FACTORS INFLUENCING THE USE OF IUD AMONG POSTPARTUM

MOTHERS AT BARANGAY SAN ANTONIO, AGDAO, DAVAO CITY

In Partial Fulfillment of the Requirements for the Degree of Bachelor of

Science in Midwifery

MARCH 2015

TABLE OF CONTENTS

PAGE NUMBER

ABSTRACT

ACKNOWLEDGEMENT

ii

DEDICATION

iii

Chapter I
BACKGROUND OF THE STUDY

STATEMENT OF THE PROBLEM

OBJECTIVES OF THE STUDY

SIGNIFICANCE OF THE STUDY

SCOPE AND LIMITATION

CONCEPTUAL FRAMEWORK

Chapter II
REVIEW OF RELATED LITERATURE

Chapter III
METHODOLOGY
Research Design

15

Research Locale

15

Unit of Analysis

16

Research Sampling

16

Variables and Measures

16

Chapter IV
RESULTS AND DISCUSSION

18

Chapter V
SUMMARY OF FINDINGS AND RECOMMENDATION
Summary of Findings

No Cues
Community
Artificial

25

CONCLUSIONS

27

RECOMMENDATIONS

28

Bibliography

29

APPENDICES

32

LIST OF TABLES
Results and Discussion
Demographic Profile

Table 1

Factors influencing the use of IUD among postpartum mothers

Table 2

Degree of importance of each influencing factors on the use of IUD among respondents

Table 3

LIST OF FIGURES

Conceptual Framework

Figure 1

Geographical Map of Barangay San Antonio

Figure 2

DEDICATION

This study is dedicated to all our families who

were there for us in our journey. This study is
also dedicated to all the respondents and
readers of this study. Thank you all!

ACKNOWLEDGEMENT

We would like to express our sincere gratitude

to our advisor Maam Evelyn Alba for the
continuous support of our study and research,
for her patience, motivation, enthusiasm, and
immense knowledge. Her guidance helped us
in all the time of research and writing of this
thesis. We could not have imagined having a
better advisor and mentor for our study.
Besides our advisor, we would like to thank
the rest of our thesis committee for their
encouragement,

insightful

comments,

and

hard questions. Our sincere thanks also goes

to the Barangay officials of Barangay San

Antonio, for offering us their support to

conduct this study in their place. Also we
thank our families and friends for inspiring
us to the first glance of research. Last but not
the least, we would like to thank God for the
undying support and love throughout our
lives.
Abstract
This study attempts to analyze the factors influencing the use of IUD among postpartum mothers
at Barangay San Antonio, Agdao, Davao City. Specifically, it aims to identify the demographic
profile of the postpartum mothers based on the following: Age; Religion; Educational
Attainment; Occupation/Source of Income and Desired Family Size, determine the factors
influencing the use of IUD among postpartum mothers; and determine the degree of importance
of each influencing factors on the use of IUD among postpartum mothers. The research design of
this study is purely descriptive. This study was conducted at Barangay San Antonio, Agdao,
Davao city.

The respondents of the study are the postpartum mothers of the research locale

who are using IUD as their contraceptive. The sampling method that was used in this study is
convenience sampling and random sampling. There were a total of 15 respondents in the study,

all postpartum mothers who are using IUD as contraceptives. Most of the age ranges from 25-34,
most of them are Christians, half of them are college level, more than half of the respondents are
private employees, 14 of the respondents have the desired family size of 1-3 children. The most
significant influencing persons for the use of IUD in their order of importance are the postpartum
mothers themselves, their partners, health providers, friends and their parents/in-law while the
influencing factors in the order of importance and significance are the Spousal Communication,
Knowledge, Service Factors and Attitude. The results of the study depicts that such influential
factors can be further implemented in the reproductive health policy to strengthen the
contraceptive use in problematic areas of the country in terms of reproductive health and are
important to be determined in order to assess the preference of mothers which may help develop
the quality of maternal health in terms of contraceptive choice not only in the country but
throughout the world.

