Abstract
Objective:
This study aimed to assess the intention and barriers to the use of immediate postpartum intrauterine contraceptive devices among pregnant women attending antenatal clinics in Jimma town public healthcare facilities, southwest Ethiopia.
Methods:
A facility-based cross-sectional study design was conducted from 1 September to 30 October 2020 by using a systematic sampling technique. Data were entered into Epi-data 3.1 version and exported to Statistical Package for Social Sciences 23 for analysis. A binary logistic regression analysis was done to sort candidate variables for multiple logistic regression, and multivariable logistic regressions were done to identify factors associated with the intention to postpartum intrauterine contraceptive devices. Factors associated with intention to use immediate postpartum intrauterine contraceptive device declared at 95% confidence interval.
Results:
This study finding showed that 37.6% (95% confidence interval (31.5, 43.7)) of pregnant women intended to use the immediate postpartum intrauterine contraceptive device after their delivery. The main reason women refused to use immediate postpartum intrauterine contraceptive devices was being satisfied with other methods to use after they gave birth (27.5 %), the concern of health harm (22.2%), and the fear of impaired future fertility (16.4%). The identified factors that were statically significant with the intention to use immediate postpartum intrauterine contraceptive devices among pregnant women were included: attended secondary education (adjusted odd ratio = 2.36; p = 0.03; 95% confidence interval (1.089, 5.128)), attended college and above (adjusted odd ratio = 2.99; p = 0.020; 95% confidence interval (1.189, 7.541)), have high knowledge on immediate postpartum intrauterine contraceptive devices ((adjusted odd ratio = 2.10; p = 0.006; 95% confidence interval (1.236, 3.564)), the previous history of LACM used (adjusted odd ratio = 6.85; p = 0.0001; 95% confidence interval (3.560, 10.021)), parity >4 (adjusted odd ratio = 1.86; p = 0.043; 95% confidence interval (3.99, 8.703)).
Conclusion:
The intention of pregnant women to use after they gave birth in the study area was low. Maternal educational level, high knowledge, history of previous long-acting contraceptive methods use, and parity were significantly associated with pregnant women’s intention to use immediate postpartum intrauterine contraceptive devices. Healthcare providers should focus on delivering crucial information about immediate postpartum intrauterine contraceptive device benefits for postpartum women, particularly concerning reducing barriers during antenatal care follow-up as they plan to use it after their delivery.
Keywords: postpartum period, Jimma, pregnant women, contraceptive methods
Introduction
Unwanted pregnancies are one of the most distressing public health issues and a significant reproductive health concern globally, placing a significant socioeconomic burden on people and society.1 Preterm birth, low birth weight, and preeclampsia are all associated with shorter intervals between pregnancies. The physical and/or emotional strain of caring for a baby or small kid may be so great for the mother that it interferes with the development of the fetus or the length of the future pregnancy.2 The World Health Organization recommends spacing pregnancies apart by at least 24 months.3 About 21% of births in Ethiopia take place within 7–23 months of the previous birth.4 On the other hand, regular birth intervals help in the complete healing of uterine scars from previous cesarean deliveries, lower the risk of vertical infection transmission, and assist women in recovering from macro- and micronutrient depletion that happens throughout pregnancy and lactation.5
The early postpartum period offers numerous potential benefits for implant or intrauterine contraceptive device (IUCD) implantation since women are known not to be pregnant and many women are motivated to avoid short-interval pregnancy. This technique helps in the decrease of both unintended and untimely pregnancies.6
Family planning after childbirth is essential for women’s health and families’ welfare.7 The IUCD is a tiny device that is inserted into the uterus and inhibits conception. The most common IUCDs are made of plastic that has been twisted with copper wire into a T shape. There are also types that are made entirely of stainless steel, plastic, or ones that release hormones. Different IUCD need to be changed after intervals ranging from 5 to 10 years.8 It is one of the long-acting, dependable, and highly effective contraceptive techniques that is safe.9,10
Within 10 min of placenta delivery, intra-cesarean insertion (following a cesarean section), and early postpartum insertion (up to 48 h after childbirth) are all types of post-placental IUCD implantation.11
The postpartum intrauterine contraceptive device (PPIUCD) can only be implanted by a healthcare professional who has received the necessary training to be competent in providing PPIUCD services in accordance with national standards because the technique for inserting immediate PPIUCDs differs from that of inserting interval IUCDs.12 The utilization of IUCDs has been essentially missing from the mix of contraceptive methods, according to the results of the 2019 Ethiopian mini-demographic health survey. Only 2% of women in the reproductive age group used IUCD to prevent unintended pregnancies out of the 41% of modern contraceptives they used overall. In order to increase the use of IUCD by women in the reproductive age group, this report recommended putting a focus on immediate postpartum IUCD use.13
