Factors influencing continuation of IUD use in south India: evidence from a multivariate analysis
Bhat, P.N.; Halli, S.S.
Journal of Biosocial Science 30(3): 297-319
1998
ISSN/ISBN: 0021-9320 PMID: 9746830 DOI: 10.1017/s0021932098002971Document Number: 276527
In northern Karnataka, South India, the IUD is the most popular reversible contraceptive method but has a low continuation rate. The determinants of this pattern, with special emphasis on the role of programmatic factors, were investigated through an analysis of data from several small-scale follow-up studies of family planning acceptors conducted by the Population Research Center. A total of 713 IUD acceptors (461 rural and 252 urban) were interviewed in these studies. The mean age of IUD acceptors was 25 years; they averaged 2.3 children. 75% of rural and 58% of urban respondents had selected the IUD for spacing reasons. 45% reported IUD-related side effects such as irregular bleeding. Only 35% of respondents had their original IUD in situ at the time of follow-up and 57% had requested removal, primarily because of side effects. A multinomial logit model identified the level of motivation to use the method and the experience of real or perceived side effects as the most significant determinants of IUD continuation; unexpectedly, the quality of services provided before and after insertion was not as influential. Medical check-ups at insertion moderately reduced the experience of side effects. Women who selected the IUD for child spacing had significantly higher discontinuation rates at 3 months and were more likely to complain about side effects than those who chose the method for other reasons. A policy shift toward recommending the IUD to older, high-parity women for limiting purposes should be considered. Such a strategy might encourage contraceptive use among women who do not want more children but are concerned about child mortality and thus reluctant to undergo sterilization.