Chapter I
INTRODUCTION
Background of the Study
According to National Institute for Health and Care Excellence (NICE)
guidelines, contraceptive methods and advice about when to start them should be discussed
within the first postpartum week, and this is usually delivered by hospital or community
midwives (NICE Clinical Guidelines, 2006).
Contraceptive use likely prevents more than 272,000 maternal deaths from childbirth
each year, according to a new study led by researchers at the Johns Hopkins Bloomberg School
of Public Health. Researchers further estimate that satisfying the global unmet need for
contraception could reduce maternal deaths an additional 30 percent. Promotion of contraceptive

10

use is an effective primary prevention strategy for reducing maternal mortality in developing
countries. Findings reinforce the need to accelerate access to contraception in countries with a
low prevalence of contraceptive use where gains in maternal mortality prevention could be
greatest, said the studys lead author, Saifuddin Ahmed, MBBS, PhD, associate professor in the
Bloomberg Schools departments of Population, Family and Reproductive Health, and
Biostatistics (www.jhsph.edu, 2012).
Intrauterine devices (IUDs) are an effective and increasingly popular form of reversible
contraception. The increase in popularity has been attributed to their efficacy, ease of
reversibility, and patient satisfaction, with minimal effort required for long-term use. IUDs are
equivalent to tubal sterilization at preventing pregnancy; in addition to vasectomy, they are the
most cost-effective method of long-term contraception available in the United States (Mosher,
2008).
Majority of postpartum women when asked will say that they do not plan to get pregnant
again in the next few years. And yet they do not access from FP services prior to going home
from a birthing facility. Postpartum women, constitute a sizeable percentage of the unmet need
for modern FP methods in the Philippines. Unfortunately, the time after birth is often a missed
opportunity for FP as a life-saving health intervention (Catibog et.al, 2012).
Nowadays, the Philippine Clinical Standards Manual discusses different contraceptive
methods that can be used in the postpartum period including timing of initiation, attributes, and
risks and benefits of the available choices. The thrust of the Department of Health (DOH) is to
meet the increasing demand for permanent and long acting reversible contraceptive (LARC)
methods and therefore more attention is given to postpartum IUD and implants in the discussion
(Catibog et.al, 2012).

11

This study will determine the factors influencing the use of IUD among postpartum
mothers at Barangay San Antonio, Agdao, Davao City. This study will also determine the
demographic profile and the degree of importance of each influencing factors.
The factors concerning the factors concerning the influences in the use of IUD among
postpartum mothers are important to be studied since these factors are needed in order to assess
the preferences of the mothers and the affectivity of such type of contraceptive which becomes
very rampant in the society today.

STATEMENT OF THE PROBLEM

This study attempts to analyze the factors influencing the use of IUD among postpartum
mothers at Barangay San Antonio, Agdao, Davao City. Specifically, it attempts to answer the
following questions:
1. What is the demographic profile of the postpartum mothers based on the following?:
a) Age
b) Religion
c) Educational Attainment
d) Occupation/Source of Income
e) Desired Family Size
2. What are the factors influencing the use of IUD among postpartum mothers?;
3. What is the degree of importance of each influencing factors on the use of IUD among
postpartum mothers?

12

OBJECTIVES OF THE STUDY

This study attempts to analyze the factors influencing the use of IUD among postpartum
mothers at Barangay San Antonio, Agdao, Davao City. Specifically, it aims to:
1. identify the demographic profile of the postpartum mothers based on the following:
a.) Age
b.) Religion
c.) Educational Attainment
d.) Occupation/Source of Income
e.) Desired Family Size
2. determine the factors influencing the use of IUD among postpartum mothers; and
3. determine the degree of importance of each influencing factors on the use of IUD
among postpartum mothers.

13

SIGNIFICANCE OF THE STUDY

This part of the study explains the importance of its results; discussion and
recommendations which will help solve future problems relating to the quality of care in birthing
clinics. Specifically, this study will be beneficial to the following:
To the Respondents
This study will help assess the factors influencing the use of IUD among postpartum
mothers. It will help identify the most influential factors affecting their decision and willingness
to use the mentioned type of contraceptive.
To the Researchers
The important factors which are identified in this study can be further implemented in the
reproductive health policy to strengthen the contraceptive use in problematic areas of the
country. This study will be a great contribution to the rising body of knowledge. Moreover, this
study may provide a basis for future researchers who are interested specifically to topics dealing
with assessments of the factors influencing the use of IUD among postpartum mothers.

14

SCOPE AND LIMITATION

This study focuses on the factors influencing the use of IUD among postpartum mothers
at Barangay San Antonio, Agdao, Davao City. Specifically, it deals with the demographic profile
of the postpartum mothers based on the following: Age; Religion; Educational Attainment;
Occupation/Source of Income and Desired Family Size, the factors influencing the use of IUD
among postpartum mothers; and the degree of importance of each influencing factors on the use
of IUD among postpartum mothers.
Furthermore, this study will be limited to some areas of the factors influencing the use of
IUD which are knowledge, attitude, spousal communication and service factors. It is also limited
to 15 respondents (postpartum mothers) of the research locale.

