THE EFFECT OF TWO LEVELS OF COUNSELLING ON ACCEPTANCE, UPTAKE AND EARLY OUTCOMES OF POST-PLACENTAL INTRA-UTERINE CONTRACEPTIVE DEVICE.

OBJECTIVE: To determine the effect of two levels of counselling on the provision of Intrauterine Contraceptive Device (IUCD) at six weeks post-partum of the post-placental intrauterine device.

SETTING: Embu Provincial General Hospital, Kenya.

SUBJECTS: One hundred and thirty seven pregnant women at the gestation of 36 weeks to term, who attended Antenatal clinic and were followed until delivery and at six weeks post-partum.

DESIGN: A randomised "open-label" clinical trial.

RESULTS: One hundred and twenty seven study participants were enrolled and randomised to intensive (64 women) or routine FP counselling (63 women). Seventy eight per cent of women in the intensive FP counselled group and 66% in the routine FP counselled group accepted to have the post-placental IUCD inserted. There was no significant difference in uptake in the two-randomisation arms (p-value 0.232). Complications included expulsion (3.7%), allergic reaction (1.8%), pelvic infection (1.8%) and abdominal pain (1.8%).The post-placental IUCD is a favourable method with continuation rates (91%), client (88%) and reported partner (77%) satisfaction were notably high at six weeks. The most critical barrier to uptake was lack of trained medical personnel to insert the post-placental IUCD, which occurred in (60%) clients who had consented.

CONCLUSION: The post-placental IUCD is an acceptable method among women irrespective of level of counselling. Intensive counselling did not significantly increase acceptance and uptake rates of post-placental IUCD insertion in comparison to routine counselling.