Postpartum intrauterine contraceptive device: effect of antenatal versus postpartum counselling in acceptance of postpartum intrauterine contraceptive device

Monika Raghuwanshi, Sonal Agrawal, Beenu Kushwash Singh, Neha Khatik


Background: The acceptance for PPIUCD in our country, especially in rural areas is very low despite all the efforts. Counselling during the antenatal visits may play a vital role in improving the acceptance of PPIUCD. Objective of this study was to assess the factors associated with the acceptability of immediate PPIUCD insertion in women; counselled during antenatal and postpartum period; according to their sociodemographic and obstetric characteristics, and future pregnancy desires.

Methods: One-year prospective study carried out in the department of obstetrics and gynecology, S. S. Medical College Rewa, Madhya Pradesh, India. a total of 4850 women were counselled for PPIUCD insertion; 2540 during their antenatal visits, and 2310 during postpartum period who visited in study centre for first time and their follow up was done. Chi square tests were applied to compare proportions.

Results: After antenatal counselling in 2540 women, (with multiple counselling sessions) about half of the women gave verbal acceptance for PPIUCD. However, during postpartum counselling in 2310 women, (where only single short session of counselling could be done) majority of the women declined (80.9%) for PPIUCD insertion with only about a fifth (19.1%) of the women giving verbal acceptance. Women who had antenatal counselling one third of them had PPIUCD insertion. In the postpartum counselling group, a meagre 15.1% women had PPIUCD insertion.

Conclusions: Counselling during antenatal and postpartum period is the key to improve the awareness and acceptance of PPIUCD in our community. Multiple counselling sessions during antenatal visits make it easier for the women to slowly understand the process and accept PPIUCD as compared to the short counseling during postpartum period.


Antenatal counselling, Postpartum intrauterine device, Postpartum intrauterine contraceptive device

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Rutstein SO. Effects of preceding birth intervals on neonatal, infant and under-five years mortality and nutritional status in developing countries: Evidence from the demographic and health surveys. Int J Gynaecol Obstet. 2005;89(Suppl 1):S7-S24.

Zhu BP, Rolfs RT, Nangle BE, Horan JM. Effect of the interval between pregnancies on perinatal outcomes. New Engl J Med. 1999;340(8):589-94.

Khoshnood B, Lee KS, Wall S, Hsieh HL, Mittendorf R. Short interpregnancy intervals and the risk of adverse birth outcomes among five racial/ethnic groups in the united states. Am J Epid. 1998;148(8):798-805.

Cleland J, Bernstein S, Ezeh A, Faundes A, Glasier A, Innis J. Family planning the unfinished agenda. Lancet. 2006;368:1810-27.

Borda M, Winfrey W. Postpartum fertility and contraception: an analysis of findings from 17 countries. Baltimore Jhpiego. 2010:15-20.

Jakson E, Glasire A. Return of ovulation and menses in postpartum nonlactating women: a systemic review. Obstet Gynecol. 2011;117:657-62.

Conolly A, Thorp J, Pahel L. Effects of pregnancy and childbirth on postpartum sexual function: a longitudinal prospective study. Int Urogynecol J. 2005;16:263-67.

United Nations, department of economic and social affairs, population division 2015. Trends in Contraceptive Use Worldwide 2015. Available at: Accessed on 10th October 2018.

International institute for population sciences (IIPS) and ICF. 2017. National family health survey (NFHS 4) 2015-2016, IIPS; 2017:111-184.

Kaneshiro B, Abey T. Long term safety, efficacy and patient acceptability of intrauterine copper T-380A contraceptive device. Int J Women’s Health. 2010:211-220.

Kathpalia SK, Mustafa MS. Awareness about postpartum insertion of intrauterine device among antenatal cases. Med J Armed Forces India. 2015;71(3):221-4.

Priya S. Postpartum intrauterine device insertion: the unfinished agenda. New Indian J Surg. 2011;2:245-7.

Achyut P, Mishra A, Montana L, Sengupta R, Calhoun LM, Nanda P. Integration of family planning with maternal health services: an opportunity to increase postpartum modern contraceptive use in urban Uttar Pradesh, India. J Fam Plann Reprod Health Care. 2016;42(2):107-15.

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

Valliappan A, Dorairajan G, Chinnakali P. Postpartum intrauterine contraception device: knowledge and factors affecting acceptance among pregnant/parturient women attending a large tertiary health care centre in Puducherry, India. Int J Adv Med Health Res. 2017;4:69-74.

Nigam A, Ahmad A, Sharma A, Saith P, Batra S. Postpartum intrauterine device refusal in Delhi: reason analysed. J Obstet Gynaecol India. 2018:68(3)208-13.

World health organization. 2016. WHO recommendations on positive pregnancy experience. Available at: handle/10665/250796/9789241549912-eng.pdf. Accessed on 24th May 2020.

Cleland J, Shah IH, Daniele M. Interventions to improve postpartum family planning in low and middle-income countries: “program implications and research priorities”. Studd Fam Plann. 2015;46(4):423-41.

Agrawal N, Gupta M, Sharma A, Arora R. Antenatal counselling as a tool to increase acceptability of postpartum intrauterine contraceptive device insertion in a tertiary care hospital. Int J Reprod Contracept Obstet Gynecol. 2015;4(4):1137-41.

Gautam R, Arya KN, Kharakwal S, Singh S, Trivedi M. Overview of immediate PPIUCD application in Bundelkhand region. J Evolution Med Dent Sci. 2014;36(3):9518-26.

Worku C, Assefa T, Bogale D, Girma A. Acceptability and factors associated with postpartum IUCD use among women who gave birth at bale zone health facilities, Southeast Ethiopia. Contracept Reprod Med. 2018;3:16.