15

CONCEPTUAL FRAMEWORK

Independent Variables

Postpartum
Mothers
Demographic Profile
Factors
Influencing IUD
Use

Knowledge

Attitude

Service Provider

Spousal Communication

Dependent Variables

IUD Usage

Practice of Using
Decision to Use
Willingness to Use

16

Figure 1.

Chapter II
REVIEW OF RELATED LITERATURE

IUD as Postpartum Contraception

As a contraceptive used during the postpartum period, the IUD has a distinct advantage:
It does not affect breastfeeding, as do many systemic contraceptive methods. The postpartum
period may also be a convenient time during a woman's life to have an IUD inserted, since it may
be one of the few times she is in contact with medical services (Family Health International,
2006).
In addition, IUDs do not require regular user compliance. Coital-dependent methods may
be used inconsistently during the postpartum period by couples who think conception is less
likely during this period. Also, if a woman says she wants no more children but has not had time
to consider sterilization carefully, an IUD offers a reversible alternative (Family Health
International, 2006).
Timing of insertion, counseling, provider training and programmatic support are critical
factors for IUD use during the postpartum period. The timing of insertion is important primarily
because it influences the risk of expulsion. Expulsion can leave a woman unprotected from

17

pregnancy without her realizing it. Ideally, postpartum insertion should take place within 10
minutes of placental delivery (immediate post placental) or at about six weeks after birth, when a
woman returns for a routine postpartum care visit.
Postpartum insertion can be done before hospital discharge (up to 72 hours after
delivery), but it should not be done between 72 hours and about six weeks postpartum because of
an increased risk of expulsion and perforation. Special training is required for immediate post
placental insertions and for insertion within the first 2 hours. Copper T IUDs may be safely
inserted as early as four weeks postpartum, but for other IUDs, one should wait until six weeks
postpartum. This is because the so-called "push insertion technique," used for some types of no
copper IUDs, might result in higher perforation rates.
Immediate post placental insertion should only be done if there is adequate prenatal
counseling. Ideally, choices of methods should be discussed during routine prenatal visits,
allowing women to choose the most appropriate method at that point. In some cases, a woman in
the early stages of labor could receive enough information after arriving at the clinic to decide to
have a post placental insertion. Likewise, a woman could decide after delivery to have an IUD
inserted before leaving the hospital. A woman should never receive an IUD immediately after
delivery without having received adequate counseling and giving her informed consent.
Counseling should be done once the emotional and physical stresses of labor have ended.
Good postpartum IUD programs in hospitals need national and regional support.
Clinicians need specialized insertion training, and prenatal clinics must give priority to
contraceptive counseling. A variety of methods should be available to potential users. Also, the
obstetric unit of the health-care center must work in close coordination with the family planning
or maternal and child health unit. Only a few countries, including Mexico and Colombia, have

18

committed major resources and programmatic attention to postpartum IUD programs (Family
Health International, 2006).
The puerperium and lactation make particular demands on the safe choice of
contraception - there is an increased risk of venous thromboembolic disease in the few weeks
following childbirth and breast-feeding is considered a contra-indication to the use of the
combined oral contraceptive pill (COCP). Postpartum, a woman's contraceptive needs may have
changed and discussions may occur regarding 'spacing' future pregnancies (very close intervals
between babies are generally thought to increase risk to mother and future infants) or preventing
further pregnancies where a family is considered complete (sterilisation may be requested as a
'final' method, but alternatives should be raised) (Amy, 2009).

Contraception Lessens Maternal Death

Further discussion and provision of contraception is an integral part of the six-week
postpartum GP check. There is great variation in the return to fertility and sexual activity
following childbirth but the earliest known time of ovulation is 27 days after delivery. Therefore,
no contraception is needed until 21 days postpartum, which is nonetheless ahead of the six-week
check. All women should be advised that they may become fertile ahead of the return of their
periods and should not delay the use of contraception if they do not wish to become pregnant
again.
Vaccination prevents child mortality; contraception prevents maternal mortality. Effective
contraception is estimated to avert nearly 230 million unintended births each year. Worldwide,
roughly 358,000 women and 3 million newborn babies die each year because of complications

19

related to pregnancy and childbirth. Nearly all of these deaths occur in developing countries,
where 10 to 15 percent of pregnancies end in maternal death due to unsafe abortions.

