Publication:

Acceptance and outcomes of postpartum intrauterine contraceptive device insertion in a tertiary care hospital: a prospective observational study

Background The postpartum period is an ideal time to address the unmet need for contraception. The postpartum intrauterine contraceptive device (PPIUCD) is a safe, effective, long-acting, reversible, and non-hormonal contraceptive that can be inserted immediately after delivery or within 48 hours. Objectives were to evaluate acceptance, demographic profile, reasons for acceptance and refusal, and clinical outcomes of PPIUCD insertion among postpartum women.

Methods This prospective observational study was conducted at Dhiraj Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, from January 2024 to January 2025. A total of 1,500 antenatal and postpartum women were counselled regarding PPIUCD. Of these, 300 women accepted copper T (Cu-T) 380A insertion and were followed up at 6 weeks and 6 months. Data on acceptance, demographic characteristics, reasons for acceptance/refusal, complications, expulsions, and removals were analysed.

Results The acceptance rate was 22.2%. Most acceptors were 20-24 years old, second gravida (60%), and educated (82%). Intra-caesarean insertion was performed in 70% of cases. Convenience, long-term contraception, avoidance of an additional hospital visit, and absence of hormonal side effects were the main reasons for acceptance, while inability to make an independent decision without partner involvement was the commonest reason for refusal. At 6 weeks, 66% of women were asymptomatic, increasing to 94.7% at 6 months. No uterine perforation or pelvic infection occurred. Six expulsions and 14 removals were recorded during follow-up.

Conclusions PPIUCD is a safe, effective, and well-tolerated postpartum contraceptive with high continuation and low complication rates. Strengthening antenatal counselling and partner involvement may improve acceptance.