A brief intervention to promote IUD use among women in Cape Town

Master Thesis


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University of Cape Town

While the Copper T intrauterine device (IUD) is one of the most used methods of contraception around the world, only 1% of women in sub-Saharan Africa use this method. The IUD is a safe and highly effective form of long-acting contraception that provides protection for up to 10 years and has a lowrisk of pregnancy (less than 1% during the first year of use). The IUD is highly beneficial in that it can provide protection for women who want to delay or space childbearing and unlike methods such as the injectable or oral contraceptive, does not require users to make numerous visits to their health care facility or obtain a further supply. The IUD is free in the public sector in South Africa, but remains an unpopular choice among women. The purpose of this study was to test the effectiveness of a brief counselling intervention on the uptake of the IUD among women in Cape Town, South Africa. Part A of this dissertation (Protocol) is comprised of a proposal that was accepted by the University of Cape Town (UCT) Human Research Ethics Committee (HREC) and the Provincial Government of the Western Cape (PGWC). It describes the study background and methods. Part B (Literature Review) presents the current state of IUD use in sub-Saharan Africa as well as the level ofunmet need for contraception in the region. It illustrates the effectiveness of the IUD and gives a summary of interventions related to IUD uptake. It also discusses the need for increased use of the long acting and permanent methods in sub-Saharan Africa. Part C (Article) presents the results as a journal article. The incidence of the primary outcome was lower than expected. Five percent of women assigned to the control group went to family planning to make an appointment for IUD insertion, while 4% of those in the intervention group made an IUD insertion appointment. Knowledge of the IUD was not high with only 46% of women having heard of the method. After being given a description of the IUD, 36% of women said they would consider using the IUD. Twenty-seven percent of women stated that they would be interested in receiving an IUD that day. The method was not often mentioned to clients as only 16% reported having discussed the IUD with a health provider. Chi-squared analysis identified characteristics which were related to a participant being aware of the IUD. In this regard, being older and having higher gravidity were both significantly associated factors. The results suggest that IUD is a method that women are interested in learning more about and potentially using. It is clear that a more intensive and comprehensive campaign is needed in order to increase demand for the IUD in South Africa.

Includes bibliographical references.