Use and discontinuation of intrauterine contraceptive device in the Greater Accra Region of Ghana
Tóm tắt
The intrauterine contraceptive device is one of the modern long-acting and reversible contraception that is very safe and effective. Yet, less than 2 % of women are using intrauterine devices in Ghana. This study therefore explored the experiences and barriers to intrauterine contraceptive device use and discontinuation in Greater Accra Region, Ghana. Intrauterine contraceptive device users and providers were purposively selected from eight private family planning clinics in the Greater Accra Region. Semi-structured interview guides were used for in-depth interviews during data collection. The interviews were audio-taped to ascertain accurate accounts of the interviews and recordings replayed for analytical responses. Field assistants transcribed the interviews conducted themselves and read through the transcripts produced twice to increase familiarity with the dataset. A list of code labels was created and a series of categories for the main themes that emerged from the transcripts were developed. The transcribed data was organized, coded and manually thematically analysed in word. Study results were presented in tables and quotes from respondents. Results showed that key motivations for intrauterine contraceptive device use include effectiveness, benefits, and efficacy of the device, fertility regulation, peace of mind, contraceptive method switching, health provider effects, desire for long-acting contraceptive method, and partner characteristics. Intrauterine contraceptive device discontinuation was due to bleeding irregularities, vaginal infections, desire to increase fertility, physical features of the intrauterine device, and partner disapproval of use. Other reasons in both cases pertained to non-hormonal aspects of the intrauterine device, partner characteristics, and provider encouragement and influence. Several factors influence the use and discontinuation of intrauterine device in Ghana. Comprehensive contraceptive counselling on the intrauterine device is essential in promoting uptake and knowledge of the intrauterine device at the health facility level. Various targeted messages are also needed to dispel misconceptions at the community level.
Tài liệu tham khảo
World Health Organization. Medical eligibility criteria for contraceptive use. 4th ed. Geneva: World Health Organization; 2009.
Trussell J, Lalla AM, Doan QV, Reyes E, Pinto L, Gricar J. Cost effectiveness of contraceptives in the United States. Contraception. 2009;79(1):5–14.
Chiou CF, Trussell J, Reyes E, et al. Economic analysis of contraceptives for women. Contraception. 2003;68:3–10.
Grimes D, Jones KP, Knutson CC, Wysocki S. Use of intrauterine contraception in the United States: Association of Reproductive Health Professionals. Washington, DC: Elsevier Inc.; 2004.
Yoost J. Understanding benefits and addressing misperceptions and barriers to intrauterine device access among populations in the United States. Patient Preference Adherence. 2014;8:947–57.
Sanfield A. Popularity disparity: attitudes about the IUD in Europe and the United States. Guttmacher Policy Rev. 2007;10:19–24.
Black K, Lotke P, Kai J, Buhling N, Zite B. A review of barriers and myths preventing the more widespread use of intrauterine contraception in nulliparous women. Eur J Contracept Reprod Health Care. 2012;17:340–50.
Stanwood NL, Garrett JM, Konrad TR. Obstetrician-gynecologists and the intrauterine device: a survey of attitudes and practice. Obstet Gynecol. 2002;99:275–80.
Postlethwaite D, Trussell J, Zoolakis A, Shabear R, Petitti D. A comparison of contraceptive procurement pre- and post- benefit change. Contraception. 2007;76:360–5.
Goodman S, Hendlish SK, Benedict C, Reeves MF, Pera-Floyd M, Foster-Rosales A. Increasing intrauterine contraception use by reducing barriers to post-abortal and interval insertion. Contraception. 2008;78:136–42.
Middleton AJ, Naish J, Singer N. General practitioners’ views on the use of the levonorgestrel-releasing intrauterine system in young, nulligravid women, in London, UK. Eur J Contracept Reprod Health Care. 2011;16:311–8.
Allen RH, Goldberg AB, Grimes DA. Expanding access to intrauterine contraception. Am J Obstet Gynecol. 2009;4(56):1–5.
Lyus R, Lohr P, Prager S. Board of the Society of family planning. Use of the Mirena LNG-IUS and Paragard CuT380A intrauterine devices in nulliparous women. Contraception. 2010;81:367–71.
Harper CC, Blum M, de Bocanegra HT, et al. Challenges in translating evidence to practice: the provision of intrauterine contraception. Obstet Gynecol. 2008;111:1359–69.
Hubacher D, Lara-Ricalde R, Taylor DJ, et al. Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women. N Engl J Med. 2001;345:561–7.
Allen RH, Bartz D, Grimes DA, et al. Interventions for pain with intrauterine device insertion. Cochrane Database Syst Rev. 2009;3:CD007373.
Mishell D, Sulak P. The IUD: dispelling the myths and assessing the potential. Dialogues Contraception. 1997;5(2):1–4.
Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF Macro. Ghana demographic and health survey 2014. Accra: GSS, GHS, and ICF Macro; 2014.
Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF Macro. Ghana demographic and health survey (1993, 1998, 2003, 2008, 2014). Accra: GSS, GHS, and ICF Macro.
Schwandt HM, Creanga AA, Adanu RM, Danso KA, Agbenyega T, Hindin MJ. Pathways to unsafe abortion in Ghana: the role of male partners, women and health care providers. Contraception. 2013;88(4):509–17.
Speidel JJ, Harper CC, Shields WC. The potential of long-acting reversible contraception to decrease unintended pregnancy. Contraception. 2008;78:197–200.
Wickstrom J, Jacobstein R. Contraceptive security: incomplete without long-acting and permanent methods of family planning. Stud Fam Plan. 2011;42:291–8.
Weston MR, Martins SL, Neustadt AB, Gilliam ML. Factors influencing uptake of intrauterine devices among postpartum adolescents: a qualitative study. Am J Obstet Gynecol. 2012;206:40.e1–7.
Mohamed AM, Rachael SK, Cleland JN, Thoai D, Shah IH. Long-term contraceptive protection, discontinuation and switching behaviour: intrauterine device (IUD) use dynamics in 14 developing countries. London: World Health Organization and Marie Stopes International; 2011.
Hatcher R, Trussell J, Nelson A, Cates W, Stewart F. Contraception technology. 19th ed. New York: Ardent Media; 2008.