Barriers of Immediate Postpartum Intrauterine Device Uptake

Study Overview
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Brief Summary
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increase immediate postpartum intrauterine device uptake and support family planning programs to overcome barriers and increase contraception prevalence rate in Egypt determine client related barriers of immediate postpartum intrauterine device uptake in Assiut Hospitals (Demand side) identify provider related barriers of immediate postpartum intrauterine device uptake in Assiut Hospitals (Supply side) describe method related barriers perceived by women

Detailed Description
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Population increase in Egypt is a major problem with the fertility rate 3.5 children per woman the postpartum period starts after the birth of the placenta and lasts for 6-8weeks after delivery Women resume sexual activity 1 to 2 months after delivery, with 45-day average till return of ovulation. women returning for intrauterine device insertion 6-8 weeks are at risk of unintended pregnancy Insertion of postpartum intrauterine device is immediate or interval. immediate Postpartum intrauterine device inserted from the placental delivery time (within 10 minutes), or within first 48 hours, it can be done after vaginal or caesarean. Postpartum intrauterine device can improve mothers' health by reducing difficulties from closely spaced pregnancies Immediate postpartum intrauterine device uptake is low in most developing countries and Egypt due to several barriers Health facility: provider knowledge, attitude, lack of training, counseling, privacy, shortage of supply of intrauterine device,poor quality of service, bad experience with the facility Community: as Sociodemographic (desire more children), cultural norms, husband opposition, and religious beliefs , fear of side effects., Cognitive (didn't hear about family planning in past 6 months), reproductive (long interval between intercourse), medical (requiring checkups) physical (distance of clinic) The rational is postpartum women are motivated to avoid pregnancy, 90% of women deliver in hospitals, they are in facilities with skilled physicians who can offer contraception. Immediate postpartum intrauterine device is cost-effective and efficient Assiut implemented a program training physicians on immediate Postpartum intrauterine device insertion in 2021. This study will support the newly implemented program to overcome barriers from demand and supply sides and direct the program to future activity.

Official Title
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Barriers of Immediate Postpartum Intrauterine Device Uptake in Assiut Public Hospitals

Conditions
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IUD

Intervention / Treatment
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* Device: Postpartum IUD


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Women who gave birth via elective Cesarian Section at 4 public hospitals in Assiut city from October 2021: woman who gave birth via elective c-section at Women Health hospital of Assiut University from October 2021 women who gave birth via elective c-section at Assiut General Hospital from October 2021 women who gave birth at via elective c-section El-Eman El-Arbaeen from October 2021 women who gave birth at via elective c-section El-Mabarra from October 2021 Exclusion Criteria: Women who delivered by vaginal delivery Women who delivered by emergency c-section women who has anomalies in the uterus

Ages Eligible for Study
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Minimum Age: 16 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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Female

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Cases women who used IUD<br>Cases: women who had immediate Copper IUD inserted since October 2021 at the 4 public hospitals | Device: Postpartum IUD<br>* Postpartum IUD prevents pregnancy and short inter-pregnancy interval and allow spacing and family regulation<br>|
| Control women who didn't use IUD<br>Controls: women who gave birth at the same hospitals and not using the immediate Copper IUD | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Identifying the different barriers of uptake of immediate Postpartum copper Intrauterine device on the demand side; barriers to immediate postpartum uptake of the intrauterine device as perceived by the clients | Determining client related barriers of uptake of immediate postpartum copper intrauterine device in Assiut public Hospitals (Demand side) and identifying the most common barriers wether it is Cognitive; if she ever heard about Immediate postpartum intrauterine device, source of information and when was she informed about the method (during antenatal care or Delivery) and her knowledge about Immediate postpartum intrauterine device or wether it is Cultural & family factors; fertility preferences of couple, husband's or family disapproval of using contraception, fear of use due to myths and misconception, cultural preference of pregnancy in young age and the belief that untraditional contraception harm the health | Baseline | 
| Identifying the different barriers of uptake of immediate Postpartum copper Intrauterine device on the supply side; barriers as perceived by the physicians and nurses and other barriers related to the facility | Identifying the barriers of uptake of immediate Postpartum copper Intrauterine device on the supply side; barriers to immediate postpartum uptake of the intrauterine device as perceived by the physicians and nurses and in the facility in Assiut public hospitals such as provider personal preference, negative attitude of the hospital staff towards immediate postpartum intrauterine device, Perceived poor quality of care in the facility, previous personal or a relatives' bad experience with the facility, shortage of stock on the supply of intrauterine device in delivery settings, bad providers attitude towards pregnant women, lack of access to Postpartum intrauterine device during delivery and cost of the IUD | Baseline | 
| Identifying the method related barriers to immediate postpartum uptake of the intrauterine device as perceived by women in Assiut public hospitals | Describing method related barriers perceived by women such as fear of side effects, tried it before and failed, used it before and caused bleeding or pain, want the best available method, wants to try other methods, already uses a certain method and doesn't wish to change and attitude towards postpartum intrauterine device | Baseline |