Intrauterine Device
The World Health Organization and the Centers for Disease Control and Prevention
(CDC) have developed guidelines for practitioners regarding IUD use in a variety of clinical
circumstances. IUDs are considered appropriate for the majority of women, including
nulliparous women and adolescents. Both immediate postpartum insertion (within 10 minutes of
placental delivery) and delayed postpartum insertion (within 4 weeks of placental delivery) are
acceptable. Similarly, post abortion (spontaneous or elective) insertion is acceptable. IUD use is
safe in women with the following conditions: History of an ectopic pregnancy, History of pelvic
surgery, Hypertension or other forms of heart disease, History of deep venous thrombosis,
History of migraine headaches, Anemia, Diabetes, Endometriosis, Smoking (Milton, 2013).
Also, women with a history of sexually transmitted infections or a history of pelvic
inflammatory disease may safely use an IUD, provided they have been treated and a test of cure
has been obtained. Absolute contraindications for IUD use include the following: Pregnancy,
Significantly distorted uterine anatomy, Unexplained vaginal bleeding concerning for pregnancy
or pelvic malignancy, Gestational trophoblastic disease with persistently elevated beta-human
chorionic gonadotropin levels, Ongoing pelvic infection, Ongoing pelvic infections (eg, pelvic
inflammatory disease, untreated cervicitis, puerperal sepsis, immediate postabortion or
postpartum infection, endomyometritis, pelvic tuberculosis) are also absolute contraindications
for IUD placement. In women with these infections, placement should be deferred for 3 months

20

after treatment and a physical examination should be performed prior to insertion to exclude any
evidence of persistent infection (Karjane, 2013).
In general, women with a new diagnosis of cervical cancer should not receive IUDs.
Although the World Health Organization and the CDC do not recommend the use of IUDs in
women with a new diagnosis of endometrial cancer, there are observational studies and case
reports suggesting that the 52 mg levonorgestrel-releasing intrauterine system (Mirena) may be
an acceptable alternative for treatment in women who strongly desire fertility (Chelmow, 2013).
Complications from IUD placement are relatively rare. The most common complication
is IUD expulsion, which occurs in approximately 2-10% of cases. Patients should be encouraged
to feel for their IUD strings on a regular basis at home to ensure correct placement. Placement in
the immediate postpartum period is associated with a higher expulsion rate than delayed
postpartum insertion. Similarly, insertion immediately following first and second trimester
spontaneous or elective abortion is also associated with a higher expulsion rate than delayed
insertion. There are, however, numerous advantages to post procedural and postpartum insertion,
which may outweigh the risk of expulsion (Milton, 2013).
Another uncommon complication of IUD placement is uterine perforation, which occurs
in 0.1% of cases. Severe pain or loss of resistance with sounding for IUD insertion are signs of
perforation. If perforation is suspected, the procedure should be stopped and postponed. The
patients vital signs should be assessed to identify and signs of hemorrhage. If any of these signs
are evident, the patient should be transported to an emergency facility rapidly. Rarely, a patient
may experience a vasovagal episode as a result of cervical or uterine manipulation. If this occurs,
the procedure should be stopped and patients condition managed appropriately (Karjane, 2013).

21

Chapter III
METHODOLOGY

This chapter explains the process on how the researchers conducted the study. This
section states the essential plans and methods that were used in attaining the research objectives.
Specifically, this section presents the following:
Research Design
The research design of this study is purely descriptive, since it deals with categorizing
and discovering information as well as determining the frequency of something that occurs.
Research Locale
This study was conducted at Barangay San Antonio, Agdao, Davao city. The research
locale has a population of 12, 211. Below is the map geographical.

22

Figure 2.
Unit of Analysis
The respondents of the study are the postpartum mothers of the research locale who are
using IUD as their contraceptive.
Research Sampling
The sampling method that was used in this study is convenience sampling and random
sampling because the accessibility and proximity of the variables to the researcher were
considered. There were a total of 15 respondents in the study, all postpartum mothers who are
using IUD as contraceptives.

