Center for Research on Environment, Health and Population Activities (CREHPA), Kathmandu, Nepal.
Harvard T. H. Chan School of Public Health, Boston, USA.
Reprod Health. 2020 Mar 18;17(1):41. doi: 10.1186/s12978-020-0892-5.
Postpartum intrauterine device (PPIUD) use remains very low in Nepal despite high levels of unmet need for postpartum family planning and the national government's efforts to promote its use. This study investigates reasons for continuing or discontinuing PPIUD use among Nepali women.
We conducted in-depth interviews (IDIs) with 13 women who had discontinued PPIUD use and 12 women who were continuing to use the method 9 months or longer following the insertion. All interviews were audio recorded, transcribed, translated into English, and analyzed using a thematic approach.
Women discontinued PPIUD for several reasons: 1) side effects such as excessive bleeding during menstruation, nausea, back and abdominal pain; 2) poor quality of counselling and, relatedly, mismatched expectations in terms of device use; and 3) lack of family support from husbands and in-laws. In contrast, women who were continuing to use the method at the time of the study stated that they had not experienced side-effects, had received appropriate information during counselling sessions, and had the backing of their family members in terms of using PPIUD.
Experiencing side-effects or complications following PPIUD insertion and poor quality of family planning counselling were the two main reasons for discontinuation. Family members appeared to play a major role in influencing a woman's decision to continue or discontinue PPIUD suggesting that counseling may need to be expanded to them as well. Improving quality of counselling by providing complete and balanced information of family planning methods as well as ensuring sufficient time for counselling and extending PPIUD service availability at lower level clinics/health posts will potentially increase the uptake and continued use of postpartum family planning, including PPIUD, in Nepal.
尽管尼泊尔对产后计划生育的需求很高，且政府努力推广，但产后宫内节育器（PPIUD）的使用仍然很低。本研究调查了尼泊尔妇女继续或停止使用 PPIUD 的原因。
我们对 13 名已停止使用 PPIUD 的妇女和 12 名在插入后 9 个月或更长时间继续使用该方法的妇女进行了深入访谈（IDIs）。所有访谈均进行了录音、转录、翻译成英文，并使用主题方法进行了分析。
妇女停止使用 PPIUD 的原因有几个：1）副作用，如月经期间出血过多、恶心、背痛和腹痛；2）咨询质量差，因此在设备使用方面存在期望不匹配；3）缺乏丈夫和姻亲的家庭支持。相比之下，在研究时继续使用该方法的妇女表示，她们没有经历过副作用，在咨询期间获得了适当的信息，并且在使用 PPIUD 方面得到了家庭成员的支持。
PPIUD 插入后出现副作用或并发症以及计划生育咨询质量差是停止使用的两个主要原因。家庭成员似乎在影响妇女继续或停止使用 PPIUD 的决定方面发挥了重要作用，这表明咨询可能也需要扩展到他们。通过提供计划生育方法的完整和平衡信息来提高咨询质量，确保咨询有足够的时间，并在较低级别的诊所/卫生所扩大 PPIUD 服务的可用性，可能会增加尼泊尔产后计划生育（包括 PPIUD）的使用率和持续使用。
