Postplacental Placement of Intrauterine Devices: Acceptability, Reasons for Refusal and Proposals to Increase its Use

Abstract Objective To evaluate the acceptability of postplacental placement of intrauterine devices (PPIUD), reasons for refusal and suggested policies to increase its use. Methods Cross-sectional study conducted at the Women Hospital of the Universidade de Campinas, Campinas, SP, Brazil. Postplacental placement of intrauterine devices was offered to women admitted in labor who did not present infections, uterinemalformation, twin pregnancy, preterm birth, and were at least 18 years old. In case of refusal, the parturient was asked to give their reasons and the answers were classified as misinformation about contraception or other reasons. The following were considered misinformation: fear of pain, bleeding, contraception failure and future infertility. Bivariate analysis was performed. Results Amongst 241 invited women, the refusal rate was of 41.9%. Misinformation corresponded to 50.5% of all refusals, and the reasons were: fear of pain (39.9%); fear of contraception failure (4.9%); fear of bleeding (3.9%); fear of future infertility (1.9%); other reasons for refusal were 49.5%. Parturients aged between 18 and 27 years old refused the PPIUD more frequently due to misinformation (67.4%), and older parturients (between 28 and 43 years old) refused frequently due to other reasons (63.6%) (p=0.002). Themean age of those who declined the PPIUD due to misinformation was 27.3 ± 6.4 years old, while those who declined for other reasons had a mean age of 29.9 ± 5.9 years old (p=0.017). Conclusion The refusal of the PPIUD was high, especially amongst young women and due to misinformation. It is necessary to develop educative measures during antenatal care to counsel women about contraception, reproductive health and consequences of unintended pregnancy.摘要 目的：本研究旨在评估产后宫内节育器放置术（postplacental placement of intrauterine devices, PPIUD）的可接受性、产妇拒绝该操作的原因以及提高其临床应用率的相关政策建议。 方法：本研究为横断面研究，实施地点位于巴西圣保罗州坎皮纳斯市坎皮纳斯大学附属妇产医院。研究对象为入院待产且无感染、子宫畸形、双胎妊娠、早产情况，且年龄≥18岁的产妇，为其提供产后宫内节育器放置术方案。若产妇拒绝该操作，则询问其拒绝原因，并将原因分为避孕认知误区及其他原因两类。其中，避孕认知误区包括：惧怕疼痛、惧怕出血、担忧避孕失败以及担忧未来不孕。本研究采用双变量分析方法。 结果：本研究共纳入241名受邀产妇，其中拒绝率为41.9%。所有拒绝案例中，50.5%源于避孕认知误区，具体构成比为：惧怕疼痛（39.9%）、担忧避孕失败（4.9%）、惧怕出血（3.9%）以及担忧未来不孕（1.9%）；剩余49.5%的拒绝原因属于其他类别。年龄在18~27岁的产妇因避孕认知误区拒绝PPIUD的比例更高（67.4%），而28~43岁的高龄产妇则更多因其他原因拒绝该操作（p=0.002）。因避孕认知误区拒绝PPIUD的产妇平均年龄为27.3±6.4岁，而因其他原因拒绝的产妇平均年龄为29.9±5.9岁（p=0.017）。 结论：PPIUD的拒绝率较高，尤其在年轻产妇群体中，且多源于避孕认知误区。因此，有必要在产前保健过程中开展健康教育，向产妇普及避孕知识、生殖健康知识以及非意愿妊娠的相关危害。