Variables and Measures

Variables
A. Demographic Profile
Age
Religion
Educational Attainment

Measures
Number of years from birth to the last birthday
Christianity, Islam, Buddhism, Others
Primary Level, Primary Graduate, High School

23

Level, High School Graduate, More than High

Occupation/Source of Income

School
Dependent/Unemployed, Student, Owns a
Business, Private Employee, Government

Desired Family Size

B. Factors Influencing IUD Use
Knowledge
Attitude
Spousal Communication
Service Factors

Employee, Others
Number of Children
None (0%), Low (1%-50%), High (51%100%)
Positive (51%-100%), Negative (1%-50%)
Agreed (51%-100%), Disagreed (1%-50%)
None (0%), Low (1%-50%), High (51%-

100%)
C. Ranking of Influencing factors according to its importance
Ranking of Influencing factors according to its 1st, 2nd, 3rd, so on.
importance

24

Chapter IV
RESULTS AND DISCUSSION
This chapter explains the results and discussions of the study. Most answers for each
problem are represented by a table and a discussion immediately below the tables.
Results:

Table 1.Demographic Profile of the Postpartum Mothers

Profile
Age
15-24
25-34
35-45
Religion
Christianity
Islam
Buddhism

Frequency

4
9
2
Mode (for age) = 9 (25-34 years old)

14
1
0
Mode (for religion) = 14 (Christianity)
Educational Attainment
Elementary
0
High School Level
0
High School Graduate
4
College Level
7
College Graduate
4
More than College Graduate
0
Mode (for educational attainment) = 7 (College level)
Occupation/Source of Income
Dependent./Unemployed
2
Student
0
Owns Business
3
Private employee
9
Government employee
1
Others
0

25

Mode (for employment status) = 9 (Private employee)

Desired Family Size (# of Children)
1-3
14
4-6
1
7-above
0
Mode (Desired Family Size) = 14 (1-3)

Discussion:
The table above shows the demographic profile of the postpartum mothers. Most of the
age ranges from 25-34 which has the frequency of 9 and the age range of 15-24 which has the
frequency of 4. Most of them are Christians which has the frequency of 14 and only one is
having the religion of Islam which has the frequency of 1. Four (4) of them are high school
graduates, half of them are college level which has the frequency of 7 and the frequency for
college graduate is 4. More than half of the respondents are private employees which has the
frequency of 9, 1 government employee, 3 of them owns a business and 2 are unemployed. 14 of
the respondents have the desired family size of 1-3 children and only one desires 4-6 number of
children.

Results:
Table 2.Factors Influencing IUD Use of the Postpartum Mothers
Factors

Score

Level (Category)

(Mean)
Knowledge
Prescription
Side Effects

14.55 (97%)
12.75% (85%)

High
High

26

Attitude
Usage
Side Effects
Spousal Communication
Agreement of IUD Use
Discussion about IUD Use
Perception of Partner
Service Factors
Availability
Accessibility

9.8 (98%)
8.5 (85%)

Positive
Positive

15 (100%)
15 (100%)
15 (100%)

Agreed
Agreed
Agreed

8.1 (90%)
9.8 (98%)

High
High

Discussion:
The table above shows the results of the factors influencing IUD use of the postpartum
mothers. The first factor which is discussed in this paper is the knowledge of the postpartum
mothers regarding the prescription and side effects of the IUD. Both knowledge areas are
categorized as high or highly knowledgeable which has the score of 97% for the prescription and
85% for the side effects. The second factor is the attitude of the postpartum mothers regarding
the usage and side effects of the IUD. Both attitude areas are categorized as positive which has
the score of 98% for the usage and 85% for the side effects. The third factor is the spousal
communication of the postpartum mothers regarding the Agreement of IUD Use, Discussion
about IUD Use and Perception of Partner of the IUD. All spousal communication areas are
categorized as agreed which has the score of 100%. Lastly, the fourth factor which is discussed
in this paper is the service provider of the postpartum mothers regarding the availability and
accessibility of the IUD. All service factor areas are categorized as high which has the score of
90% on availability and 98% on accessibility.

27

Results:
Table 3. Ranking of Factors Influencing IUD Use of the Postpartum Mothers (based on
importance/degree of significance)
Influences

Score

Rank

(Mean)
Influencing Persons
Myself
My Spouse
Health Providers
Friends
Parents/in-law
Influencing Factors
Spousal Communication
Knowledge

14.1 (94%)
13.8 (92%)
11.7 (78%)
10.5 (70%)
9.6 (64%)

1st
2nd
3rd
4th
5th

14.7 (98%)
13.8 (92%)

1st
2nd

28

Service Factors
Attitude

13.5 (90%)
13.2 (88%)

3rd
4th

Discussion:
The table above shows the results of the ranking of factors influencing IUD use of the
postpartum mothers based on importance. The most significant influencing persons for the use of
IUD in their order of importance are the postpartum mothers themselves, their partners, health
providers, friends and their parents/in-law. While the influencing factors in the order of
importance and significance to the postpartum mothers are the Spousal Communication,
Knowledge, Service Factors and Attitude.

