Immediate Postpartum and Post Abortion Long Acting Reversible Contraception in Referral Level Facility: Time to Make up for lost Opportunities
TIME TO MAKE UP FOR LOST OPPORTUNITIES
Keywords: LARC, PPIUCD, Subdermal implants
AbstractObjective: To determine the frequency and acceptance of post-partum and post-abortion long-acting reversible contraceptive methods (LARC) at Maternal and Child Health Center (MCHC), Pakistan Institute of Medical Sciences (PIMS), Islamabad.
Methodology: A retrospective study of postpartum and post-abortion women in MCHC unit 1 was undertaken from 1st January 2015 to 1st June 2017. The data of women who accepted LARC was retrieved from departmental registers. Their gravidity and mode of delivery was noted and frequencies calculated. Data from Family Planning Reproductive Health Services (RHS-A) center affiliated with MCHC was also collected for determining uptake of interval LARC during this period.
Results: Total number of deliveries in MCHC I, PIMS from January 2015 to June 2017 were 13844. Among these, 1122 (8.1%) had postpartum intrauterine device insertion (PPIUCD) and 80 (0.5%) subdermal implants were placed. Total Manual and electrical vaccum aspiration and Evacuation and curettage (E&C) were 670 over these two and half years. Among 670 women receiving postabortion care, 23 (3.4%), women had subdermal implants. No postabortion IUCD was inserted in this group of women. The uptake of postpartum LARC for Primigravidae, Multigravida and grand multigravida was 0.6%, 9.8% and 17.8%, respectively (p-value 0.001). As regards the mode of delivery, acceptance of post-partum LARC was similar for vaginal deliveries and cesarean section (p=0.790). During the period of study 13312 women visited the family planning RHS-A center and 2,227 (16.7%) had interval IUCD while 144 (1%) accepted subdermal implant.
Conclusion: As almost 8% women opted for LARC in the post-partum and post-abortion period, their use in referral level facilities is a timely initiative to increase the use of modern contraceptives. This can reduce the high unmet need for contraception and more women can be counseled to avail LARC at this time of contact with referral healthcare facility.