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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 27  |  Issue : 4  |  Page : 379-384

Demographic features of users and uptake of intrauterine contraceptive device (IUCD) and reasons for removal at University of Calabar Teaching Hospital, Nigeria: A 5-year review


Department of Obstetrics and Gynecology, University of Calabar Teaching Hospital, Calabar, Nigeria

Date of Submission23-Feb-2022
Date of Decision18-May-2022
Date of Acceptance23-Jun-2022
Date of Web Publication22-Sep-2022

Correspondence Address:
Patience O Odusolu
Department of Obstetrics and Gynecology, University of Calabar Teaching Hospital, Calabar
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmh.ijmh_31_22

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  Abstract 

Background: Intrauterine contraceptive device (IUCD) is an effective long-acting reversible contraceptive method that is suitable for women of reproductive age. Despite this, its uptake by women in Nigeria is not optimum. Objectives: The objectives were to determine the uptake, demographic characteristics of users, and reasons for the removal of IUCD use at the University of Calabar Teaching Hospital (UCTH), Nigeria. Materials and Methods: This was a retrospective study of family planning clients, who accepted and inserted IUCD at UCTH, Calabar, between January 1, 2013, and December 31, 2017. Case records of clients were retrieved and reviewed. Data extracted were entered into excel and analyzed using SPSS. Results: Out of 10,102 clients during the period, 1,032 clients accepted and inserted IUCD, giving an uptake rate of 10.2%. There was a gradual decline in the uptake of IUCD from 383 (37.1%) in 2013 to 96 (9.3%) in 2017. The sociodemographic features of IUCD users showed a mean age of 33.53 ± 5.94 with the majority, 696 (67.4%) having tertiary education. The majority were para 3 or 4 and accounted for 627 (60.7%), whereas 662 (64.2%) had previously used a modern contraceptive method. Sixty-five (6.3%) clients had their IUCD removed. The commonest reason for the removal was desire to get pregnant, 44 (67.7%), and side effects of IUCD (20.6%). Conclusion: There was a low uptake of IUCD, with a decline in the trend over the study period. Side effects affected the removal of the the IUCD. There is a need for awareness creation and education of women, appropriate counseling, and good patient selection in order to increase uptake.

Keywords: Intrauterine contraceptive device, removal, side effects, uptake


How to cite this article:
Odusolu PO, Egbe JJ, Okpebri KO, Uduigwomen PA. Demographic features of users and uptake of intrauterine contraceptive device (IUCD) and reasons for removal at University of Calabar Teaching Hospital, Nigeria: A 5-year review. Int J Med Health Dev 2022;27:379-84

How to cite this URL:
Odusolu PO, Egbe JJ, Okpebri KO, Uduigwomen PA. Demographic features of users and uptake of intrauterine contraceptive device (IUCD) and reasons for removal at University of Calabar Teaching Hospital, Nigeria: A 5-year review. Int J Med Health Dev [serial online] 2022 [cited 2022 Oct 7];27:379-84. Available from: https://www.ijmhdev.com/text.asp?2022/27/4/379/356628




  Introduction Top


The use of contraception to limit or regulate family size is a basic human right, and all couples and individuals have the right to decide freely and responsibly the number and spacing of their children.[1] Contraception can be defined as a voluntary prevention of pregnancy, and it entails the interruption of the chain of processes that lead to conception.[2],[3],[4]

Contraception is very paramount in reducing the risk of unintended pregnancies and its attendant complications especially because of the restrictive abortion laws in Nigeria.[3] Although culturally there is a high premium on child bearing and parenthood,[3] the alarming increase in the rate of unwanted pregnancies indicates considerably unmet needs for contraception in the community.[4],[5],[6]

More than 220 million women in developing countries currently have unmet need for modern contraception, mainly in South Asia and Sub-Saharan Africa.[7],[8],[9],[10]

The program of action of the international conference on population and development urged all countries to strive to make contraceptive accessible to all individuals. The overall intent being to reduce unintended pregnancies, thereby reducing unsafe abortion and maternal deaths.[11],[12]

There are a wide range of contraceptives, ranging from barrier methods, spermicides, progesterone-only pills to combined oral contraceptive pills, progesterone injectables method, surgical sterilization, progesterone-only implants, and intrauterine contraceptive devices (IUCDs).[2],[4],[7]

