception counseling: lessons from a country with high cesarean rates. Rev Bras Ginecol Obstet 2019; 41 (08) 485-492
• 19 Machado MC, Assis KF, Oliveira FdeC, Ribeiro AQ, Araújo RMA, Cury AF. et al. Determinants of the exclusive breastfeeding abandonment: psychosocial factors. Rev Saude Publica 2014; 48 (06) 985-994
• 20 Tang JH, Dominik R, Re S, Brody S, Stuart GS. Characteristics associated with interest in long-acting reversible contraception in a postpartum population. Contraception 2013; 88 (01) 52-57
• 21 Makins A, Taghinejadi N, Sethi M, Machiyama K, Thapa K, Perera G. et al. Factors influencing the likelihood of acceptance of postpartum intrauterine devices across four countries: India, Nepal, Sri Lanka, and Tanzania. Int J Gynaecol Obstet 2018; 143 (Suppl. 01) 13-19
• 22 Nigam A, Ahmad A, Sharma A, Saith P, Batra S. Postpartum intrauterine device refusal in Delhi: reasons analyzed. J Obstet Gynaecol India 2018; 68 (03) 208-213
• 23 Hochmuller JT, Lopes KS, Guazzelli CAF, Gomes MKO, Araujo Júnior E, Peixoto AB. Expulsion rate of intrauterine device: mediate vs. immediate puerperium period. J Turk Ger Gynecol Assoc 2020; 21 (03) 143-149
• 24 Laporte M, Marangoni Jr M, Surita F, Juliato CT, Miadaira M, Bahamondes L. Postplacental placement of intrauterine devices: A randomized clinical trial. Contraception 2020; 101 (03) 153-158
• 25 Hubacher D, Masaba R, Manduku CK, Veena V. Uptake of the levonorgestrel intrauterine system among recent postpartum women in Kenya: factors associated with decision-making. Contraception 2013; 88 (01) 97-102
• 26 Chacko MR, Wiemann CM, Buzi RS, Kozinetz CA, Peskin M, Smith PB. Choice of postpartum contraception: factors predisposing pregnant adolescents to choose less effective methods over long-acting reversible contraception. J Adolesc Health 2016; 58 (06) 628-635
• 27 Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO). Contracepção reversível de longa ação. São Paulo: FEBRASGO; 2016. . (Série Orientações e Recomendações FEBRASGO; vol. 3, no.1).