Kayiga Herbert, Looft-Trägårdh Emelie, Cleeve Amanda, Kakaire Othman, Tumwesigye Nazarius Mbona, Byamugisha Josaphat, Gemzell-Danielsson Kristina
Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda.
Department of Women's and Children's Health, Karolinska Institutet, and WHO Collaborating Centre, Karolinska University Hospital, Stockholm, Sweden.
PLoS One. 2024 Dec 5;19(12):e0301748. doi: 10.1371/journal.pone.0301748. eCollection 2024.
Despite access to post abortion intrauterine contraception, the uptake of Intrauterine devices (IUDs) in Uganda remains low. Whether the perceptions of healthcare providers towards IUDs have a role in the provision of post abortion IUDs remains unclear. We explored perceptions on post abortion IUD provision among healthcare providers in Uganda, focusing on barriers and facilitators in regards to provision and uptake.
Between 1st August 2022 and 30th September 2022, forty-five in-depth interviews were conducted among healthcare providers of different cadres at sixteen public health facilities in central Uganda. We used the case study design to explore the healthcare providers' perceptions. The interviews were primarily to help us understand the perceptions of healthcare providers towards IUDs. All interviews were audio-recorded and transcribed verbatim. Themes were identified using the conventional inductive content analysis.
From the analysis, three themes emerged. Theme one covered health system related barriers in regards to IUD provision such as healthcare providers' and health facility challenges. The second theme focused on the challenges in post abortion contraceptive counselling focusing on IUDs. The third theme covered the motivating factors and participants' views on how to scale up IUD uptake and provision within post abortion care in Uganda. We found that lack of appropriate knowledge and skills on IUD provision, and heavy workloads, negatively impacted IUD provision. Inadequate facilities, IUD stock-outs, and minimal community sensitization also limited the utilization of IUDs. Furthermore, language barriers, community misconceptions around IUDs, long travel distances to the health facility, and partner refusal, contributed to the low uptake of post abortion IUDs. To address the identified barriers and scale up post abortion IUD provision, participants recommended addressing health system barriers, regular in-service refresher trainings, mentoring and supervision. They emphasized the importance of addressing contraceptive misconceptions and men's opposition to IUDs through community sensitization.
In this study we identified several barriers to post abortion IUD provision, highlighting an urgent need to address health system barriers including healthcare providers' skills and knowledge gaps, supply chain challenges, and to ensure that facilities are conducive to quality contraceptive counselling. Provision of on-job refresher trainings, mentoring and supervision, are key motivators that can be utilized in supporting healthcare providers towards post abortion IUD provision. To further increase uptake, efforts are needed to dispel contraceptive myths and misconceptions at the community level.
尽管可获得流产后宫内避孕服务，但乌干达宫内节育器（IUD）的使用率仍然很低。医疗服务提供者对宫内节育器的看法是否在流产后宫内节育器的提供中起作用仍不清楚。我们探讨了乌干达医疗服务提供者对流产后宫内节育器提供的看法，重点关注提供和使用方面的障碍及促进因素。
在2022年8月1日至2022年9月30日期间，对乌干达中部16家公共卫生机构中不同岗位的45名医疗服务提供者进行了深入访谈。我们采用案例研究设计来探究医疗服务提供者的看法。访谈主要是为了帮助我们了解医疗服务提供者对宫内节育器的看法。所有访谈均进行了录音并逐字转录。使用传统归纳性内容分析法确定主题。
通过分析，出现了三个主题。主题一涵盖了宫内节育器提供方面与卫生系统相关的障碍，如医疗服务提供者和卫生机构面临的挑战。第二个主题聚焦于流产后避孕咨询中关于宫内节育器的挑战。第三个主题涵盖了激励因素以及参与者对如何在乌干达流产后护理中扩大宫内节育器的使用和提供的看法。我们发现，缺乏关于宫内节育器提供的适当知识和技能以及工作量过大，对宫内节育器的提供产生了负面影响。设施不足、宫内节育器缺货以及社区宣传极少也限制了宫内节育器的使用。此外，语言障碍、社区对宫内节育器的误解、到卫生机构的路途遥远以及伴侣拒绝，都导致流产后宫内节育器的使用率较低。为解决已确定的障碍并扩大流产后宫内节育器的提供，参与者建议解决卫生系统障碍、定期进行在职进修培训、指导和监督。他们强调通过社区宣传消除避孕误解以及男性对宫内节育器的反对意见的重要性。
在本研究中，我们确定了流产后宫内节育器提供的几个障碍，凸显了迫切需要解决卫生系统障碍，包括医疗服务提供者的技能和知识差距、供应链挑战，并确保设施有利于进行高质量的避孕咨询。提供在职进修培训、指导和监督，是可用于支持医疗服务提供者提供流产后宫内节育器的关键激励因素。为进一步提高使用率，需要在社区层面努力消除避孕神话和误解。
