Barriers of Immediate Postpartum Intrauterine Device Uptake

Barriers of Immediate Postpartum Intrauterine Device Uptake in Assiut Public Hospitals

increase immediate postpartum intrauterine device uptake and support family planning programs to overcome barriers and increase contraception prevalence rate in Egypt determine client related barriers of immediate postpartum intrauterine device uptake in Assiut Hospitals (Demand side) identify provider related barriers of immediate postpartum intrauterine device uptake in Assiut Hospitals (Supply side) describe method related barriers perceived by women

Population increase in Egypt is a major problem with the fertility rate 3.5 children per woman the postpartum period starts after the birth of the placenta and lasts for 6-8weeks after delivery Women resume sexual activity 1 to 2 months after delivery, with 45-day average till return of ovulation. women returning for intrauterine device insertion 6-8 weeks are at risk of unintended pregnancy Insertion of postpartum intrauterine device is immediate or interval. immediate Postpartum intrauterine device inserted from the placental delivery time (within 10 minutes), or within first 48 hours, it can be done after vaginal or caesarean.

Postpartum intrauterine device can improve mothers' health by reducing difficulties from closely spaced pregnancies Immediate postpartum intrauterine device uptake is low in most developing countries and Egypt due to several barriers

• Health facility: provider knowledge, attitude, lack of training, counseling, privacy, shortage of supply of intrauterine device,poor quality of service, bad experience with the facility
• Community: as Sociodemographic (desire more children), cultural norms, husband opposition, and religious beliefs , fear of side effects., Cognitive (didn't hear about family planning in past 6 months), reproductive (long interval between intercourse), medical (requiring checkups) physical (distance of clinic) The rational is postpartum women are motivated to avoid pregnancy, 90% of women deliver in hospitals, they are in facilities with skilled physicians who can offer contraception. Immediate postpartum intrauterine device is cost-effective and efficient Assiut implemented a program training physicians on immediate Postpartum intrauterine device insertion in 2021.

This study will support the newly implemented program to overcome barriers from demand and supply sides and direct the program to future activity.

Inclusion Criteria:

Women who gave birth via elective Cesarian Section at 4 public hospitals in Assiut city from October 2021:

• woman who gave birth via elective c-section at Women Health hospital of Assiut University from October 2021
• women who gave birth via elective c-section at Assiut General Hospital from October 2021
• women who gave birth at via elective c-section El-Eman El-Arbaeen from October 2021
• women who gave birth at via elective c-section El-Mabarra from October 2021

Exclusion Criteria:

• Women who delivered by vaginal delivery
• Women who delivered by emergency c-section
• women who has anomalies in the uterus