The revised reproductive health policy prioritizes long-acting family planning methods by 2020, with specific goals to increase IUCD prevalence to 15% and achieve 100% immediate postpartum contraceptive coverage.14 The intention has been established as the most close-proximate motivator of actual action in numerous behavior modification theories. Furthermore, numerous studies have shown that intention is a potent predictor of behavior.15
Even though some women use postpartum IUCD after giving birth, the most important time to decide whether or not to use it is during pregnancy. The chance to counsel women on immediate PPIUCD was made possible by placing more emphasis on the intention to utilize the device during antenatal care. This might lead to a rise in the use of postpartum IUCD insertion, which is beneficial for both mothers and children’s health. Therefore, it is crucial to comprehend the motivations behind and obstacles to taking PPIUCD during pregnancy in order for healthcare professionals to implement appropriate counseling techniques depending on their intended usage of PPIUCD. The aims and obstacles to the application of PPIUCD in Ethiopia are not well understood, yet. The current study investigated the PPIUCD use intentions and risk factors among pregnant women receiving antenatal care follow-up in Jimma town public healthcare facilities. Barriers to using the immediate postpartum intrauterine device (PPIUD) were also identified.
Methods and materials
Study design and setting
From September 1 to October 30, 2020, a facility-based cross-sectional survey was conducted in Jimma town public healthcare facilities. Jimma town is the capital city of Jimma Zone which is found in Oromia Regional State and is located 346 km away from the capital city of Addis Ababa. The town had a total population of 120,960; of which 60,824 were male and 60,136 were female. Age distribution shows about 28.7% were below the age group of 14 years whereas those who were in the working-age group (15–64) and old age (>64) were 69.5% and 2.8%, respectively.16 In Jimma town, there are four public health centers and two public hospitals.
Source and study population
All pregnant women attending the antenatal clinics in Jimma town public healthcare facilities were the source of population. All sampled pregnant women attending the antenatal clinic that fulfilled the inclusion criteria were the study population.
Inclusion and exclusion criteria
This study included all pregnant women who attended antenatal clinics in Jimma town public healthcare facilities and were willing to participate. All pregnant women who were critically ill and developed emergency cases were excluded from the study.
Sample size determination
With the following assumptions, the sampling size was determined using a single population proportion formula: Z = the standard normal deviation at a 95% confidence interval (CI) = 1.96; d = the tolerable margin of error, 5% (0.05), and 50% maximum sample size. The finite population correction formula was used to adjust the sample size because there were less than 10,000 participants overall. After taking into consideration a 5% non-response rate, the final sample size became 339.
Sampling technique
Every six pregnant women were interviewed using a simple systematic process, with the first women selected by lottery method. Two public health centers (Medera Kochi and Higher two health centers) and one hospital (Jimma medical center) which provide antenatal care services during the study period were selected by a simple random sampling technique. The total population for this study was obtained from average monthly attending antenatal clinics. Then the sample size was proportionally allocated for each public health facility depending on their monthly antenatal care flow-ups.
Measurement and data collection procedures
Data was collected using semi-structured questionnaires that were adapted from literature.17,18,19,20 The questionnaire was originally developed in English before being consistently translated into versions in Afan Oromo and Amharic. It comprises five parts: background of respondents, obstetric characteristics, history of contraceptive use, knowledge, and attitude toward the use of PPIUCD. Three Likert-type measures were included in the attitude regarding the use of PPIUCD. The respondent’s level of agreement with regard to the use of PPIUCD was evaluated using a Likert-type scale. Pregnant women’s intent was measured by asking them if they intended to use a PPIUCD (Yes or No). Women who agreed to use a PPIUCD after giving birth were regarded as having the intention to do so, whereas those who declined were regarded as not having such an intention. The potential barriers to using PPIUCDs were identified using one query. Three diploma nurses were required for data collection. Data collectors received a full day of training on the objectives of data collection, procedures, how to approach respondents, and how to handle any problems that might come up while collecting the data. One week prior to the actual data collection, the questionnaire was pretested on 5%17 of the sample size at the Yabu Health Center, and changes were made depending on the results. Before, during, and after the time for collecting data, all of the questionnaires were checked for accuracy and completeness. Interviewers were supervised during collecting the data, and problems and solutions to the methods were reviewed. In order to assure the quality of the data, the principal investigator has regularly conduct checks on the completed questionnaires.
