Maternal and Child Survival Program, Jhpiego, Washington, DC, USA.
Maternal and Child Survival Program, Jhpiego, Nairobi, Kenya.
Glob Health Sci Pract. 2021 Mar 31;9(1):89-106. doi: 10.9745/GHSP-D-20-00556.
Few women in low- and middle-income countries have access to the hormonal intrauterine system (IUS). Past research from a small number of facilities and the private sector suggest the IUS could be an important addition to the contraceptive method mix because it is the only long-acting method some women will adopt and users report high satisfaction and continuation. We aimed to determine whether these promising results were applicable in public facilities in Kenya and Zambia.
We used a mixed-methods approach with program monitoring data, interviews with women who received an IUS, and qualitative focus group discussions with providers. Data were collected in 2017-2019.
Facilities in Kenya and Zambia reported 1,985 and 428 IUS insertions, respectively. If the IUS had not been available, 30% of adopters would have chosen a short-acting method. Women and providers gave diverse reasons for adopting the IUS, with the desire for fewer side effects being frequently mentioned in focus group discussions. Many IUS adopters first heard of the method on the day it was inserted (70% in Kenya, 47% in Zambia), yet providers reported that many women were unwilling to try a method they were just hearing about for the first time. Satisfaction and continuation were high: 86% of adopters in Kenya were still using the method 3-6 months after insertion and 78% were in Zambia (average 10 months post insertion). Providers also reported that most IUS adopters were satisfied; they rarely returned with complaints that could not be addressed with additional counseling.
Expanding IUS access through the public sector shows promise to increase contraception use and continuation in low- and middle-income countries. Efforts to strengthen availability should consider demand and engage directly with various communities, including youth, around availability of a new long-acting option.
在中低收入国家，很少有女性能够获得荷尔蒙宫内节育系统（IUS）。过去，少数医疗机构和私营部门的研究表明，IUS 可能是避孕方法组合中的一个重要补充，因为它是一些女性唯一会选择的长效避孕方法，且使用者报告满意度和续用率都很高。我们旨在确定这些有希望的结果是否适用于肯尼亚和赞比亚的公共设施。
我们采用了混合方法，包括项目监测数据、对接受 IUS 的女性进行的访谈以及对提供者进行的定性焦点小组讨论。数据收集于 2017-2019 年。
肯尼亚和赞比亚的医疗机构分别报告了 1985 例和 428 例 IUS 插入。如果没有 IUS，30%的使用者会选择短效避孕方法。女性和提供者对采用 IUS 的原因各不相同，在焦点小组讨论中经常提到希望减少副作用。许多 IUS 使用者是在插入当天第一次听说这种方法（肯尼亚为 70%，赞比亚为 47%），但提供者报告说，许多女性不愿意尝试她们第一次听说的方法。满意度和续用率很高：肯尼亚有 86%的使用者在插入后 3-6 个月仍在使用该方法，赞比亚有 78%（平均插入后 10 个月）。提供者还报告说，大多数 IUS 使用者都很满意；他们很少因无法通过额外咨询解决的投诉而返回。
通过公共部门扩大 IUS 的可及性有望增加中低收入国家的避孕使用率和续用率。为加强可用性而进行的努力应考虑需求，并直接与包括青年在内的各个社区接触，了解新的长效选择的可用性。