IUCDs are long-acting reversible contraceptives.[6] The copper IUCDs are highly effective and licensed to the last 3–10 years. Failure rate among IUCD users is minimal and therefore has a significant effect on contraceptive prevalence rate.[11],[12],[13] The exact mechanism of action is unknown although current theories include spermicidal activity and activity on endometrium that may promote the phagocytosis of sperm leading to impedance to sperm migration or capitation.[3],[11] IUCDs though effective are not without side effects, which often prompt users to request removal; these include pain, bleeding, and pelvic inflammatory disease (PID).[6],[14],[15] Restricting use to monogamous couples and couples at a low risk of sexually transmitted infection can reduce to a negligible extent the risk of PID associated with IUCD.[14] It requires little effort on the part of the user once inserted and can offer up to 10 years protection against pregnancy.[8]

In Sub-Saharan African countries including Nigeria, IUCD despite its efficacy is underutilized. The use of IUCD in relation to other methods is reported to have either stagnated or declined.[4],[9] Even though the occurrence of side effects is one of the common reasons for removal,[13] the reported discontinuation rates in Nigeria range from 2.8% to 42.9% with a major reason for discontinuation being desire for pregnancy.[14] It is on this background that this study aims at determining the uptake, demographic characteristics, side effects, and the reasons for the removal at the University of Calabar Teaching Hospital (UCTH). It is hoped that the knowledge gained from this research would provide better insight and, when applied, would lead to an improved service delivery that will increase the uptake of IUCD in the family planning clinic.

Objective

The objective of this study was to determine the uptake, demographic characteristics of IUCD users, and the reasons for the removal at the Family Planning Clinic of UCTH.


  Materials and Methods Top


This was a retrospective descriptive study in the family planning clinic of UCTH from January 1, 2013 to December 31, 2017. Clients’ records were obtained from the family planning register. The case records of those that used IUCD were retrieved, and data obtained include the type of contraceptive, sociodemographic details, side effects, and reasons for removal. Data were entered into Microsoft Excel, and Statistical package for social sciences (SPSS) IBM version 25 was used to analyze the data. Descriptive analysis was done using tables and charts to present the results. Categorical data were summarized using frequencies and percentages, whereas numerical data with mean and standard deviation. Bivariate analysis using chi-square (χ2) test of independence was employed to check associations. Variables have significant association at a P value of <0.05. Ethical clearance was obtained from the Health Research and Ethics Committee of the hospital.


  Result Top


Out of 10,102 clients that accepted contraceptive methods during the period, 1,032 clients accepted and inserted IUCD, giving a prevalence of 10.2%. There was an overall increase in contraceptive use from 1,679 (16.62%) in 2013 to 3,242 (32.09%) in 2017, with the commonest method used by clients being condoms, 5,336 (52.82%), and IUCDs accounted for 1,032 (10.22%) as seen in [Table 1]. The uptake of IUCD by clients gradually declined from 383 (37.1%) in 2013 to 96 (9.3%) in 2017. See [Figure 1].
Table 1: Summary of contraceptive methods per year for the period under review

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Figure 1: Yearly uptake of IUCD during study period

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[Table 2] shows the mean age of IUCD users to be 33.53 ± 5.94, whereas the modal age group was 31–35, accounting for 400 (38.76%). Many had a tertiary level of education, 696 (67.4%), and were civil servants, 414 (40.1%), and businesswomen, 381 (36.9%). Six hundred and twenty-seven (60.7%) were para 3–4, 53.7% still wanted more children in the future, and 662 (64.2%) had previously used a modern contraceptive method. Out of the total number of participants, only 557 (60.9%) came back for follow-up visit, and out of those that came back for follow-up visit, 114 (20.6%) of them complained of various side effects following the insertion of IUCD as shown in [Figure 2].
Table 2: Sociodemographic/clinical characteristics

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Figure 2: Side effects following the insertion of IUCD

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A total of 65 clients had IUCD removal during the study period, giving a rate of 6.3%. The commonest reason for the removal was the desire to get pregnant, 44 (67.7%). See [Figure 3].
Figure 3: Reasons for the removal of IUCD

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In [Table 3], the relationship between age, education, parity, and side effect and the removal of IUCD was explored using chi-square test of independence. Only side effect to IUCD showed significant relationship with the removal of IUCD. The result showed that the proportion of those that removed their IUCD was significantly higher among those who experienced side effects compared with those who did not (41.9% versus 27.7%, P value = 0.048).
Table 3: Relationship between age, education, parity, side effect, and removal of IUCD

