Immediate IUD insertion after second trimester abortion: implications for service delivery

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dc.contributor.authorSomefun, O
dc.contributor.authorConstant, D
dc.contributor.authorEndler, M
dc.date.accessioned2021-12-06T10:00:40Z
dc.date.available2021-12-06T10:00:40Z
dc.date.issued2021-12-04
dc.date.updated2021-12-05T04:12:11Z
dc.description.abstractBackground The availability of modern contraception including long-acting reversible contraceptives (LARC), is a fundamental component of postabortion care. Findings from a recent randomized controlled trial (RCT) in South Africa comparing immediate to delayed insertion of the copper intrauterine device (IUD) after medical abortion (MA) at 17-20 gestational weeks showed that immediate insertion resulted in higher IUD use at 6 weeks postabortion, but that expulsion rates were significantly higher than for delayed insertion. This study aims to explore barriers, facilitators, and context-specific factors relevant to the implementation of immediate IUD provision after second trimester medical abortion. Methods We performed a qualitative study alongside the RCT in which we conducted in-depth interviews with 14 staff providing healthcare to study participants and 24 study participants. Research questions explored barriers and facilitators to implementation of immediate IUD insertion, contraceptive decision-making, and the impact of context and supplementary trial activities on service provision. Interviews were recorded and transcribed, with translation into English if needed. We performed a triangulated thematic analysis at the level of the transcribed interview text. Results Contraceptive counselling at the abortion facility by a study nurse improved knowledge, corrected misconceptions, and increased demand for the IUD postabortion. Women expressed a clear preference for immediate insertion. Convenience, protection from pregnancy and privacy issues were paramount and women expressed preference for engagement with staff who knew their abortion history, and with whom they had an established connection. Doctors and nurses were generally in favour of immediate insertion and said it could be incorporated into standard care if women wanted this. This contrasted with the need for interventions by the research team to reinforce adherence by staff to provide contraception as allocated during the trial. Conclusions Women and staff favour immediate IUD insertion after second trimester medical abortion, but service delivery may require structures that ensure timely insertion postabortion, continuity of care, communication that mitigates loss to follow-up and training of staff to ensure competence.en_US
dc.identifier.apacitationSomefun, O., Constant, D., & Endler, M. (2021). Immediate IUD insertion after second trimester abortion: implications for service delivery. <i>BMC Health Services Research</i>, 21(1), 1304. http://hdl.handle.net/11427/35427en_ZA
dc.identifier.chicagocitationSomefun, O, D Constant, and M Endler "Immediate IUD insertion after second trimester abortion: implications for service delivery." <i>BMC Health Services Research</i> 21, 1. (2021): 1304. http://hdl.handle.net/11427/35427en_ZA
dc.identifier.citationSomefun, O., Constant, D. & Endler, M. 2021. Immediate IUD insertion after second trimester abortion: implications for service delivery. <i>BMC Health Services Research.</i> 21(1):1304. http://hdl.handle.net/11427/35427en_ZA
dc.identifier.ris TY - Journal Article AU - Somefun, O AU - Constant, D AU - Endler, M AB - Background The availability of modern contraception including long-acting reversible contraceptives (LARC), is a fundamental component of postabortion care. Findings from a recent randomized controlled trial (RCT) in South Africa comparing immediate to delayed insertion of the copper intrauterine device (IUD) after medical abortion (MA) at 17-20 gestational weeks showed that immediate insertion resulted in higher IUD use at 6 weeks postabortion, but that expulsion rates were significantly higher than for delayed insertion. This study aims to explore barriers, facilitators, and context-specific factors relevant to the implementation of immediate IUD provision after second trimester medical abortion. Methods We performed a qualitative study alongside the RCT in which we conducted in-depth interviews with 14 staff providing healthcare to study participants and 24 study participants. Research questions explored barriers and facilitators to implementation of immediate IUD insertion, contraceptive decision-making, and the impact of context and supplementary trial activities on service provision. Interviews were recorded and transcribed, with translation into English if needed. We performed a triangulated thematic analysis at the level of the transcribed interview text. Results Contraceptive counselling at the abortion facility by a study nurse improved knowledge, corrected misconceptions, and increased demand for the IUD postabortion. Women expressed a clear preference for immediate insertion. Convenience, protection from pregnancy and privacy issues were paramount and women expressed preference for engagement with staff who knew their abortion history, and with whom they had an established connection. Doctors and nurses were generally in favour of immediate insertion and said it could be incorporated into standard care if women wanted this. This contrasted with the need for interventions by the research team to reinforce adherence by staff to provide contraception as allocated during the trial. Conclusions Women and staff favour immediate IUD insertion after second trimester medical abortion, but service delivery may require structures that ensure timely insertion postabortion, continuity of care, communication that mitigates loss to follow-up and training of staff to ensure competence. DA - 2021-12-04 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Health Services Research KW - Second trimester medical abortion KW - Copper IUD KW - Immediate insertion KW - Implications for service delivery KW - South Africa LK - https://open.uct.ac.za PY - 2021 T1 - Immediate IUD insertion after second trimester abortion: implications for service delivery TI - Immediate IUD insertion after second trimester abortion: implications for service delivery UR - http://hdl.handle.net/11427/35427 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12913-021-07306-2
dc.identifier.urihttp://hdl.handle.net/11427/35427
dc.identifier.vancouvercitationSomefun O, Constant D, Endler M. Immediate IUD insertion after second trimester abortion: implications for service delivery. BMC Health Services Research. 2021;21(1):1304. http://hdl.handle.net/11427/35427.en_ZA
dc.language.isoenen_US
dc.language.rfc3066en
dc.rights.holderThe Author(s)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.sourceBMC Health Services Researchen_US
dc.source.journalissue1en_US
dc.source.journalvolume21en_US
dc.source.pagination1304en_US
dc.source.urihttps://bmchealthservres.biomedcentral.com/
dc.subjectSecond trimester medical abortionen_US
dc.subjectCopper IUDen_US
dc.subjectImmediate insertionen_US
dc.subjectImplications for service deliveryen_US
dc.subjectSouth Africaen_US
dc.titleImmediate IUD insertion after second trimester abortion: implications for service deliveryen_US
dc.typeJournal Articleen_US
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