Hanna Mireille M, El Gibaly Omaima, Fathalla Mohamed M F, Mohammed Heba M
Public Health and Community Medicine Department, Faculty of Medicine, Assiut University, Assiut City, 71515, Egypt.
Obstetrics and Gynecology Department, Faculty of Medicine, Assiut University, Assiut City, 71515, Egypt.
BMC Health Serv Res. 2025 Aug 14;25(1):1081. doi: 10.1186/s12913-025-13306-3.
Egypt faces significant economic and healthcare challenges due to overpopulation. The Strengthening Egypt Family Planning Program tackles the rapid population growth by improving access to family planning services. Given Egypt's high cesarean section rates, the program leverages this opportunity to facilitate immediate postpartum IUD (IPPIUD) insertion as a safe and efficient method. This study identifies barriers and predictors of IPPIUD uptake, providing valuable insights to enhance family planning services in Egypt and other low- and middle-income countries facing overpopulation, such as Kenya, India, and Ethiopia, which have implemented similar initiatives.
A case-control study was conducted on women who underwent cesarean sections in three public hospitals in Assiut City, Egypt. The study included two groups: 210 cases (women who used IPPIUD), and 210 controls (women who did not). Data was collected using a semi-structured questionnaire covering sociodemographic data, obstetric history, reproductive history, and barriers to IPPIUD uptake. Statistical analyses employed Chi-square tests, t-tests, and logistic regression to identify predictors of IPPIUD use.
The study found that the main barriers to IPPIUD use were disapproval from husbands (73.3%), desire for more children (71.9%), lack of knowledge about IPPIUD (67.6%), preference for female providers (64.3%), and negative provider attitudes (20.0%), fear of side effects (27.6%), and misconceptions (22.4%). The significant predictors of IPPIUD use were receiving IPPIUD counseling during antenatal care (AOR = 11.42, 95% CI: 4.58-28.49), having husband's support for family planning (AOR = 9.43, 95% CI: 3.44-25.83), receiving IPPIUD counseling during labor (AOR = 5.63, 95% CI: 2.56-12.33), and having sons (AOR = 4.24, 95% CI:1.37-13.14), their source of knowledge about FP is from ANC (AOR = 2.39, 95% CI: 1.89-5.83), high socioeconomic status (AOR = 1.54, 95% CI: 1.23-1.95), increased women's age (AOR = 1.13, 95% CI: 1.06-1.21).
Barriers to IPPIUD use include husbands' disapproval, desire for more children, lack of knowledge, preference for female providers, provider negativity, and fear of side effects. Key predictors of uptake are counseling during antenatal care and labor, husband's support, and having sons. Policymakers should enhance family planning education targeting men and address gender norms, while providers must leverage every opportunity during antenatal, labor, and postpartum care to provide counseling.
Number: NCT05471362.
由于人口过剩，埃及面临重大的经济和医疗保健挑战。加强埃及计划生育项目通过改善计划生育服务的可及性来应对人口的快速增长。鉴于埃及的高剖宫产率，该项目利用这一契机，将产后即时放置宫内节育器（IPPIUD）作为一种安全有效的方法加以推广。本研究确定了IPPIUD使用的障碍和预测因素，为加强埃及以及其他面临人口过剩问题的低收入和中等收入国家（如肯尼亚、印度和埃塞俄比亚，这些国家也实施了类似举措）的计划生育服务提供了有价值的见解。
对埃及阿斯尤特市三家公立医院接受剖宫产的妇女进行了一项病例对照研究。该研究包括两组：210例病例（使用IPPIUD的妇女）和210名对照（未使用IPPIUD的妇女）。使用半结构化问卷收集数据，内容涵盖社会人口统计学数据、产科病史、生殖史以及IPPIUD使用的障碍。采用卡方检验、t检验和逻辑回归进行统计分析，以确定IPPIUD使用的预测因素。
研究发现，IPPIUD使用的主要障碍包括丈夫的反对（73.3%）、想要更多孩子（71.9%）、对IPPIUD缺乏了解（67.6%）、偏好女性医护人员（64.3%）、医护人员态度消极（20.0%）以及对副作用的恐惧（27.6%）和误解（22.4%）。IPPIUD使用的显著预测因素包括在产前护理期间接受IPPIUD咨询（比值比[AOR]=11.42，95%置信区间[CI]：4.58 - 28.49）、丈夫对计划生育的支持（AOR = 9.43，95% CI：3.44 - 25.83）、分娩期间接受IPPIUD咨询（AOR = 5.63，95% CI：2.56 - 12.33）、有儿子（AOR = 4.24，95% CI：1.37 - 13.14）、她们关于计划生育的知识来源是产前护理（AOR = 2.39，95% CI：1.89 - 5.83）、社会经济地位高（AOR = 1.54，95% CI：1.23 - 1.95）、女性年龄增加（AOR = 1.13，95% CI：1.06 - 1.21）。
IPPIUD使用的障碍包括丈夫的反对、想要更多孩子、缺乏知识、偏好女性医护人员、医护人员消极态度以及对副作用的恐惧。使用的关键预测因素是产前护理和分娩期间的咨询、丈夫的支持以及有儿子。政策制定者应加强针对男性的计划生育教育并解决性别规范问题，而医护人员必须利用产前、分娩和产后护理的每一个机会提供咨询。
编号：NCT05471362
