Immediate IUD insertion after second trimester abortion: implications for service delivery

Abstract Background The availability of modern contraception including long-acting reversible contraceptives (LARC), is a fundamental component of postabortion care. Findings from a recent randomized controlled trial (RCT) in South Africa comparing immediate to delayed insertion of the copper intrau...

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Autores principales:	O. Somefun, D. Constant, M. Endler
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Second trimester medical abortion Copper IUD Immediate insertion Implications for service delivery South Africa Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/3c01ab5b4e8647939ba0fc9754f650a2
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spelling	oai:doaj.org-article:3c01ab5b4e8647939ba0fc9754f650a22021-12-05T12:06:39ZImmediate IUD insertion after second trimester abortion: implications for service delivery10.1186/s12913-021-07306-21472-6963https://doaj.org/article/3c01ab5b4e8647939ba0fc9754f650a22021-12-01T00:00:00Zhttps://doi.org/10.1186/s12913-021-07306-2https://doaj.org/toc/1472-6963Abstract Background The availability of modern contraception including long-acting reversible contraceptives (LARC), is a fundamental component of postabortion care. Findings from a recent randomized controlled trial (RCT) in South Africa comparing immediate to delayed insertion of the copper intrauterine device (IUD) after medical abortion (MA) at 17-20 gestational weeks showed that immediate insertion resulted in higher IUD use at 6 weeks postabortion, but that expulsion rates were significantly higher than for delayed insertion. This study aims to explore barriers, facilitators, and context-specific factors relevant to the implementation of immediate IUD provision after second trimester medical abortion. Methods We performed a qualitative study alongside the RCT in which we conducted in-depth interviews with 14 staff providing healthcare to study participants and 24 study participants. Research questions explored barriers and facilitators to implementation of immediate IUD insertion, contraceptive decision-making, and the impact of context and supplementary trial activities on service provision. Interviews were recorded and transcribed, with translation into English if needed. We performed a triangulated thematic analysis at the level of the transcribed interview text. Results Contraceptive counselling at the abortion facility by a study nurse improved knowledge, corrected misconceptions, and increased demand for the IUD postabortion. Women expressed a clear preference for immediate insertion. Convenience, protection from pregnancy and privacy issues were paramount and women expressed preference for engagement with staff who knew their abortion history, and with whom they had an established connection. Doctors and nurses were generally in favour of immediate insertion and said it could be incorporated into standard care if women wanted this. This contrasted with the need for interventions by the research team to reinforce adherence by staff to provide contraception as allocated during the trial. Conclusions Women and staff favour immediate IUD insertion after second trimester medical abortion, but service delivery may require structures that ensure timely insertion postabortion, continuity of care, communication that mitigates loss to follow-up and training of staff to ensure competence.O. SomefunD. ConstantM. EndlerBMCarticleSecond trimester medical abortionCopper IUDImmediate insertionImplications for service deliverySouth AfricaPublic aspects of medicineRA1-1270ENBMC Health Services Research, Vol 21, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Second trimester medical abortion Copper IUD Immediate insertion Implications for service delivery South Africa Public aspects of medicine RA1-1270
spellingShingle	Second trimester medical abortion Copper IUD Immediate insertion Implications for service delivery South Africa Public aspects of medicine RA1-1270 O. Somefun D. Constant M. Endler Immediate IUD insertion after second trimester abortion: implications for service delivery
description	Abstract Background The availability of modern contraception including long-acting reversible contraceptives (LARC), is a fundamental component of postabortion care. Findings from a recent randomized controlled trial (RCT) in South Africa comparing immediate to delayed insertion of the copper intrauterine device (IUD) after medical abortion (MA) at 17-20 gestational weeks showed that immediate insertion resulted in higher IUD use at 6 weeks postabortion, but that expulsion rates were significantly higher than for delayed insertion. This study aims to explore barriers, facilitators, and context-specific factors relevant to the implementation of immediate IUD provision after second trimester medical abortion. Methods We performed a qualitative study alongside the RCT in which we conducted in-depth interviews with 14 staff providing healthcare to study participants and 24 study participants. Research questions explored barriers and facilitators to implementation of immediate IUD insertion, contraceptive decision-making, and the impact of context and supplementary trial activities on service provision. Interviews were recorded and transcribed, with translation into English if needed. We performed a triangulated thematic analysis at the level of the transcribed interview text. Results Contraceptive counselling at the abortion facility by a study nurse improved knowledge, corrected misconceptions, and increased demand for the IUD postabortion. Women expressed a clear preference for immediate insertion. Convenience, protection from pregnancy and privacy issues were paramount and women expressed preference for engagement with staff who knew their abortion history, and with whom they had an established connection. Doctors and nurses were generally in favour of immediate insertion and said it could be incorporated into standard care if women wanted this. This contrasted with the need for interventions by the research team to reinforce adherence by staff to provide contraception as allocated during the trial. Conclusions Women and staff favour immediate IUD insertion after second trimester medical abortion, but service delivery may require structures that ensure timely insertion postabortion, continuity of care, communication that mitigates loss to follow-up and training of staff to ensure competence.
format	article
author	O. Somefun D. Constant M. Endler
author_facet	O. Somefun D. Constant M. Endler
author_sort	O. Somefun
title	Immediate IUD insertion after second trimester abortion: implications for service delivery
title_short	Immediate IUD insertion after second trimester abortion: implications for service delivery
title_full	Immediate IUD insertion after second trimester abortion: implications for service delivery
title_fullStr	Immediate IUD insertion after second trimester abortion: implications for service delivery
title_full_unstemmed	Immediate IUD insertion after second trimester abortion: implications for service delivery
title_sort	immediate iud insertion after second trimester abortion: implications for service delivery
publisher	BMC
publishDate	2021
url	https://doaj.org/article/3c01ab5b4e8647939ba0fc9754f650a2
work_keys_str_mv	AT osomefun immediateiudinsertionaftersecondtrimesterabortionimplicationsforservicedelivery AT dconstant immediateiudinsertionaftersecondtrimesterabortionimplicationsforservicedelivery AT mendler immediateiudinsertionaftersecondtrimesterabortionimplicationsforservicedelivery
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Immediate IUD insertion after second trimester abortion: implications for service delivery

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