Iyengar Sharad, Iyengar Kirti, Anand Ankit, Suhalka Virendra, Jain Manju
Action Research and Training for Health Society, Udaipur, Rajasthan, India.
Sexual & Reproductive Health Specialist, Udaipur, Rajasthan, India.
Contracept X. 2022 Jun 30;4:100079. doi: 10.1016/j.conx.2022.100079. eCollection 2022.
The levonorgestrel-releasing intrauterine device (LNG-IUD) is a well-accepted contraceptive across developed countries, yet there is limited experience in use and acceptance amongst women living in low-resource, developing country settings. We studied the feasibility of providing the LNG-IUD through a primary care service, and its acceptability amongst women living in a low-income, rural-tribal community in India.
We conducted an observational study of feasibility and acceptability at four health facilities (three rural, and one urban) in Rajasthan, India. Women seeking contraception were offered the LNG-IUD in addition to existing contraceptive methods. We followed all those who adopted LNG-IUD from August 2015 to September 2019 (= 1266) till discontinuation or 12 months, whichever was earlier. The primary outcome was continuation rate and acceptability, and the secondary outcome was change in hemoglobin levels, which we measured before insertion and at 12-month follow-up, using Sahli's method.
Most users lived in villages, were illiterate, belonged to marginalized groups, had 2 or more children, and wished to limit births when they adopted the method. The 12-month continuation rate was 87.6%. Amongst all users, 7.4% of women sought removal for side effects and 2% for change in reproductive intention, while another 2% reported spontaneous expulsion. Most continuing users reported hypomenorrhea (54%) or amenorrhea (42%) by 12 months of use. User satisfaction was high at 91.6%, with 92% of women rating their experience as equaling or exceeding expectations. Moderate and severe anemia reduced, and mean hemoglobin levels increased by 0.7 g/dL ( < 0.01).
Primary care clinics can feasibly deliver LNG-IUD, with high acceptability amongst women living in low resource settings. Given the paucity of long-acting reversible contraceptive options and high prevalence of anemia among women in India and similar countries, the method should be piloted through the public health system.
Long duration of contraceptive action, ability to reduce menstrual bleeding and reduce anemia, reversibility, and easy removal, combine to make LNG-IUD acceptable to women, especially in regions with high prevalence of anemia. This study demonstrates the feasibility and acceptability of introducing LNG-IUD in a low resource, primary care setting.
左炔诺孕酮宫内节育器（LNG-IUD）在发达国家是一种广泛接受的避孕方法，但在资源匮乏的发展中国家，女性对其使用和接受程度的经验有限。我们研究了通过初级保健服务提供LNG-IUD的可行性，以及其在印度低收入农村部落社区女性中的可接受性。
我们在印度拉贾斯坦邦的四个卫生设施（三个农村和一个城市）进行了一项关于可行性和可接受性的观察性研究。除了现有的避孕方法外，还向寻求避孕的女性提供LNG-IUD。我们对2015年8月至2019年9月期间采用LNG-IUD的所有女性（n = 1266）进行随访，直至停用或12个月，以先到者为准。主要结局是持续使用率和可接受性，次要结局是血红蛋白水平的变化，我们在放置前和12个月随访时使用萨利氏法进行测量。
大多数使用者居住在村庄，文盲，属于边缘化群体，有2个或更多孩子，在采用该方法时希望限制生育。12个月持续使用率为87.6%。在所有使用者中，7.4%的女性因副作用要求取出，2%因生育意愿改变要求取出，另有2%报告自发排出。大多数持续使用者在使用12个月时报告月经量减少（54%）或闭经（42%）。使用者满意度很高，为91.6%，92%的女性将她们的体验评为等于或超过预期。中度和重度贫血减少，平均血红蛋白水平增加0.7 g/dL（P < 0.01）。
初级保健诊所可以切实提供LNG-IUD，在资源匮乏地区的女性中具有很高的可接受性。鉴于印度和类似国家长效可逆避孕选择匮乏且女性贫血患病率高，该方法应通过公共卫生系统进行试点。
LNG-IUD避孕作用持续时间长、能减少月经出血和减轻贫血、具有可逆性且易于取出，这些因素共同使得LNG-IUD为女性所接受，尤其是在贫血患病率高的地区。本研究证明了在资源匮乏的初级保健环境中引入LNG-IUD的可行性和可接受性。
