Knowledge and attitude towards post-partum insertion of intra uterine devices among pregnant women attending antenatal clinic at a tertiary care teaching hospital

INTRODUCTION

The postpartum period is an important phase in the life of a woman and her baby. It is a time of transition, adjustment, and adaptation along with significant biological and psychosocial changes. Further, postpartum period is one of crucial times when women are more accessible to family planning methods. If a contraceptive is provided prior to discharge from the hospital then the women need not return specially for contraception. The couple has been protected before they assume sexual activity.¹ PPIUCD are still emerging as relatively new contraception choice in India.² Postpartum intrauterine contraceptive device is the only family planning method which is highly effective, reliable, inexpensive, non-hormonal, immediately reversible, and long-acting contraceptive that can be initiated during the immediate postpartum period and it has no a negative effect on lactation.^3-5 According to Medical Eligibility Criteria of WHO, an IUCD can be inserted within 48 hours postpartum or after 6 weeks following birth is known as PPIUCD. Insertion of IUCD in postpartum period has various benefits over interval insertion.⁶ Advantage includes high motivation with surety the woman being not pregnant. Postpartum insertion avoids the discomfort during interval insertion and insertion related bleeding will be masked by lochia.⁷

In India, 65% of women in the first year postpartum have an unmet need for family planning, 26% of women are using any method of family planning during the first year postpartum. 8% of the women desire to have another child within the next 2 years after giving birth and are vulnerable to the risks of early pregnancy.⁸ Fear of complications and lack of information are the common problems for unmet need.⁹ Therefore, it is necessary to assess the knowledge and attitude regarding PPIUCD among pregnant women to enhance the PPIUCD awareness program in India.

METHODS

A cross-sectional descriptive research was conducted at antenatal outpatient unit, over a period of 6 months from 1st August 2018 to 1st January 2019 at All India Institute of Medical Sciences, Jodhpur. Antenatal mothers, gestational age more than 20 weeks, attending AIIMS antenatal OPD was selected by purposive sampling technique. The sample size of this study was calculated as 183, by using similar previous study 13% good knowledge on PPIUCD, with 95% set interval and 5% confidence interval. Pregnant women who are registered at AIIMS, Jodhpur, and gestation age more than 20 weeks and able to read and understand Hindi were included.

Data were collected by interview using a data sheet for recording personal variables details of pregnant women such as age, education, husband’s education, occupation, husband’s occupation, type of family, religion, parity, previous contraceptive use, wish to use postpartum contraception, gestational age and desire for next pregnancy. Knowledge was assessed by a structured questionnaire comprising of 15 items to assess the knowledge of antenatal mothers regarding postpartum insertion of intra uterine devices. One mark will be given for each correct answer and zero for each incorrect or the unanswered item. Scores of knowledge are categorized into three levels: poor, fair and good. Out of a total score of 15, a score of 5 or below is considered as a poor level of knowledge, 6 to 10 is considered as fair knowledge, and 11 or great is considered as good knowledge.

A structured 5 point Likert scale was used to assess the attitude of antenatal mothers regarding postpartum insertion of intra uterine devices. Attitudes scale consisted of 10 items. The scores for the responses ranged from 1-5 for the answers from strongly disagree to strongly agree. Score of attitude is categorized into positive, neutral and negative. A score of less than 17 was considered as negative attitude and score of 17 to 33 was considered as neutral and 34 to 50 was considered as positive attitude. The self - structured knowledge questionnaire and attitude scale were found to be valid and reliable with score of internal consistency more than 0.7. Data were analyzed using SPSS 16 version descriptive statistics were employed. Karl Pearson’s correlation coefficient was computed to determine the relationship between the knowledge and attitude regarding PPIUCD. Chi-square test was done to determine the association between the knowledge, attitude.

RESULTS

A total of 183 subjects in the gestational age more than 20weeks who visited antenatal OPD were enrolled for the study. All subjects were completed questionnaires.

Table 1 shows that majority 69.4% (127) belongs to the age group of 18-28 years, 31.7% (58) had degree and above, 77% (141) were housewife, 62.8% (115) were primi gravid, average gestational age of pregnant women was 28 weeks and desired for next pregnancy was 63.1% (119). Table 2 shows mean knowledge score was found to be 6.14 and standard deviation was 1.48. The Figure 1 shows that majority 57.4% (105) had fair level of knowledge, 24.6% (45) had poor level of knowledge and none of them had excellent knowledge on PPIUCD.

*Correlation is sign at the 0.05 level (2 tailed)

*Correlation is sign at the 0.05 level (2 tailed).

*Correlation is sign at the 0.05 level (2 tailed).

Table 3 shows mean attitude score was found to be 32.09 and standard deviation was 4.28. Figure 2 shows that majority 64.5% (118) had neutral attitude, 33.3% (61) had positive attitude and 2.2% (4) of them had negative attitude on PPIUCD.

Table 4 shows that there was no association between the level of knowledge and selected personal variables except education.

Table 5 shows that there was no association between the level of attitude and selected personal variables except education.

Table 6 shows that there was positive correlation exit between the level of knowledge and attitude.

DISCUSSION

Most women in present study belong to 18-28 years age group and degree and above had good knowledge on PPIUCD. Similarly, in a study by Saroj et al. majority of women belong to 20-25 years. Awareness level about PPIUCD was highest among age group of 25-35 years and in women who were educated as postgraduate or more.¹⁰

Yadav et al stated that majority of the participants 65.7% (46) were not used any family planning method in past and majority of the participants 45.7% (32) were not decided their future pregnancy whereas 31.4% (22) participants were desire no more pregnancy in future.¹¹ In the present study gestational age of pregnant women on an average 28 weeks, majority 80.3% (147) were not used any family planning measures in past, 65% of participants had desire to more pregnancy, 35% of participants were desire no more pregnancy in future. More 73.8% (135) of participants were not willing for postpartum contraception.

Yadav et al stated that majority (81.4%) of the antenatal mothers had poor knowledge regarding PPIUCD. 50% of the antenatal mothers had favourable attitude towards PPIUCD. There was a significant positive relationship between knowledge and attitude (r=0.749) at 0.05 level of significance.¹¹ As like in this study fair level u knowledge about 57.4%, poor level of knowledge 24.6% and there was significant positive relationship between knowledge and attitude (r =0.509) at p<0.0001 level of significance.

Asnani et al. was found that 18% acceptance rate for insertion of PPIUCD after the delivery.¹² Nayak et al reported the low (25.32%) rate of PPIUCD insertion acceptance rate among pregnant women in a tertiary care centre. More acceptances were higher in the age group of 26-30 years (35.3%), para-2 (42.84%).¹³ But, in the present study majority reported neutral attitude 64.5% and 33.3% had positive attitude towards PPIUCD. More, the majority the age group between 18-28 years (23.5%), primi gravida (23.5%) and degree holders (14.8%) had positive attitude towards PPIUCD.

The present study is limited with OPD, AIIMS Jodhpur and the participants were assessed by verbal response. The present study included a large sample of women; the findings cannot necessarily be generalized to all of India since the participants were purposive samples rather than a sample representative of the country.

CONCLUSION

This present study finding revealed the majority of antenatal mothers having lack of knowledge and less favourable attitude regarding PPIUCD. Hence, this study imply the strong need for awareness programme on PPIUCD among antenatal mothers in order to meet the family planning needs after delivery.

ACKNOWLEDGEMENTS

Authors would like to thank the participants for their continuous support with interest for the study.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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