Date/Time: Wednesday, November 13, 2013 Session: Poster Session 1 Effective Family Planning Programs, Practice, Services &

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Author(s): Title of Abstract: Abstract Type: Topic: Saroj Dhaka Neelam Bhardwaj, S M S Medical College Kailash Saran, Jhpiego Sudharshanam Bala Subarmanium, Jhpiego Client Acceptability of Postpartum Intrauterine Contraceptive Device (PPIUCD) in a Tertiary Care Teaching Hospital in Jaipur Rajasthan, India Research Abstract Integrating family planning services

Significance/background
Indias population is growing exponentially and currently Indian population has grown up to 121 Million. This growing population is putting immense pressure on the constrained resources which are not growing in pace with this population growth. Family planning program has been in place from 1950s and despite of all efforts it is reported in last District Household Survey-3 (DLHS-3) that contraceptive use is only 54% out of that 7% are using less reliable traditional methods.[1] As per this report utilization of contraceptive is skewed towards female sterilization and very few couples are opting for spacing methods, which resulted in high unintended pregnancies which ultimately increasing maternal and infant morbidity and mortality.[2] This unmet need for spacing method is very high in the postpartum period and this is mainly attributed to low level of knowledge and myths and misconceptions for spacing methods, particularly for Cu-T, in community which resulted in low utilization and discontinuation of method after some time.[3],[4]

Main question/hypothesis
With above background this study was aimed for finding the association of timing of counseling with acceptability of IUCD as method of contraception in postpartum period and also to find evidence of association of IUCD acceptance in postpartum period with different socio-demographic and obstetric factors in tertiary care teaching hospital of SMS Medical College, Jaipur.

Methodology
This prospective descriptive study was conducted in the Department of Obstetrics & Gynecology, Zenana Hospital SMS Medical College Jaipur from November 2011 to June 2012 after taking approval from ethical committee of SMS medical college. Every pregnant woman who was counseled for family planning and gave consent was enrolled in this specific time period. Around 5000 pregnant women were enrolled in the study were counseled for all family planning methods including PPIUCD using a standardized counseling approach and delivered in this institution only. Those who gave verbal informed consent for accepting PPIUCD and the clients who finally accepted PPIUCD as the family planning method were enlisted. For women who refused PPIUCD as the method the reasons for refusal were also recorded. Demographic characteristics of clients like age, parity, religion (Hindus and Muslims are selected as per population dynamics); literacy was also collected for clients using a standardized interview schedule. The data was compiled and analyzed using SPSS.

Results/key findings
Majority of women (52%) belonged to age group 20-25 years. Acceptance rate was more among Hindu (81.40%) women. Majority of women were literate (65.20%) and belonged to middle class families as per socio-economic status (75.60%). Acceptance was more among primiparous (45.70%) women. Of the 1500, 889 (59.27%) women belonged to urban areas. Among 5000 pregnant women, 1500 women verbally accepted the use of PPIUCD and 327 women actually accepted the PPIUCD (21.80%). 26% of the women who were counseled in the antenatal period accepted this method when compared to 16% of women who were counseled in post natal period and this difference was statistically significant. Counseling of husband plays important role in antenatal counseled women which was 68 / 202 (33.70%). Delivering a male child plays an important role in acceptance of PPIUCD among postpartum women that is 39 / 125 (31.20%). Refusal by husband plays important role in non-acceptance of PPIUCD in both the groups in Group-A 164/548 (29.90%) and in Group-B 209/625 (33.40%). Delivering a female child also plays an important role in non-acceptance of PPIUCD and it is 139 (25.40%) in Group-A and 181 (29.00%) in GroupB.Most important factor to refuse for PPIUCD was planning of another pregnancy in near future in Group-A 264/548 (48.17%) and in Group-B 272/625 (43.52%). When a mathematical modeling was applied women who were counseled in antenatal period had twice the odds of accepting PPIUCD when compared to women who were counseled in the post natal period (95% CI 1.683.16) The previous history of IUCD use (OR 15.4 95% CI 9.72-24.4) and family history of IUCD OR 11.10 (95% CI (7.22-17.10)) were other factors. These factors are adjusted for age, parity, socio economic status and residence of the clients.

Knowledge contribution
Acceptance of PPIUCD as method of FP is low in comparison to female sterilization. The woman's choice of suitable methods of contraception during the period of lactation is affected by her knowledge, and literacy status, social factor and family structure, negative attitudes and misconception.The receptivity of compliance towards contraceptive method and their acceptance is highest when it is provided during antenatal period. Acceptability of PPIUCD is also influenced by the past and family history of IUCD use.