Publication:

Determinants of postpartum intrauterine contraceptive device use: a case-control study at a tertiary care center in India

Background Postpartum intrauterine contraceptive devices (PPIUCD) offer safe, effective, long-term contraception during the immediate postpartum period. Despite its advantages, acceptance remains low in India. Understanding the determinants of PPIUCD use is crucial for improving family planning services. This study aimed to identify determinants of PPIUCD use among postnatal women at a tertiary care center and determine their strength of association.

Methods A hospital-based case-control study was conducted from March 2023 to February 2025. Cases included 70 postnatal women using PPIUCD, and controls included 70 age-matched postnatal women not using PPIUCD. Data were collected using predesigned questionnaires covering sociodemographic characteristics, reproductive history, and obstetric factors. Univariate and multivariate logistic regression analyses were performed.

Results The mean age was 24.57±3.87 years among cases and 23.85±3.70 years among controls. Significant determinants in univariate analysis included education level, husband's education and occupation, age at marriage, fertility preference, planned pregnancy, PPIUCD counseling, gravidity, and parity. In multivariate analysis, joint decision-making on family size (OR: 0.043, 95% CI: 0.007-0.275), planned pregnancy (OR: 2.674, 95% CI: 1.022-6.995), PPIUCD counseling (OR: 12.674, 95% CI: 4.668-34.411), and multiparity (OR: 0.147, 95% CI: 0.055-0.393) remained significant determinants.

Conclusions PPIUCD counseling emerged as the strongest predictor of acceptance. Comprehensive antenatal counseling involving both partners, promoting planned pregnancies, and addressing cultural barriers through community education are essential for improving PPIUCD uptake.