Chapter V
SUMMARY OF FINDINGS AND RECOMMENDATION
Summary of Findings
This study was conducted at Barangay San Antonio, Agdao, Davao City. This study deals
with the factors influencing the use of IUD among postpartum mothers, the demographic profile
and the degree of importance of each influencing factors to the postpartum mothers. The
respondents of the study are 15 random postpartum mothers. From the data presented, analyzed
and interpreted; the researchers came about the following findings:

Most of the age ranges from 25-34 which has the frequency of 9 and the age range of 1524 which has the frequency of 4.

29

Most of them are Christians which has the frequency of 14 and only one is having the

religion of Islam which has the frequency of 1.

Four (4) of them are high school graduates, half of them are college level which has the

frequency of 7 and the frequency for college graduate is 4.

More than half of the respondents are private employees which has the frequency of 9, 1

government employee, 3 of them owns a business and 2 are unemployed.

14 of the respondents have the desired family size of 1-3 children and only one desires 4-6

number of children.
Both knowledge areas are categorized as high or highly knowledgeable which has the

score of 97% for the prescription and 85% for the side effects.
Both attitude areas are categorized as positive which has the score of 98% for the usage

and 85% for the side effects.

All spousal communication areas are categorized as agreed which has the score of 100%.
All service factor areas are categorized as high which has the score of 90% on availability

and 98% on accessibility.

The most significant influencing persons for the use of IUD in their order of importance
are the postpartum mothers themselves, their partners, health providers, friends and their

parents/in-law.
While the influencing factors in the order of importance and significance to the
postpartum mothers are the Spousal Communication, Knowledge, Service Factors and
Attitude.

30

CONCLUSIONS:
This study deals with the factors influencing the use of IUD among postpartum mothers,
the demographic profile and the degree of importance of each influencing factors to the
postpartum mothers.
Based on the results, most postpartum mothers age range is from 25-34

years

old,

Christians, College level, Private employees and has the desire number of children from 1-3
only. Thus, these demographic profiles indicate that the postpartum mothers are after the benefits
of contraceptives, especially the use of IUD, based on their desired family size and other
demographic profile.
The factors influencing the postpartum mothers decision and willingness to use IUD are
their knowledge towards IUD, attitude towards IUD, spousal communication regarding the use
of IUD and also the availability and accessibility of the service factors who offers IUD use. Most
of the results are on the positive, high and agreed side (affirmative) because the respondents
considers the stated factors as their influences to the type of contraceptive that they are using.

31

Furthermore, the respondents rank the things that they consider which are some
influencing persons and factors that encourage them to use IUD as their contraceptive. The
ranking shows that the postpartum mothers themselves are the most influencing person who
moved them to use IUD while the most influential factor is the spousal communication between
husband and wife to use IUD.
We can draw conclusions from the results that the discussion of the contraceptive type
and even the use of contraceptive in the postpartum period of mothers are very important to
discuss. It should be realized by the postpartum mothers themselves and agreed by them and
their partners in order for them to be able to come up with the things and plans that will suit them
best. Lastly, the results of the study depicts that influential factors which are the knowledge,
attitude, spousal communication and service providers, such factors are important to be
determined in order to assess the preference of mothers which may help develop the quality of
maternal health in terms of contraceptive choice not only in the country but throughout the
world.

32

RECOMMENDATIONS
The following are key recommendations which can contribute greatly in the improvement
of the reproductive health programs:
a. future programs to expand or increase the contraceptive use among postpartum mothers to
avoid maternal deaths
b. future programs to expand or increase the contraceptive use among adolescent mothers to
avoid maternal deaths
c. correction of misperceptions and negative attitudes of contraceptive use
d. promotion of the husband/partners involvement in the communication on contraceptive use
e. promotion of the importance of the role of peers in the involvement in the communication on
contraceptive use
f. promotion of the importance of the role of service providers in the involvement in the
communication on contraceptive use

33

Bibliography
Researches

Sivin I, Greenslade F, Schmidt F, et al. The Copper T 380 Intrauterine Device: A

Summary of Scientific Data. (New York: The Population Council, 1992) 15.

Thiery M, Van Kets H, Van Der Pas H. Immediate postplacental IUD

insertion: The expulsion problem. Contraception 1985;31(4):331-49.

O'Hanley K, Huber DH. Postpartum IUDs: keys for success. Contraception

1992;45(4):351-61.

Morrison C, Waszak C, Katz K, et al. Clinical outcomes of two postpartum IUD insertion
programs in Africa. Contraception, in press.

