PMID- 36327214 OWN - NLM STAT- MEDLINE DCOM- 20221107 LR - 20221108 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 17 IP - 11 DP - 2022 TI - A mixed-methods study of factors influencing postpartum intrauterine device uptake after family planning counseling among women in Kigali, Rwanda. PG - e0276193 LID - 10.1371/journal.pone.0276193 [doi] LID - e0276193 AB - INTRODUCTION: Rwanda has high unmet need for family planning (FP), especially in the postpartum period when women are advised to space pregnancies at least two years for improved maternal-child health. Despite interest in the copper intrauterine device (IUD), a highly cost-effective method, access and uptake remain low. This study aimed to determine factors associated with postpartum IUD (PPIUD) uptake after postpartum family planning (PPFP) counseling as well as provider perceptions of facilitators and barriers to clients' PPIUD uptake. METHODS: Postpartum women who received PPFP counseling and were less than 6 weeks postpartum were recruited for a case-control study in Kigali, Rwanda in 2018. We recruited n = 74 women who had accepted and n = 91 women who had declined the PPIUD. Multivariate logistic regression analyses evaluated associations between women's socio-demographics, FP knowledge and decision-making, and the outcome of PPIUD uptake. Six focus groups (FGs) were conducted with FP providers (n = 24) and community health workers (n = 17) trained to deliver PPFP counseling to assess perceptions of PPFP counseling and facilitators and barriers to PPIUD uptake. FG discussions were recorded, translated, and analyzed for themes. RESULTS: Factors associated (P<0.1) with PPIUD uptake included citing its non-hormonal nature, effectiveness, and duration of protection against pregnancy as advantages. Exclusive male partner control over FP decisions (relative to women's control or joint decision-making) was associated with non-use. Overall, limited knowledge about some aspects of the PPIUD persisted among clients even after counseling. Provider FGs highlighted client concerns, inconsistent FP messaging, and lack of male partner involvement as factors influencing non-use. CONCLUSIONS: Knowledge of the IUD and its benefits was associated with PPIUD uptake. There is need to refine PPFP counseling messages to address remaining knowledge gaps and concerns. Additionally, male partner involvement in FP counseling and decisions with their partners could be a key strategy to increase both PPIUD and FP uptake in Rwanda. FAU - Tounkara, Mariama S AU - Tounkara MS AUID- ORCID: 0000-0002-9146-1835 AD - Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America. FAU - Ingabire, Rosine AU - Ingabire R AD - Projet San Francisco, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Kigali, Rwanda. FAU - Comeau, Dawn L AU - Comeau DL AD - Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America. FAU - Karita, Etienne AU - Karita E AD - Projet San Francisco, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Kigali, Rwanda. FAU - Allen, Susan AU - Allen S AD - Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, United States of America. FAU - Nyombayire, Julien AU - Nyombayire J AD - Projet San Francisco, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Kigali, Rwanda. FAU - Parker, Rachel AU - Parker R AD - Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, United States of America. FAU - Haddad, Lisa B AU - Haddad LB AD - Center for Biomedical Research, Population Council, New York, New York, United States of America. FAU - Da Costa, Vanessa AU - Da Costa V AD - Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America. FAU - Tichacek, Amanda AU - Tichacek A AD - Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, United States of America. FAU - Mazzei, Amelia AU - Mazzei A AD - Projet San Francisco, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Kigali, Rwanda. FAU - Mukamuyango, Jeannine AU - Mukamuyango J AD - Projet San Francisco, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Kigali, Rwanda. FAU - Wall, Kristin M AU - Wall KM AUID- ORCID: 0000-0001-8547-2004 AD - Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America. LA - eng GR - P30 AI050409/AI/NIAID NIH HHS/United States GR - R01 AI064060/AI/NIAID NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20221103 PL - United States TA - PLoS One JT - PloS one JID - 101285081 SB - IM MH - Pregnancy MH - Female MH - Male MH - Humans MH - *Family Planning Services MH - Rwanda MH - Case-Control Studies MH - *Intrauterine Devices MH - Postpartum Period/psychology MH - Counseling MH - Contraception/methods PMC - PMC9632907 COIS- The authors have declared that no competing interests exist. EDAT- 2022/11/04 06:00 MHDA- 2022/11/08 06:00 PMCR- 2022/11/03 CRDT- 2022/11/03 13:33 PHST- 2022/06/09 00:00 [received] PHST- 2022/10/01 00:00 [accepted] PHST- 2022/11/03 13:33 [entrez] PHST- 2022/11/04 06:00 [pubmed] PHST- 2022/11/08 06:00 [medline] PHST- 2022/11/03 00:00 [pmc-release] AID - PONE-D-22-16684 [pii] AID - 10.1371/journal.pone.0276193 [doi] PST - epublish SO - PLoS One. 2022 Nov 3;17(11):e0276193. doi: 10.1371/journal.pone.0276193. eCollection 2022.