BACKGROUND: The levonorgestrel intrauterine system (LNG IUS) may become more available in the public sector of resource-poor countries, but it is unclear what product features might be attractive to users and what factors will influence uptake. STUDY DESIGN: We recruited 671 women in Kenya who were seeking contraception at 6-12 weeks postpartum and gave them an opportunity to try the LNG IUS. We asked why they did or did not choose it, relative to the alternative options. χ² tests of association were done to examine participant characteristics and decision-making associated with choice. RESULTS: Participants chose the following methods: LNG IUS (16%), injectable (36%), subdermal implant (30%), progestin-only pills (15%) and copper intrauterine device (IUD) (3%). Reasons for not choosing the LNG IUS included fear of pain/injury/discomfort (34%), modesty issues regarding insertion (33%) and fear of hormonal/health side effects (31%). Nearly a third of LNG IUS acceptors said they would have chosen a short-acting method if the LNG IUS were not available, and only 21% would have chosen the copper IUD. CONCLUSIONS: The LNG IUS could be an ideal method for increasing uptake of long-acting methods among recent postpartum women. Product attributes and comparisons to other contraceptive options are important factors in decision-making. Even among women comfortable with intrauterine contraception, great distinctions and preferences are apparent. Addressing specific misconceptions and fears with better information can help women make the best personal choices.
BACKGROUND: The levonorgestrel intrauterine system (LNG IUS) may become more available in the public sector of resource-poor countries, but it is unclear what product features might be attractive to users and what factors will influence uptake. STUDY DESIGN: We recruited 671 women in Kenya who were seeking contraception at 6-12 weeks postpartum and gave them an opportunity to try the LNG IUS. We asked why they did or did not choose it, relative to the alternative options. χ² tests of association were done to examine participant characteristics and decision-making associated with choice. RESULTS:Participants chose the following methods: LNG IUS (16%), injectable (36%), subdermal implant (30%), progestin-only pills (15%) and copper intrauterine device (IUD) (3%). Reasons for not choosing the LNG IUS included fear of pain/injury/discomfort (34%), modesty issues regarding insertion (33%) and fear of hormonal/health side effects (31%). Nearly a third of LNG IUS acceptors said they would have chosen a short-acting method if the LNG IUS were not available, and only 21% would have chosen the copper IUD. CONCLUSIONS: The LNG IUS could be an ideal method for increasing uptake of long-acting methods among recent postpartum women. Product attributes and comparisons to other contraceptive options are important factors in decision-making. Even among women comfortable with intrauterine contraception, great distinctions and preferences are apparent. Addressing specific misconceptions and fears with better information can help women make the best personal choices.
Authors: Kazuyo Machiyama; Fauzia Akhter Huda; Faisal Ahmmed; George Odwe; Francis Obare; Joyce N Mumah; Marylene Wamukoya; John B Casterline; John Cleland Journal: Reprod Health Date: 2018-05-08 Impact factor: 3.223
Authors: Geeta Nanda; Kate Rademacher; Marsden Solomon; Sarah Mercer; Jim Wawire; Rose Ngahu Journal: Eur J Contracept Reprod Health Care Date: 2018-09-10 Impact factor: 1.848
Authors: Danielle M Harris; Anita Dam; Kate Morrison; Chastain Mann; Ashley Jackson; Shannon M Bledsoe; Andrea Rowan; Kim Longfield Journal: Stud Fam Plann Date: 2022-08-03
Authors: Kate H Rademacher; Marsden Solomon; Tracey Brett; John H Bratt; Claire Pascual; Jesse Njunguru; Markus J Steiner Journal: Glob Health Sci Pract Date: 2016-08-18
Authors: Rubee Dev; Pamela Kohler; Molly Feder; Jennifer A Unger; Nancy F Woods; Alison L Drake Journal: Reprod Health Date: 2019-10-29 Impact factor: 3.223