Journals

Postnatal care: Routine postnatal care of women and their babies; NICE Clinical

Guideline (2006)
Postnatal Sexual and Reproductive Health; Faculty of Sexual and Reproductive

Healthcare (2009)
UK Medical Eligibility Criteria for Contraceptive Use; Faculty of Sexual and
Reproductive Healthcare (2009)

34

Contraception - progestogen-only methods; NICE CKS, June 2012

Espey E, Ogburn T, Leeman L, et al; Effect of progestin compared with combined oral
contraceptive pills on lactation: a randomized controlled trial. Obstet Gynecol. 2012

Jan;119(1):5-13. doi: 10.1097/AOG.0b013e31823dc015.

Contraception - combined hormonal methods; NICE CKS, June 2012 (UK access only)

Long-acting reversible contraception; NICE Clinical Guideline (2014)

Contraception - IUS/IUD; NICE CKS, June 2012

Kapp N, Curtis KM; Intrauterine device insertion during the postpartum period: a

systematic review. Contraception. 2009 Oct;80(4):327-36. Epub 2009 Aug 29.

Celen S, Moroy P, Sucak A, et al; Clinical outcomes of early postplacental insertion of

intrauterine contraceptive devices. Contraception. 2004 Apr;69(4):279-82.

Mwalwanda CS, Black KI; Immediate post-partum initiation of intrauterine
contraception and implants: a review of the safety and guidelines for use. Aust N Z J

Obstet Gynaecol. 2013 Aug;53(4):331-7. doi: 10.1111/ajo.12095. Epub 2013 May 2.

Contraception - natural family planning; NICE CKS, June 2012 (UK access only)

Male and female sterilisation; Royal College of Obstetricians and Gynaecologists

(2004)
Johnson LK, Edelman A, Jensen J; Patient satisfaction and the impact of written
material about postpartum contraceptive decisions.; Am J Obstet Gynecol. 2003
May;188(5):1202-4.

Books

Mosher WD, Jones J. Use of contraception in the United States: 1982-2008. Vital
Health Stat 23. Aug 2010;1-44. [Medline].

Trussell j. Contraceptive Failure in the United States. Contraception. 2010;83:397404.

Andersson K, Batar I, Rybo G. Return to fertility after removal of a levonorgestrelreleasing intrauterine device and Nova-T. Contraception. Dec 1992;46(6):57584. [Medline].

Peipert JF, Zhao Q, Allsworth JE, Petrosky E, Madden T, Eisenberg D, et al.

Continuation and satisfaction of reversible contraception. Obstet Gynecol. May
2011;117(5):1105-13. [Medline].

35

Hatcher RA, Trussell J, Nelson AL, Cates W, Stewart F, Kowal D. Contraceptive

Technology. 19. New York, NY: Ardent Media; 2007.

Trussell J. Update on the cost-effectiveness of contraceptives in the United

States. Contraception. Oct 2010;82(4):391. [Medline].

US Medical Eligibility Criteria for Contraceptive Use. MMWR Recomm Rep:

Centers for Disease Control and Prevention; 2010. 591-86.

Trussell J. Medical eligibility criteria for contraceptive use Medical eligibility criteria
for contraceptive use , 4th edition, 2010 , WHO Press , Geneva, Switzerland , ISBN:
9789241563888 , 125 pages, CHF/US$ 25.00; in developing countries: CHF/US$
17.50. Hum Fertil (Camb). Sep 2011;14(3):203. [Medline].

APPENDICES

36

Information Consent Letter for Interview

Date

Dear (Insert participants name):

This letter is an invitation to participate in a study I am conducting for a Midwifery Research

course project at North Davao Colleges. I would like to provide you with more information
about this project and what your involvement would entail if you decide to take part.
The project will help me learn more about the topic area and develop skills in research design,
collection and analysis of information, and writing a research paper. The research title is
FACTORS INFLUENCING THE USE OF IUD AMONG POSTPARTUM MOTHERS AT
BARANGAY SAN ANTONIO, AGDAO, DAVAO CITY.
Participation in this study is voluntary. It will involve an interview of approximately 15 minutes
in length to take place in a mutually agreed upon location and time. You may decline to answer
any of the interview questions if you so wish. Your name or any other personal identifying
information will not appear in the course project paper resulting from this study; however, with
your permission anonymous quotations may be used. Notes and/or tapes collected during this

37

study will be retained for 15 minutes in a secure location and then destroyed. Even though I may
present the study findings to the class, only the course instructor and I will have access to the
data. There are no known or anticipated risks to you as a participant in this study.
I very much look forward to speaking with you and thank you in advance for your assistance in
this project.

