Global Journal of Medical Research, E: Gynecology and Obstetrics, Volume 21 Issue 3

Educated women understand the risk of close pregnancies and willing to space out pregnancy by using PPIUCD. This was similar to the studies conducted by Safwat et al 19 , Anjali et al 20, Gunjan et al 21 and Vidyaraman et al. 22 Uneducated women tend to overlook the benefits and their decision making is highly influenced by their family members. Educated women tend to voice out their concerns and this facilitates in removing their misconceptions over PPIUCD. It is easy to convince an educated woman about the benefits of PPIUCD usage. Higher educated women also had lower acceptance of PPIUCD as they have easy access to other methods of contraception like condoms, OCPs and permanent sterilization. Majority of the women in this study were housewives. Most of the women (69.5%) in the study group belong to rural area. The acceptance of PPIUCD was higher among the rural women as compared to urban women. This is because the women of urban areas rely on other methods of contraception like OCPs, injectable hormonal contraceptives, condoms, permanent sterilization. Katheit G et al 23 found that acceptance of PPIUCD was almost equal among rural (47.6%) and urban women (52.4%). This clearly indicates that training to ASHA, ANMs and anganwadi workers and integrating this method in national programmes like National rural health mission has contributed significantly in family planning programme. Majority of the women in this study were multiiparous. This is similar to studies by Grimes et al 24 , Shukla M et al. 25 , Borthakur S et al. 26 , Goswami G et al 21 and Maluchuru S et al. 27 Mishra S, 28 Gautam R et al 29 , Vidyarama R et al 22 and Anjali et al found a higher acceptance in primipara. Some studies shows that women with higher parity prefer permanent mode of contraception unlike primiparous women who use PPIUCD to space out their pregnancy. The study group was analysed according to the number of living children. It was found that (50.3%) women had one living child. This shows that majority of women with one living child are willing to use PPIUCD as a method of contraception. This was similar to the studies by Kumar S et al 30 andBhalerao AR et al 31 . Contrary to the present study, Katheit G et al 23 found that 35.76% of total PPIUCD acceptors were having 2 children. According to Patel and Khan, 32 men approve use of contraceptive only after having 2 or 3 children. Awareness of IUCD was 44.3%. In a study conducted by Gujju RLB et al, 33 only 54% of the women were aware of IUCD before they received counselling. Awareness of IUCD has a direct relation with women’s education. According to Ullah and Chakraborty, 34 women’s education was the most important determining factor for contraceptive use. The reasons for acceptance among women was analysed in the study. Most women preferred PPIUCD for the reversible nature. This was contrary to the studies by Satyavathi et al 27 and found that reasons for IUCD acceptance were long acting nature in 55.28% and 20.73% due to safety. PPIUCD has many advantages including its reversibility, not requiring regular user compliance, lack of systemic side effects, coitus independent, no interference with breast feeding. In this study it was found that the acceptance of PPIUCD was more in women who had at least one living male child. In a society that values highly a male child, it probably was reassuring to the women that by having a male child a significant milestone has been achieved. Therefore they were more inclined to accept PPIUCD. The study by Bhalerao and Purandare 31 reported that acceptance was high among women who had at least one male child. In this study, out of 203 women, 21(10.3%) women were lost to follow up. Among the remaining 182 acceptors, 26 women spontaneously expelled PPIUCD. The gross cumulative expulsion rate at the end of 3 months was 12.8%. All the expulsions occur within 6 weeks. Gunjan et al 21 reported 10% expulsion rate and 30% lost follow up. Sangeetha et al 35 study resulted 6.8% expulsion. Kittur et al. 36 reported 5.23% expulsion rate and they also concluded that the expulsion rate could be minimized if the insertion was done by trained person and proper fundal placement was assured. In this study, expulsion rate was high in primiparous women than multiparous women. This finding was contrary to other studies in which expulsion rate was high in multiparous women which is very significant due to parous cervix in multiparous women. According to Gupta et al 37 expulsion rate was significantly higher in multiparous women (4.67%) compared to primiparous women (2%) following vaginal PPIUCD insertions. The higher rate of expulsion in primiparous women can be misleading because it can be due to wrong reporting by the PPIUCD acceptor women. May be these women had voluntarily removed the PPIUCD under family pressure. As education level is low in Jhalawar, uneducated people have many taboos for PPIUCD like it can decrease fertility or it can cause ill effect on health. Due to these psychosocial factors, a woman can remove PPIUCD voluntarily and can misguide the Doctor that it has been expelled spontaneously. In this study, analyzing the complications following PPIUCD insertions, heavy menstrual bleeding and pain abdomen was the most common complains. This was similar to the studies conducted by by Satyyawathi et al 27 , Farhat Arshad et al 61 and Gunjan et al 21 . In the present study, one case of failure in the form of pregnancy was observed. Eroglu et al 38 found 2/84 pregnancies in post placental Copper-T 380A, 2/43 in early postpartum (10 min-72 hrs) and 4/130 in interval insertion group at 1 year of follow up. Contrary to this, Ricalde et al 25 reported no pregnancy after 1 year of 24 Year 2021 Global Journal of Medical Research Volume XXI Issue III Version I ( D ) E © 2021 Global Journals Immediate Postpartum Insertion of Intrauterine Contraceptive Device after Vaginal Delivery: It’s Safety, Efficacy and Expulsion