intrauterine device use

Knowledge, Attitude and Use among Women Seeking Termination of

Pregnancy in Gauteng, South Africa

INT

Ajibola Awotiwon | Stellenbosch University | September 2013

Contraception IUD http://intimatehealthhelp.net/wp-content/uploads/2012/09/contraception-IUD-300x213.jpeg

250 million pregnancies globally;

33.3% unintended;

20% undergo induced abortion [1]

In South Africa, 75% of pregnancies are unintended [2-

4] ; 1 in 8 pregnancies ends up in abortion.

IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013

http://i.telegraph.co.uk/multimedia/archive/01450/pregnant_1450316c.jpg

Between 1997 and 2008, approx. 731’193 induced

abortions were reported [8]

125,000 unsafe abortions (out of approximately

200,000 total abortions) are performed annually [9, 10–

13]

Lack of access to contraceptives is the most commonly

cited cause


Prevalence of contraceptive use in Africa – 20% (WHO)

[28]

In South Africa, 65% of sexually active women use a

method [16]

In Durban, 75% of those seeking abortion had

previously used some form of contraception


BC http://peacockwings.files.wordpress.com/2011/07/1309400592-16.jpg?w=300&h=248

5% had some knowledge of emergency contraception

[23].

In Cape Town, 21% reported using contraception when

they became pregnant, most commonly the condom

(53%) or pill (35%). [24]


IUD retains a unique capacity as it can be used

both as an emergency contraceptive method

and a long-acting contraceptive method.

within 5 days of unprotected intercourse.

prevent pregnancy for up to ten years.


http://www.surebaby.com/blog/wp-content/v93-15-IUD-300x232.jpg

The knowledge, usage of and attitude towards

intrauterine device method of contraception(IUD)

among women seeking termination of pregnancy (TOP)

in Gauteng, South Africa

The factors that influence the health seeking

behaviour and practices of women seeking TOP with

regards to the IUD contraceptive method


1. To determine the knowledge and use of IUD for preventing unintended pregnancy among women seeking TOP in Gauteng.

2. To determine the level of awareness and uptake of IUD by women seeking TOP in Gauteng.

3. To determine the factors that influence contraceptive choice, use and non-use by the target population.


A cross sectional study of women seeking TOP

With assessment of contraceptive seeking behaviour

through an interviewer-administered structured

questionnaire


02A1499R http://www.redcresearch.ie/wp-content/uploads/2011/01/F2F-interviewer-199x300.jpg

Hillbrow Community Health Centre – a

provincial health facility based in the old

Hillbrow Hospital.

Gauteng has consistently reported the highest

abortion numbers among other provinces over

the years.


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13497

429

3796

21318

1144

11928

0

5000

10000

15000

20000

25000

Gauteng Northern Cape Western Cape

1997

2011


The number of abortions reported in South Africa by

province between 1997 and 2011

Inclusion criteria

*Age 18 years or older

*Able to communicate in English/Afrikaans/IsiZulu

*Who have completed informed consent, will be included.

Exclusion criteria

*Less than 18 years old

*Or who do not give consent to participate in the study

*Mentally unstable women, will be excluded.


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All consecutively registered women will be screened for

enrollment over a period of 4 months using systematic random

sampling. (Feb – May 2014)

Using a sampling frame of 1600 women over a period of 4

months, the sampling interval k will be 3

(k=N/n = 1600/461 = 3).

A random starting point will then be picked between 1 and k

and every 3rd eligible participant presenting at the community

center will be sampled until the required sample size is

reached.


Outcome variables will include:

1. Percentage of women seeking TOP who are aware of IUD contraceptive

method.

2. Percentage of women seeking TOP who use IUD contraceptive method.

Independent variables will include:

1. Knowledge of IUD contraceptive method using the validated

questionnaire

2. Attitude to IUD contraceptive method using the validated questionnaire

3. Socio-demographic and economic characteristics

4. Reasons for use or non-use of IUD contraceptive method which will be

measured using open-ended and multiple response questions.


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*


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Data collection

Data will be collected by the principal investigator (PI).

Validated interviewer-administered structured questionnaire

Validating questionnaire and interviews

Crede S et al: Is 'planning' missing from our family planning services?

Data entry, storage and validation

A data dictionary and a relational database will be developed in EpiData

Data analysis

STATA (version 12)


Research ethics committee of Stellenbosch University

Gauteng Province Department of Health and the management of Hillbrow Community Health Centre.

Written Informed consent

Confidentiality


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Through academic journals and presentation

at relevant conferences.

The funders, Gauteng Province Department

of Health and the Stellenbosch University

Library, Comm. Health Dept.

Secular female health oriented

newspaper/magazine


STUDY TIMELINE /Activity Sep

2013

Oct

2013

Nov

2013

Dec

2013

Jan

2014

Feb

2014

Mar

2014

Apr

2014

May

2014

Jun

2014

Jul

2014

Aug

2014

Sep

2014

Oct

2014

Nov

2014

Protocol development,

Submission of protocol to

ethics for approval and

obtaining funding

x x x

Developing forms and piloting x x

Data collection and entering x x x x

Data cleaning and analysis x x x

Manuscript preparation,

submission of thesis and Data

dissemination

x x x


This will be a cross-sectional study that will rely mainly on

participant recall.

