Clinical trial NCT05471362: Barriers of Immediate Postpartum Intrauterine Device Uptake
Official title: Barriers of Immediate Postpartum Intrauterine Device Uptake in Assiut Public Hospitals
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: IUD
Lead sponsor: Assiut University
Sponsor class: OTHER
First posted: 2022-07-22
Enrollment: 400
Sex: FEMALE
Minimum age (years): 16
Maximum age (years): 50
Standard ages: CHILD
ADULT
Observational model: CASE_CONTROL
Time perspective: RETROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Women aged from 16 to 50 who are pregnant and delivering in Assiut public hospitals via c-section

Brief summary: 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: 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.

Eligibility criteria: 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

Primary outcomes:
measure: 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
timeFrame: Baseline
measure: 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
timeFrame: Baseline
measure: Identifying the method related barriers to immediate postpartum uptake of the intrauterine device as perceived by women in Assiut public hospitals
timeFrame: Baseline
Secondary outcomes:
Other outcomes:
Locations:
Study officials:
affiliation: Assiut University
name: Omaima El Gibaly, PhD
role: STUDY_DIRECTOR
References:
citation: Ganatra B, Faundes A. Role of birth spacing, family planning services, safe abortion services and post-abortion care in reducing maternal mortality. Best Pract Res Clin Obstet Gynaecol. 2016 Oct;36:145-155. doi: 10.1016/j.bpobgyn.2016.07.008. Epub 2016 Aug 3.
citation: Holden EC, Lai E, Morelli SS, Alderson D, Schulkin J, Castleberry NM, McGovern PG. Ongoing barriers to immediate postpartum long-acting reversible contraception: a physician survey. Contracept Reprod Med. 2018 Nov 8;3:23. doi: 10.1186/s40834-018-0078-5. eCollection 2018.
citation: Eltomy EM, Saboula NE, Hussein AA. Barriers affecting utilization of family planning services among rural Egyptian women. East Mediterr Health J. 2013 May;19(5):400-8.
citation: Divakar H, Bhardwaj A, Purandare CN, Sequeira T, Sanghvi P. Critical Factors Influencing the Acceptability of Post-placental Insertion of Intrauterine Contraceptive Device: A Study in Six Public/Private Institutes in India. J Obstet Gynaecol India. 2019 Aug;69(4):344-349. doi: 10.1007/s13224-019-01221-7. Epub 2019 May 10.