Reasons for Intrauterine Device Use, Discontinuation and Non-Use in Malawi: A Qualitative Study of Women and their Partners

• Published in: African journal of reproductive health 2015-12, Vol.19 (4), p.50-57
• Main Authors: Bryant, Amy G., Hamela, Gloria, Gottert, Ann, Stuart, Gretchen S., Kamanga, Gift
• Format: Article
• Language: English
• Subjects: Adult; Analysis; Birth control; Children; Complications and side effects; Contraception; Contraception - methods; Contraception - psychology; Contraception - statistics & numerical data; Decision making; Device Removal - psychology; Device Removal - statistics & numerical data; Dosage and administration; Family planning; Family Planning Services - methods; Family Planning Services - statistics & numerical data; Female; Humans; Intrauterine devices; Intrauterine Devices, Copper - statistics & numerical data; Intrauterine Devices, Copper - utilization; IUD; Malawi - epidemiology; Male; Methods; Nurses; Oral contraceptives; Pilot Projects; Postpartum Period; Reproductive health; Rumors; Sexual Partners - psychology; Side effects; Womens health
• ISSN: 1118-4841

The copper intrauterine device (IUD) is a safe, long-acting, and effective method of contraception that is under-utilized in many countries, including Malawi. A unique cohort of women who had enrolled in a trial of postpartum IUD use one year earlier gave insights into reasons for using, discontinuing, or not using the IUD. We conducted in-depth interviews with 18 women one year after they participated in a pilot study of a randomized controlled trial of postpartum IUD insertion, and 10 of their male partners. Women and their partners expressed a strong desire for family planning, and perceived numerous benefits of the IUD. However, fear of the IUD was common among successful users and non-users alike. This fear arose from rumours from friends and neighbors who were non-users. How women and their partners responded to this fear affected IUD adoption and continuation. Key themes included (1) Trust in information received from health care providers versus rumours from community members; (2) Partner involvement in IUD decision-making; and (3) Experience with side effects from short-term hormonal contraceptive methods. Broad community education about the IUD's benefits and safety, and proactive counseling to address couples' specific fears, may be needed to increase uptake of the method. Le dispositif intra-utérin de cuivre (DIU) est une méthode de contraception efficace de longue durée d'action non dangereuse, qui est sous-utilisée dans de nombreux pays, dont le Malawi. Une cohorte unique de femmes qui étaient inscrites dans un procès de l'utilisation du DIU post-partum un an plus tôt ont donné un aperçu de raisons pour l'utilisation, l'arrêt, ou de ne pas utiliser le DIU. Nous avons mené des entrevues en profondeur auprès des 18 femmes un an après leur participation à une étude pilote d'un essai contrôlé randomisé d'insertion d'un DIU post-partum, et 10 de leurs partenaires masculins. Les femmes et leurs partenaires ont exprimé un fort désir pour la planification familiale, et de nombreux avantages perçus du DIU. Cependant, la peur du DIU était courante chez les utilisateurs qui ont eu de succès ainsi que chez les non-utilisateurs. Cette crainte provenait de rumeurs de la part des `amis et des voisins qui étaient des non-utilisateurs. Comment les femmes et leurs partenaires ont répondu à cette peur a affecté l'adoption et le maintien d'un DIU. Les principaux thèmes inclus (1) La confiance dans les informations reçues des fournisseurs de soins de santé par ra