Sincerely,
ERLINDA U. PADILLA

JOSEPHINE A. DENOLAN

CONSOLACION L. PALAS

MARCELA GUISOK

FLORA R. RUBIS

NEMIA C. PEREZ

CONSENT FORM

I have read the information presented in the information letter about a study being conducted for
a Midwifery Research course project at North Davao Colleges. I have had the opportunity to
ask any questions related to this study, to receive satisfactory answers to my questions, and any
additional details I wanted.
I am aware that I have the option of allowing my interview to be tape recorded to ensure an
accurate recording of my responses. I am also aware that excerpts from the interview may be
included in the course project paper to come from this research, with the understanding that the
quotations will be anonymous.
I was informed that I may withdraw my consent at any time by advising the student researcher.
With full knowledge of all foregoing, I agree, of my own free will, to participate in this study.
____ YES

___

NO

I agree to have my interview tape recorded.

____ YES

___

NO

I agree to the use of anonymous quotations in the course project paper

38

____ YES

___

NO

Participants Name (please print) _____________________________

Participants Signature _____________________________________

Date ______________

Researchers Signature _____________________________________

Date ______________

Researchers Title __________________________ Department _________________________

Questionnaire Sheet

Name (Optional:
Date:
Name of Interviewer:
Instruction: Put a CHECK Mark on the spaces which may be true to you. Leave BLANK
the spaces that doesnt describe or conform to your information.
I.

Demographic Profile
Profile
Age
15-24
25-34
35-45
Religion
Christianity
Islam
Buddhism
Educational Attainment

39

Elementary
High School Level
High School Graduate
College Level
College Graduate
More than College Graduate
Occupation/Source of Income
Dependent./Unemployed
Student
Owns Business
Private employee
Government employee
Others
Desired Family Size (# of Children)
1-3
4-6
7-above
II.

Factors Influencing IUD Use of the Postpartum Mothers

Knowledge
Prescription
1. Have you heard of any contraceptive?
( ) Yes

( ) No

2. Have you ever known on the following contraception?

Pills

( ) Yes

( ) No

Injection

( ) Yes

( ) No

IUD

( ) Yes

( ) No

Condom

( ) Yes

( ) No

Emergency Contraceptive

( ) Yes

( ) No

Female sterilization

( ) Yes

( ) No

40

Male sterilization

( ) Yes

( ) No

Norplant

( ) Yes

( ) No

3. Which period do you need to start IUD?

( ) First 5 days of menstruation
( ) Mid-cycle of menstruation
( ) 5 days before menstruation
( ) Dont Know
4. Do you know the place where you can have IUD?
( ) Yes
( ) No
5. Mention the place where you can have IUD insertion.
_______________________________________________
Side Effects
6. Have you heard of the side effects of IUD?
( ) Yes (identify)________
( ) No
7. What are they?
Vomiting
( ) Yes
( ) No
Headache
( ) Yes
( ) No
Painful Breast
( ) Yes
( ) No
Weight Gain
( ) Yes
( ) No
Scanty Menstruation
( ) Yes
( ) No
Amenorrhea
( ) Yes
( ) No
Others (Specify) _____________________________

Attitude
Strongly Agree
Agree
IUD use can improve the mothers
health.
IUD use is against the human nature.
IUD use has negative effects on

Uncertai
n

Disagre
e

Strongly
Disagree

41

menstrual cycle of women.

Advantages of IUD use outweigh the
side effects.
IUD is comfortable to use.
IUD has fewer side effects than other
methods.
IUD can increase the risk of cancer.
IUD makes the menstruation regular.

Spousal Communication
Agreement of IUD Use
Have you discuss with your spouse about contraception?
( ) Yes

( ) No

Discussion about IUD Use

Do you both agree to use IUD as contraceptive?
( ) Yes

( ) No

Perception of Partner
What is your spouse opinion on IUD use?
( ) Agree

( ) Disagree

Service Factors
Availability
Are IUD and other contraceptives that were mentioned above available in your community
health center?

42

( ) Yes

( ) No

Accessibility
What is the estimated distance between your house and nearest health center having IUD
services? ___________________ km/miles
How can you go to the mentioned place?
( ) Walking
( ) Automobile
( ) Boat/Ship
( ) Others (Specify) ______________
How long does it take to reach that place? ________________ minutes.