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Abstract
Background:
Postpartum family planning (PPFP) plays a critical role in reducing maternal and neonatal morbidity by preventing closely spaced and unintended pregnancies. The immediate postpartum intrauterine contraceptive device (PPIUCD) is a highly effective, long-acting, reversible contraceptive method that can be inserted within minutes of placental delivery. Despite its proven safety, efficacy, and cost-effectiveness, awareness and utilization of PPIUCD remain suboptimal in low- and middle-income countries such as Pakistan, largely due to limited counseling and sociocultural barriers.
Objective:
To evaluate the awareness, acceptance, and early complications associated with PPIUCD among women delivering at a tertiary care hospital in Karachi.
Method:
A descriptive cross-sectional study was conducted from June 2024 to December 2024 at Obstetrics and Gynecology department, Koohi Goth Women’s Hospital. A total of 200 antenatal women aged ≥18 years with gestational age ≥28 weeks and no contraindications to IUCD insertion were recruited after informed consent. Baseline demographic data and prior knowledge regarding PPIUCD were recorded. All participants received standardized antenatal counseling regarding benefits, risks, and effectiveness of PPIUCD. Acceptance was documented as a binary outcome. Women who consented underwent post-placental or intra-cesarean IUCD insertion performed by trained healthcare providers. Follow-up evaluations were conducted at 6 weeks and 3 months postpartum to assess early complications. Statistical analysis was performed using descriptive statistics and chi-square tests, with p<0.05 considered significant.
Results:
Baseline awareness of PPIUCD was observed in 30% of participants. Following counseling, 25% accepted IUCD insertion. Among acceptors, 60% delivered vaginally and 40% via cesarean section. At 6 weeks, reported complications included pain (16%), spotting (12%), infection (6%), partial expulsion (8%), and complete expulsion (6%). At 3 months, complications remained low, with pain (12%), bleeding (6%), infection (4%), and expulsions (16%). No cases of uterine perforation or severe infection were reported. The continuation rate at 3 months was 84%.
Conclusion:
Awareness of PPIUCD remains low, although acceptance improves significantly following structured counseling. The method demonstrates a favorable safety profile with minimal complications and high continuation rates. Strengthening antenatal counseling and integrating PPIUCD services into routine maternal healthcare can substantially improve postpartum contraceptive uptake.