Attitudes, Experiences and Use of Postpartum Intrauterine Contraceptive Device Service Provision in the Amhara Region Public Health Facilities in Ethiopia: Providers’ Perspective

Abstract

Objective: Despite the provision of free family planning in Ethiopia, contraceptive uptake is still low. Provider proficiency in carrying out comprehensive counseling on postpartum contraception use is important in developing countries. The reasons for non-use of Postpartum Intrauterine Contraceptive Device (PP-IUCD) are not clear and barriers impede provider use of this approach burdening Ethiopian women’s health. Hence, the aim of this study was to assess experiences and attitudes of providers about (PP-IUCD) service provision. Methods: A facility-based cross-sectional study design was used from September 18th, 2015 to December 18th, 2016. A total of 197 health facilities and 864 health care providers, using simple random sampling techniques, were included in the study. We used a pretested and structured, selfadministered questionnaire. A multilevel logistic regression model to determine factors associated with providers’ attitudes towards use of IUCD. Results: The mean (± SD) age of study participants was 27.8 years (± 5.4). IUCD was available in 168 (85.3%) of the health facilities. Attitudes towards acceptance of PP-IUCD among providers was 547 (63.4%) [95% CI: 60.3, 66.7], however PP-IUCD use was very low 100 (11.5%). IUCD use was higher among health facilities that had available guidelines for family planning counseling (AOR=8.27; 95% CI: 1.56, 43.8). Training on IUCD (AOR=7.75; 95% CI: 3.71, 16.23). Providers’ with favorable attitudes towards PP-IUCD (AOR=2.47; 95% CI: 1.044, 5.87); regular Antenatal Care (ANC) counseling (AOR=11.28; 95% CI: 4.04, 31.5), and providing ANC service at a health facility (AOR=1.94; 95% CI: 1.17, 3.22) were significantly associated with receiving training on PP-IUCD. Providers who preferred to use injectable contraceptive methods were 72% less likely to accept PPIUCD (AOR=0.28; 95% CI: 0.16, 0.49). Conclusion: Acceptance of PP-IUCD and IUCD insertion use among family planning providers remained low in the study setting. We found that while provider training remains low among study providers, it was associated with favorable attitudes towards PP-IUCD