Table 2
Socio-demographic characteristics of women using other contraceptive methods but not IUD.
Variables | Category | Frequency | Percentage (%) |
Age | 15–25 | 20 | 63 |
26–35 | 10 | 31 |
36–45 | 2 | 6 |
Region of residence | Central region | 32 | 100 |
Occupation | Working | 25 | 78 |
Not working | 7 | 22 |
Marital status | Married | 25 | 78 |
Not married | 7 | 22 |
Religion | Christians Moslems | 23 9 | 72 28 |
Level of education | Primary level | 15 | 47 |
Secondary Level | 14 | 44 |
Not educated | 3 | 9 |
Experiences of using IUD contraceptive
Experiences for mothers were assessed and both positive and negative experiences were reported. The positive experiences which were reported by women included; IUD is a long-term method of family planning; unaffected libido, convenient and comfortable for them. This was emphasized by a mother.
“That for it you insert it for a period you want as long as the person who has inserted it inserts it well, it can be there for that period until when you reach time when you are tired of it! More so you remain with your sexual feelings” (participant 1)
Women also reported that the method was convenient and comfortable for them, it does not need adherence like other methods and the side effects of other methods like injecta plan (depovera) where the experience was uncomfortable.
“Pills were giving me nausea and for the case of injector plan I would always be bleeding abnormally but for it (IUD) my menstrual days stay normal as there is nothing like missing my periods” (participant 4)
Some women reported that they were first screened for cervical cancer before the procedure and this created awareness of their status which they believed was good for their health.
“…of course, they first screened me for cervical cancer …… and they confirmed that I was ok they inserted it” (participant 1)
Most women received support from health workers. Some health providers they re-assured them when they had concerns while using IUD by providing them with knowledge, their personal experiences for those who had used IUD, sensitizing and counseling them.
“The health worker who worked on me also had IUD for the last 5 years so she told me; I shouldn’t worry that happened because of heavy bleeding. She also told me that if I happen to see again heavy bleeding, I should take Ibuprofen to reduce on the blood, that also candida disrupts IUD, so she emphasized the importance of personal hygiene, and that if I get it I should make sure I take medicine to avoid infections because its problem is infection” (participant 8)
The negative experiences which were reported by women included pain on insertion, discomfort and bleeding after insertion.
“By the way nurse it can also cause prolonged menstrual bleeding like for two (2) additional days. I experienced prolonged bleeding for the first three (3) weeks when I had just started using it but it finally normalized “(participant5)
Motivations to choose IUD contraceptive
Women in this study cited several factors that motivated them to use IUDs. These included previous experience of failure from other contraceptives methods, availability of the IUD services at the facility, unaffected body image while using IUDs and information from the health providers, peer influence and media.
Failure of the other family planning method motivated some clients to use IUD.
“, the condom burst, then I got pregnant and before that pregnant, I had undergone a C-section (for that last born), they don’t allow you to give birth to another child when the child is not yet 3 years, by then he was like one month so I got pills from the hospital and aborted. IUD.” (participant 37)
Peer influence and relying on the information provided by the health providers motivated some mothers to use IUD.
“what also motivated me was that it has no problem in the body the way health providers teach us, right now I also feel free as if I don’t have anything in my body, there is nothing like pulsations, (participant 8)
Side effects of other family planning methods such as irregular bleeding, change in body size, motivated the women to use IUD
“for 1st born I was using injectaplan and I could not manage it then I stopped… I was not menstruating… ok it also used to make me have a headache… for the 2nd born I used implant… even with it I was not menstruating, and it used to bring headache and pulsations” (Participant 7)
Barriers influencing the nonuse of IUD contraceptive
The decision to use or not to use FP services is the product of several demographic and service-related barriers. In this study the following themes were identified as barriers; mistrust of health workers, financial constraints, myth and misconceptions, lack of social support from their partners and misplacement of IUD leading to pregnancy.
The cost attached to IUD service provision and unavailability of IUDs in health facilities discourages some women from using IUD because they must pay in order to insert or remove the IUD. This barrier is worsened by the lack of social support from partners that deters women from asking for financial support from their husbands who are bread winners and do not support the use of family planning. This barrier was cited by both women using IUDs and those who were not)
“imagine nurse what I went through when my IUD got misplaced, I had only 10000(Ugandan shillings) with me, I couldn’t ask anybody money, my husband didn’t know about it, because I had lied to him that it’s an infection, I was so... scared but if the same problem happens to others, they may end up discontinuing and decide to give birth to children. Some may be doing it secretly, lack money even to take them to the hospitals” (participant 8)
Some women believed that of some health providers were incompetent and they developed mistrust. And others cited the process of IUD insertion as uncomfortable, and painful which deters them form using it. And indeed, the latter was described as a negative experience among the users as described above
“… have ever seen someone... it seems they (healthcare provider) had inserted it badly. She was complaining that it hurt her uterus and they were almost removing it (IUD). There is also another one who got pregnant with it, yeah they say women get pregnant with it” (FGD 1)
“… going and un dress, squat (expose private parts) for the health worker, {she laughs} when you have not gone to give birth” (Participant 7)
The women had myth and misconceptions about IUD and these included; misplacement of IUD during sexual intercourse abnormal fetus when the IUD is misplaced, getting cancer, fibroids due to its long use, fear of strings getting stack and fearing to have sex with their husband because it would cause injury to the cervix. These concerns were reported by both users and non-users. These resonated a lot in these quotes;
they (other people) tell us that it causes cancer when it over stays in you, it can burn you {she laughs} things like those, those who are not health workers… they have the perception that it can cause cancer, death and very many other things like burning lungs, uterus, things like it(IUD)can be knocked off(displaced) during sex….” (participant 4)
Some women reported the fear of getting pregnant when the IUD is misplaced and the inability to easily recognize such situations and some restrictions that come with IUD use such as good hygiene and limiting sexual partners.
“…it worries me, because they taught us that incase a man goes and gets another woman and he gets UTI not UTI, sorry STI you can also get it, and immediately you contract it you have to remove eeeee that’s where my fear is…” (participant 1’)
“… I heard about it with a woman when we were in the market, she told me for her she was using it …. She was married but complaining about it, saying it(IUD) does not want a second man you are supposed to have only one man (she laughs) (FGD 4)