Operational definitions
Intention to use PPIUCD: Pregnant women are required to use the PPIUCD method after their delivery within 48 h.
PPIUCD: An IUCD that can be inserted after removal of placental, intra-cesarean, and within 48 h of their delivery.12
Knowledge on PPIUCD: Pregnant women with scores above or equal to the mean on the knowledge questions for the immediate PPIUCD are considered to have high knowledge, while those with scores below the mean are considered to have low knowledge.21
The attitude of PPIUCD: To determine if pregnant women had a positive or negative attitude about the usage of PPIUCD, the mean score was used. Pregnant women with scores above or equal to the mean attitude score have a positive attitude about using PPIUCDs, while those with scores below the mean attitude score have the negative attitude.21
Statistical analysis
Epi-data version 3.5.1 was used to enter the data, which was then exported to Statistical Package for Social Sciences version 23 for analysis. Descriptive statistics like frequencies, percentages, and means were performed. Bivariate logistic regression analysis was done to select candidate variables for multivariate logistic regression. Variables with a p-value less than or equal to 0.25 in the bivariate analysis were considered as a candidate to be entered into the final model with a 95% CI by using a backward likelihood ratio. Finally, the significance level was declared at the adjusted odd ratio (AOR) 95% CI. Hosmer and Lemeshow’s test was found to be insignificant, and the Omnibus test was significant, which indicates that the model was fitted.
Ethics approval and consent to participate
Ethical clearance to conduct this study was obtained from the Institutional Review Board of the Institute of Health, Jimma University. Written informed consent was obtained from study subjects and the legally authorized representative of minor subjects before the study; we got the informed consent from illitrate respondents signed with their fingerprint. Each participant was informed about the objectives and benefits of the research and its findings, preceding the data collection, and confidentiality was maintained by keeping the data collection forms locked in a secure cabinet.
Result
Description of the participants
The participants were given a total of 339 questionnaires, but only 314 of them received responses; the remaining 25 participants had incomplete responses and were therefore excluded from the study, yielding a response rate of 92.6%.
About 37.9% of the respondents were in the age group of 25–29 years old. Regarding the educational status of respondents, 40.4% attended secondary school. More than half (51.3%) of the respondents were Oromo and about 54.8% were Muslim. Of the total 314 pregnant women, 92.0% were married and 36.9% were housewives (Table 1).
Table 1.
Sociodemographic characteristics of pregnant women attending antenatal clinics in Jimma town public healthcare facilities, southwest Ethiopia, 2020 (n = 314).
| Variables | Category | Frequency | Percentage |
|---|---|---|---|
| Age in years | 15–19 | 47 | 14.9 |
| 20–24 | 110 | 35.0 | |
| 25–29 | 119 | 37.9 | |
| 30–34 | 32 | 10.1 | |
| ⩾35 | 6 | 1.9 | |
| Educational | Illiterate | 86 | 27.4 |
| Primary | 127 | 40.4 | |
| Secondary | 66 | 21.0 | |
| Colleges and above | 35 | 11.1 | |
| Religion status | Protestant | 45 | 14.3 |
| Muslim | 172 | 54.8 | |
| Catholic | 13 | 4.5 | |
| Orthodox | 76 | 24.2 | |
| Wakefata | 8 | 2.5 | |
| Occupation status | Housewife | 116 | 36.9 |
| Gov’t employee | 80 | 25.4 | |
| Private employee | 52 | 16.5 | |
| Daily laborer | 20 | 6.4 | |
| Farmer | 31 | 9.8 | |
| Student | 15 | 4.7 | |
| Marital status | Single | 5 | 1.6 |
| Married | 289 | 92.0 | |
| Divorced | 14 | 4.5 | |
| Widowed | 6 | 1.9 |
Reproductive characteristics of the participants
Regarding the age of first marriage, 197 (62.7%) were married after 18 years old. Two hundred twenty-five (71.7%) gave birth less than or equal to four times and 237 (75.4%) have less than or equal to four living children. About 254 (80.9%), women discussed family planning methods with their husbands. Concerning the number of children decided to have, two hundred sixty (82.8%) of pregnant women decided jointly with their partner. About 253 (83.8%) had a history of any family planning methods use and 81 (28.3%) had a history of previous long-acting contraceptive methods use (Table 2).
