Factors associated with removal of postpartum intrauterine contraceptive device among acceptors in rural areas of Nadia district, West Bengal: a case-control study

Jayita Pal, Jitu Sharma, Sankalpa Satapathy


Background: The unmet need for contraception remains high in the postpartum period. Postpartum intrauterine contraceptive device (PPIUCD), despite being an effective and well-suited contraceptive method for this period, many women discontinue its use due to various reasons just after a few days or weeks. The study aimed to identify the factors associated with the removal of the same.

Methods: A community-based case-control study had been conducted in Nadia district of West Bengal. A multi-stage sampling technique had been applied to identify and interview the cases and controls with the help of a predesigned pretested semi-structured schedule.

Results: The overall removal and expulsion rates were found to be quite high (21.5% and 16.3% respectively). Multivariate analysis revealed that acceptors belonging to joint family, educated only up to middle level, if place of delivery and insertion of PPIUCD was BPHC, the same had been inserted by nursing staff, experienced pain after insertion,  not given consent before insertion, not counselled ever on PPIUCD, not decided to accept PPIUCD before delivery, not satisfied with its use and undergone no follow up visit after its insertion, were having higher odds of removal of the same.

Conclusions: Rigorous counselling during the antenatal period should be focused to achieve a declining trend regarding PPIUCD removal.


Case-control, Factors, Postpartum intrauterine contraceptive device, Removal, Rural, West Bengal

Full Text:



Chauhan R, Sahni S, Hanumantaiya S. Evaluation of acceptability, safety and expulsion rate of PPIUCD. Int J Reprod Contracept Obstet Gynecol. 2018;7(3):1083-9.

Family Planning Division. IUCD Reference Manual for Medical Officers and Nursing Personnel. New Delhi: Ministry of Health and Family Welfare, Government of India; 2013. Available at: planning/4.Manuals_of_FP-2015-16/IUCD_ Reference_Manual_for_MOs_n_Nursing_Personnel-Final-Sept_29,_2013.pdf. Accessed on 14th August 2019.

Pal J, Ahmad S, Siva A. Contraception-still miles to go: a study among married women in a rural area of West Bengal. Int J Reprod Contracept Obstet Gynecol. 2017;6(8):3618-23.

Family Planning Division. Postpartum IUCD Reference Manual. New Delhi: Ministry of Health and Family Welfare, Government of India; 2010. Available at: PPIUCD%20Reference%20Manual.pdf. Accessed on 14th August 2019.

International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-4), 2015-16. Mumbai: International Institute for Population Studies; 2017. Available at: Accessed on 14th August 2019.

Chethan R, Anitha GS, Savitha C. Study on post-partum intrauterine contraceptive device practices and causes for discontinuation of PPIUCD at follow up in a tertiary hospital. Int J Reprod Contracept Obstet Gynecol. 2018;7:2299-303.

WHO medical eligibility criteria for contraception.4.Geneva. WHO, 2010. Available at: Accessed on 14th August 2019.

National Rural Health Mission Ministry of Health and Family Welfare Government of India. JSY. Availableat 06;.pdf. Accessed on 14th August 2019.

Kelsey. Methods in Observational Epidemiology 2nd Edition, Table 12-15. Available at: Accessed on 15th March 2019.

Pandey VK, Aggarwal P, Kakkar R. Modified BG Prasad’s Socio-economic Classification-2018: The need of an update in the present scenario. Indian J Comm Health. 2018;30(1):82-4.

Mishra S. Evaluation of safety, efficacy, and expulsion of post-placental and intra-cesarean insertion of intrauterine contraceptive devices (PPIUCD). J Obstet Gynaecol India. 2014;64(5):337-43.

Doley R, Pegu B. A retrospective study on acceptability and complications of PPIUCD insertion. J Evolution Med Dent Sci. 2016;5(31):1631-4.

Maluchuru S, Aruna V, Prabhavathi N. Post-partum intrauterine device insertion-2 years’ experience at tertiary care center in Guntur medical college/govt general hospital, Guntur. J Dent Med Sci. 2015;14(3):56-61.

Tatum HJ, Beltran RS, Ramos R, Van Kets H, Sivin I, Schmidt FH. Immediate post placental insertion of GYNE-T 380 and GYNE-T 380 postpartum contraceptive devices: randomized study. Am J Obstet Gynecol. 1996;175(5):1231-5.

Goswami G, Yadav K, Patel A. A prospective study to evaluate safety, efficacy and expulsion rate of post placental insertion of intra uterine device. J Evol Med Dent Sci. 2015;4(56):9770-4.

Safwat A, Mohamed MA, Kamel OM, Salem SH. Acceptability for the use of postpartum intrauterine contraceptive devices: assiut experience. Med Princ Pract. 2003;12:170-5.

Thomas D, Maluccio J. Fertility, contraceptive choice, and public policy in Zimbabwe. World Bank Econ Rev. 1996;10(1):189-222.