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  Discussion Top


There was an increase in the uptake of contraceptive methods from 16.62% in 2013 to 32.09% in 2017. Condoms (52.82%) was the commonest method, and the least was implants (12.47%). Although there was a general increase in the uptake of contraceptives during the period, there was a decline in the uptake of all the other methods. This could be due to unfounded fears and beliefs of side effects of other methods of contraception or perhaps increased awareness on safe sex practices because of the human immunodeficiency virus (HIV) pandemic, resulting in an increased use of condoms. The trend in this study is in consonance with other studies where a decline in contraceptive acceptance was reported.[10],[11],[15] There was a progressive decline in the uptake of IUCD through the study period. The use of IUCD in relation to other contraceptives methods has been reported to be either stagnated or declined.[4]

The rate of the uptake of IUCD was 10.2%, which was very low compared with higher figures reported in other studies including previous studies done in this center.[5],[6],[13],[14] This low uptake rate may be due to the very high uptake of condoms, and also family planning is still a contentious issue in our environment especially IUCD because of cultural and religious beliefs, myths, and misconceptions about IUCD. The acceptability of IUCD can be increased by health education, adequate counseling, careful client selection, and provision of free services.[13]

The mean age in the study was 33.53; this is comparable with a mean age of 31.3 in Lagos[16] and Benin,[17] though the mean age in the study done in Port Harcourt (PH)[18] was higher (37.8). The modal age group was 31–35 years; this was higher than the 25–29 age group from a previous study in this center[5] and one from Uyo,[19] but lower than the 35–39 age group from the study in PH.[18] The high modal age of the uptake of IUCD may also be because at this age many women may defer child bearing in order to pursue their careers, hence the need for contraception so as to prevent unwanted pregnancies. There were no teenagers in this study; this was also noted in the study from PH. Other studies show the number of teenagers who took up IUCD as a contraceptive measure to be inconsequential.[13],[14],[20],[21] This scenario is a reflection of the fact that the integration of adolescent reproductive health into our system still poses a challenge.[13] There has been some worry about the use of IUCDs in nulliparous or adolescent women because of difficulties with insertion, the fear of expulsion of the IUCD, and the higher risks of PID and infertility because of the likelihood of having multiple sexual partners.[3],[10],[13],[14],[22]

A majority of users had a tertiary level of education and were civil servants. This positive association of the uptake with a high level of education agrees with the observation by other studies.[14],[16],[21] This may be linked with the role of female education in empowering women through their participation in decision-making and influencing their health-seeking behavior.[13],[14] From the study, those who were para 3–4 were the leading users of IUCD, which is in agreement with previous studies,[17],[18],[21] which showed that multiparous women took up IUCD more compared with those in who were nulliparous or of low parity. This may be due to the fear of negative effect on future conception for the nulliparous or low parity women, whereas for the high parity women, this may represent the peak period of their reproductive life, and having possibly completed their family size, the women who had previously refused this form of contraception now begin to take it up since they were no longer desirous of fertility.[17]

The removal rate of 7.5% though low falls within the reported range of 2.8%–42.9% in Nigeria.[2],[14],[18],[23] The commonest reason for discontinuation was desire for pregnancy; this is comparable to many studies.[8],[13],[14],[16],[21] although a few studies had side effects as the commonest reason for removal.[18],[20] More than 70% of the clients had no side effects indicating a good safety profile of the contraceptive. The commonest side effect was menstrual irregularities, which accounted for 51.6% of the complications; this is in agreement with some other studies.[13],[18] The study in Uyo however found lower abdominal pains the commonest side effect.


  Conclusion Top


There was a low uptake of IUCD, with a decline in the trend over the study period. Side effects affected the removal significantly. There should be an improvement in female education and public enlightenment and awareness creation on the benefits and importance of family planning. The provision of free IUCDs and services will enhance its utilization, and inclusion of devices like Levonorgestrel intrauterine system, which reduces menstrual loss, will be of great value.

Limitations

  1. This was a retrospective review of records, so there was a possibility that some information may not been well documented.


  2. About 40% of IUCD users did not come back for follow-up; hence, some side effects and possible removal may have been missed.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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