Table 2.
Reproductive characteristics of pregnant women attending antenatal clinics in Jimma town public healthcare facilities, southwest Ethiopia, 2020 (n = 314).
| Variables | Categories | Responses | |
|---|---|---|---|
| Frequency | Percentage | ||
| Age at first marriage | Less or equal to 18 years | 117 | 37.3 |
| Greater than 18 years | 197 | 62.7 | |
| Number of birth | Less or equal to 4 | 225 | 71.7 |
| Greater than 4 | 89 | 28.3 | |
| Number of alive children | Less or equal to 4 | 237 | 75.4 |
| Greater than 4 | 77 | 24.5 | |
| Want to have children within 2 years | Yes | 37 | 11.8 |
| No | 277 | 88.2 | |
| Discuss family planning methods with the partner | Yes | 254 | 80.9 |
| No | 60 | 19.1 | |
| Decision on the number of children want to have | Husband | 13 | 4.1 |
| Wife | 41 | 13 | |
| Both | 260 | 82.8 | |
| Ever used the FP method previously | Yes | 263 | 83.8 |
| No | 51 | 16.2 | |
| The method used previously (if yes) | Natural family planning | 9 | 2.8 |
| Pills | 86 | 27.3 | |
| Injectable | 112 | 35.6 | |
| Implants | 90 | 28.6 | |
| IUD | 8 | 2.5 | |
| Condom | 9 | 2.8 | |
FP: family planning; IUD: intrauterine device.
Participants’ knowledge about the immediate PPIUCD
According to the results of the current study, 117 participants (or 40.5%) were aware that PPIUCD can prevent pregnancies for up to 10 years. About 120 (38.2%) of pregnant women knew as pregnancy can be reversed after IUCD removal, and 198 (63.1%) knew as the use of PPIUCD does not interfere with breastfeeding. More than half of the responders did not know as PPIUCD can be withdrawn at any time 188 (59.9%). According to the mean score, about two-thirds (66.9%) of respondents had high knowledge, whereas about one-third (33.1%) had low knowledge about immediate PPIUCDs (Table 3).
Table 3.
Knowledge of pregnant women about PPIUCD attending antenatal clinics in Jimma town public healthcare facilities, southwest Ethiopia, 2020.
| Statements | Response | Frequency | Percentage | |
|---|---|---|---|---|
| Knowledge of pregnant women about PPIUD | PPIUD can prevent pregnancies for more than 10–12 years. | Yes | 127 | 40.5 |
| No | 187 | 49.5 | ||
| PPIUD is not appropriate for females at high risk of getting STIs. | Yes | 102 | 32.7 | |
| No | 212 | 67.3 | ||
| PPIUD has no interference with sexual intercourse or desire. | Yes | 80 | 25.5 | |
| No | 234 | 74.5 | ||
| PPIUD is immediately reversible (become pregnant quickly when removed). | Yes | 120 | 38.3 | |
| No | 194 | 61.7 | ||
| PPIUD does not cause cancer. | Yes | 165 | 52.5 | |
| No | 149 | 47.5 | ||
| PPIUD can be used by breastfeeding mothers. | Yes | 198 | 63.1 | |
| No | 116 | 36.9 | ||
| PPIUD has no systemic side effect | Yes | 162 | 61.6 | |
| No | 152 | 48.4 | ||
| PPIUD can insert immediately after childbirth | Yes | 124 | 39.5 | |
| No | 190 | 60.5 | ||
| PPIUD is inserted free of charge in Ethiopia. | Yes | 130 | 41.4 | |
| No | 184 | 58.6 | ||
| PPIUD can be removed at any time you wish. | Yes | 126 | 40.1 | |
| No | 188 | 59.9 | ||
PPIUCD: postpartum intrauterine contraceptive device; PPIUD: postpartum intrauterine device; STIs: sexual transmitted diseases.
Participant’s attitude toward the immediate PPIUCD
The majority of respondents (55%) agreed that placing an IUCD into the uterus does not result in a loss of privacy. More than two-thirds (67.7%) of the respondents agreed that using PPIUCD cannot limit usual activities. One hundred forty-six (56.3%) of the respondents agreed that using PPIUCD can affect their health. About 225 (71.6%) of respondents believe that using PPIUCD does not interfere with newborn breastfeeding. More than half (53.2%) of the respondents had a positive attitude toward the intention to use immediate PPIUCDs (Table 4).
Table 4.
Participant’s attitude toward PPIUCD attending antenatal clinics in Jimma town public healthcare facilities, southwest Ethiopia, 2020.
| Statement | Responses (N/%) | ||
|---|---|---|---|
| Agree | Neutral | Disagree | |
| Using PPIUCD cause irregular bleeding | 161 (51.6) | 33 (10.5) | 120 (38.2) |
| The insertion and removal of PPIUD is highly painful | 125 (39.8) | 52 (16.6) | 137 (43.6) |
| Placing an IUCD into the uterus does not result in a loss of privacy | 176 (56) | 67 (21.4) | 71 (22.6) |
| Using PPIUCD cannot limit usual activities | 213 (67.7) | 41 (13.1) | 60 (19.2) |
| Using PPIUCD does not interfere with newborn breastfeeding | 225 (71.6) | 57 (18.2) | 33 (10.2) |
| PPIUCD does not interfere with sexual intercourse | 102 (32.5) | 22 (7.0) | 190 (60.5) |
| Using PPIUCD affects the health | 145 (56.3) | 35 (11.1) | 134 (42.6) |
| PPIUCD does not move through the body after insertion | 163 (51.9) | 74 (23.6) | 77 (24.5) |
IUCD: intrauterine contraceptive device; PPIUCD: postpartum intrauterine contraceptive device; PPIUD: postpartum intrauterine device.
The intention of pregnant women to use immediate PPIUCD
Regarding the respondent’s intention to utilize immediate postpartum IUCD, it was shown that about 37.6% (95% CI (31.5, 43.7)) of pregnant women intended to use PPIUCD and more than half of the 197 (62.4%) did not intend to use PPIUCD after they gave birth.
Barriers not to using immediate PPIUCD
The most frequent reason given by pregnant women for not using immediate postpartum IUCD was that they were satisfied with the contraceptive methods they intended to use once they gave birth (27.5%), followed by worry for their health (22.2%) (Figure 1).
Figure 1.
Potential barriers to not preferring PPICUD among pregnant women attending antenatal clinics in Jimma town public healthcare facilities, southwest Ethiopia, 2020 (N = 197).
PPIUCD: postpartum intrauterine contraceptive device.
Factors associated with intention to immediate PPIUCD among pregnant women attending antenatal care
The bivariate analysis revealed that at p-value less or equal to 0.25 significance level 8 variables (educational status, occupational status, parity, attitude toward immediate postpartum IUCD use, the knowledge of immediate IUCD, history of previous LACM used, the interval of next pregnancy, and discuss family planning methods with a partner) were identified for multivariable logistic regression. In multivariable logistic regression, four variables were found to be statistically significant of intentions to use IPPIUD with a p-value of <0.05 and 95% CI. Accordingly, educational status, knowledge of PPIUCD, history of previous LACM use, and parity were found to be predictors. With regard to the educational status of respondents, those who attended secondary education were 2.36 times more likely to have the intention to use as compared to those who did not attend formal education (AOR = 2.36; p = 0.03; 95% CI (1.089, 5.128)); similarly, those respondents who attended college and above were 2.99 times more likely to have the intention to use PPIUCDs immediately as compared to who didn’t have education ((AOR = 2.99; p = 0.020; 95% CI (1.189, 7.541)).
Concerning the knowledge of respondents, respondents who have high knowledge of PPIUD were 2.10 times more likely to have the intention to use immediate PPIUCDs as compared to those who have low knowledge about immediate PPIUCDs ((AOR = 2.10; p = 0.006; 95% CI (1.236, 3.564)). Pregnant women who have a history of previous LACM use were 6.85 times more likely to have the intention to use immediate PPIUCDs compared to those who had no history of previous LACM use ((AOR = 6.85; p = 0.0001; 95% CI (3.560, 10.021)).
Relating to the parity status of the respondents, those who gave birth to more than four were 1.86 times more likely to have the intention to use PPIUCD as compared to those who gave birth less or equal four times ((AOR = 1.86; p = 0.043; 95% CI (3.99, 8.703)) (Table 5).
Table 5.
Factors associated with intention to use immediate PPIUCDs among pregnant women attending antenatal clinic in Jimma town public healthcare facilities, southwest Ethiopia, 2020.
| Variables | Categories | Intention to use PPIUD | COR (95% CI) | AOR (95% CI) | p-Value | |
|---|---|---|---|---|---|---|
| Yes N (%) | No N (%) | |||||
| Educational status of pregnant women | Not attended | 26 (30.2) | 60 (69.8) | 1 | 1 | |
| Primary education | 46 (36.2) | 81 (63.8) | 1.31 (0.73, 2.35)* | 1.49 (0.767, 2.905) | 0.238 | |
| Secondary | 29 (43.9) | 37 (56.1) | 1.81 (0.926, 3.532)* | 2.36 (1.089, 5.128) ** | 0.030 | |
| College and above | 17 (48.6) | 18 (51.4) | 2.18 (0.973, 4.884)* | 2.99 (1.189, 7.541)** | 0.020 | |
| Knowledge about PPIUCD | High | 76 (45.5) | 91 (54.5) | 2.09 (1.305, 3.340)* | 2.10 (1.236, 3.564)** 1 | 0.006 |
| Low | 42 (28.5) | 105 (71.4) | 1 | |||
| History of the previous LACM used | Yes | 67 (69.1) | 30 (30.9) | 7.27 (4.267, 12.384)* | 6.85 (3.560, 10.021)** | 0.0001 |
| No | 51 (23.5) | 166 (76.5) | 1 | 1 | ||
| Parity | Less or equal to 4 | 56 (24.9) | 169 (75.1) | 1 | 1 | |
| Greater than 4 times | 62 (69.7) | 27 (30.3) | 6.93 (4.024, 11.935)* | 1.86 (3.99, 8.703)** | 0.043 | |
CI: confidence interval; AOR: adjusted odd ratio; COR: crude odd ratio; PPIUCD: postpartum intrauterine contraceptive device; PPIUD: postpartum intrauterine device; 1: reference group.
p < 0.25 in bivariate.
Statistically significant in multivariate.
Discussion
According to the current study, the percentage of women planning to utilize IUDs immediately postpartum was 37.6% (95% CI (31.5. 43.7)). This result was higher when compared to studies conducted in Rwanda and India, where women’s intentions to use IUDs postpartum were18.1% and 28.1%, respectively.20,22 However, this result is lower than that of a study conducted in Nekemte Town, western Ethiopia, which investigated at women’s intentions to use immediate postpartum intrauterine contraceptives (47.9%).17 This discrepancy may be due to the variation of respondents’ sociodemographic characteristics and may be due to the time gap between the study and the sample size.
In this study, it was identified that the use of immediate PPIUCDs increased with the level of education. The intention to use immediate postpartum IUCD was higher among pregnant women who attended secondary school, college, and higher than pregnant women who didn’t have education. This finding was consistent with other studies in Bahir Dar and Rwanda.18,20 The possible explanation might be that educated women might discuss their concerns openly and freely so that they become closer to healthcare providers. In addition to this woman with some basic level of education can better understand the advantages of immediate PPIUCDs and can better understand the health information provided to them concerning the use of immediate PPIUCDs.
Similarly, the knowledge of immediate PPIUCDs was another predictor of intention to use immediate postpartum IUCD among pregnant women. Pregnant women who have high knowledge about immediate PPIUCDs were 2.1 times more likely to have the intention to use immediate postpartum IUCD. This finding agreed with the study finding in Mekele city, Ethiopia.23 The possible explanation might be due to knowledge essential to determine better health status as gaining knowledge and being aware is the first step to adopting as well as sustaining recommended and safe health-related behavior and practice.
Furthermore, in the present study, history of previous reversible LACM use was also a predictor of intention to use immediate PPIUCDs among pregnant women. Pregnant women who have a history of reversible LACM use were 6.85 more likely to have intentions to use immediate PPIUCDs. This might be because women who had a history of previous LACM use know the advantage of it and as it does not harm health as well as it is better than short-acting contraceptives.
In this study, the parity was statically significant with the use of immediate PPIUCDs by pregnant women. Being high parity was more likely to have the intention to use immediate PPIUCDs as compared with pregnant women who were with low parity. The findings were consistent with the studies done in Rwanda and Ghana.20,24 The reason behind this might be due to women with high parity requiring long-term contraceptives for spacing and women who are multipara were more likely to contact healthcare professionals and gain important information about the IUD method.
Finally, there were several reasons why pregnant women did not plan to use immediate PPIUCDs after they gave birth. These included “worry about future fertility,” fear of harm to their health, fear of being pregnant with an IUCD in place, fear of insertion and removal procedures, partner opposition, having another method that satisfied with it, plan to have more children, and lack of awareness about this method. Uncertainties about the risk and side effects of immediate PPIUCDs were one reason that prevented pregnant women from using immediate postpartum IUCD after giving birth. Women in Uganda have also similar concerns.25 Another barrier that prevents women’s preference to use immediate PPIUCDs has the familiar contraceptive methods they used in the past. This was their main reason not to use immediate PPIUCDs. The study population in Tanzania and Rwanda has similar concerns.19,20 This might be due to their fear as it has side effects and can harm their body. In this study, the other barrier that prevent pregnant women not intended to using immediate PPIUCDs after they gave birth was a lack of awareness concerning this method. The study participants in Tanzania and Meru also have the same fear and therefore decline this method.19,26 Information can give them many things like its availability, the benefit of the method for postpartum women, and its eligibility so they might be empowered to use this method. It was found that the process of insertion or removal was another potential barrier that prevents women from using immediate PPIUCDs. This is supported by the study findings on the acceptance and women’s perspectives of immediate PPIUCDs that they have a similar worry in Tanzania and Ghana,19,24 respectively. This might be due to their thought that immediate PPIUCDs can breach the privacy of the women during the insertion and removal procedure.
Limitations of the study
The study has some limitations that did not consider the role of the husband’s contribution to women’s use of immediate PPIUCDs. Since this study design is cross-sectional, the cause and effect relationship could not have been established, and also the possibility of recall bias may result in underreporting of the results.
Conclusion
The intention to use immediate PPIUCDs among pregnant women after they gave birth was low in the study areas. Maternal educational level, having a high knowledge of immediate postpartum IUCD, previous use of LACM, and being high parity were significantly associated with pregnant women’s intention to use immediate PPIUCDs after their delivery was included being satisfied with other methods, fear of impaired future fertility, fear of harm to health, lack of awareness of regard to immediate PPIUCDs, fear of insertion or removal procedure, plan to have more children, and fear of being pregnant with IUCD in place. To help women to make decisions on the use of immediate PPIUCDs, healthcare professionals should pay attention to providing women with important information connecting with immediate postpartum IUCD benefits for postpartum women, especially with concerns about lessening the barriers during attending antenatal clinics as they plan to use after they gave birth.
Supplemental Material
Supplemental material, sj-docx-1-smo-10.1177_20503121231157212 for Immediate postpartum intrauterine contraceptive device use among pregnant women attending antenatal clinics in Jimma town public healthcare facilities, Ethiopia: Intentions and barriers by Gemechu Terefe, Diriba Wakjira and Fikadu Abebe in SAGE Open Medicine
Acknowledgments
We are impressively thankful to Jimma University for the financial support provided for the work of this article. We are also grateful to study participants and data collectors in particular for their cooperation and the information they provide. Last but not least, appreciation goes to colleagues and friends for their encouragement and support throughout the work of this study.
Footnotes
Author contributions: GT designed and conceptualized the study, analyzed and interpreted the data, discussed the findings of the study, prepared the manuscript, and revised the manuscript. DW and FA participate in analyzing and interpreting the data, discussing the findings of the study, and drafting the manuscript. All authors have read and approved the manuscript.
Availability of data and materials: Data will be available upon request from the corresponding author.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
Ethics approval: Ethical clearance to conduct this study was obtained from the Institutional Review Board of the Institute of Health, Jimma University (IHR/PGP/468/2020).
Informed consent: Written informed consent was obtained from the subjects and the legally authorized representatives of minor subjects before the study and after we repeatedly explained to them those illiterate pregnant women the informed consent of respondents got by signed with their fingerprint.
ORCID iD: Gemechu Terefe 
https://orcid.org/0000-0003-3248-6343
Supplemental material: Supplemental material for this article is available online.
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Supplementary Materials
Supplemental material, sj-docx-1-smo-10.1177_20503121231157212 for Immediate postpartum intrauterine contraceptive device use among pregnant women attending antenatal clinics in Jimma town public healthcare facilities, Ethiopia: Intentions and barriers by Gemechu Terefe, Diriba Wakjira and Fikadu Abebe in SAGE Open Medicine