Due to the sensitive nature of the study (abortion), recall

bias is likely to occur.

While the study site is likely to be representative of the

Gauteng province and its findings generalizable to other

provinces

It may not be generalizable to other countries


Direct costs Amount requested

Rand (R)

Personnel Compensation

Research assistantship 6000

Research Travel

Travel to Gauteng 3500

Travel to clinic 4000

Other Direct Costs

Internet and Email 1500

Office supplies 3000

Printing and copying 3000

Staff training 1500

Reimbursement of participants 9220

Publication costs

Publication in electronic/print media 5000

Bursary supplementation 20000

Total Direct costs 56720.00

Total Expenditures 56720.00

Budget motivation

Research assistant: A research assistant (who is fluent in English and Xhosa), most likely a nurse from the study hospital will be trained to obtain consent and interview participants. She will be paid R1500 per month for 4 months.

Research travel includes PI’s airfare (return ticket) to and from Gauteng, South Africa, and fuel cost for traveling to and from study hospital for 4 months.

Office Supplies/Consumables such as stationery, papers, printer cartridges as well as support for communication will be needed.

Printing and copying of data collection forms, manuscript etc.

Reimbursement of participants: 461 participants at R20 per participant.

Publication fees will be required for data dissemination.

Bursary supplementation for the PI to assist with accommodation and cost of living.


http://notanotherzebra.files.wordpress.com/2012/09/sa_bank_note_r500-back_thumb5.jpg?w=490&h=483

www.guttmacher.org

VIDEO | Reducing Unwanted Pregnancieshttp://www.youtube.com/watch?v=YVJu61BKpkI&list=PLh1fAcf0oiNu2GH2J4HV0hi8tmCPL9V9v&feature=player_detailpage

1. WHO and Gutmacher Institute: Facts on induced abortion worldwide. 2007 [http://www.searo.who.int/LinkFiles/Publications_Facts_on_Induced_Abortion_Worldwide.pdf].

2. Morroni C, Tibazarwa K, Myer L (2006) Combined condom and contraceptive use among South African women. S Afr Med J 96: 620-622.

3. Morroni C, Moodley J (2006) The role of urine pregnancy testing in facilitating access to antenatal care and abortion services in South Africa. BMC Pregnancy Childbirth 6: 26.

4. Jewkes R, Abrahams N (2002) The epidemiology of rape and sexual coercion in South Africa: an overview. Soc Sci Med 55:1231-44.

5. Rees H et al., The epidemiology of incomplete abortion in South Africa, South African Medical Journal, 1997, 87(4):432–437. PubMed

6. Kay BJ et al., An analysis of the cost of incomplete abortion to the public health sector in South Africa—1994, South African Medical Journal, 1997, 87(4):442–447. PubMed

7. South African Government, Choice on Termination of Pregnancy, Act No. 92, Nov. 12, 1996, art. 2(b).

8. Department of Health South Africa. Choice of Termination in South Africa (Draft). Statistical Notes Available at http://wwwdohgovza/facts/indexhtml. 2009.

9. Aahman E and Shah I, eds., Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2008, sixth ed., Geneva: World Health Organization, 2011.

10. Epidemiology and Surveillance Directorate, Statistical Notes: Choice on Termination in South Africa, Pretoria, South Africa: National Department of Health, 2009.

11. Blaauw D and Penn-Kekana L, Maternal health, in: Fonn S and Padarath A, eds., South African Health Review, Durban, South Africa: Health Systems Trust, 2010, pp. 3–28.

12. Daulaire N et al., Promises to Keep: The Toll of Unintended Pregnancies on Women’s Lives in the Developing World, Washington, DC: Global Health Council, 2002.

13. Statistics South Africa, Mid-Year Population Estimates, 2010, Pretoria, South Africa: Statistics South Africa, 2010.

14. Mookodi, G., Ntshebe, O. & Taylor, I. (2003). Contraception, Abortion, and Population Planning 93. http://www.kinseyinstitude.org.ccies/bw.php

15. Tamire, W. & Enqueselassie, F. (2007). Knowledge, attitude, and practices on emergency contraceptives among female university students in Addis Ababa, Ethiopia. Ethiopia Journal of Health Development, 21(2), 111–116.

16. Department of Health, Medical Research Council, South Africa: Demographic and Health Survey 2003, Pretoria: Department of Health; 2007.

17. Ross J, Hardee K, Mumford E, Eid S: Contraceptive Method Choice in Developing Countries. Int Fam Plan Perspect 2002, 28(1): 32-40

18. Delvaux T, Nostlinger C: Reproductive choice for women and men living with HIV: contraception, abortion and fertility. Reprod Health Matters 2007, 15(29 suppl):S46-S66

19. Pariani S, Heer DM, Van Arsdol MD: Does Choice Make a Difference to Contraceptive Use? Evidence from East Java. Stud Fam Plann 1991, 22(6):384.

20. Crede et al: Factors impacting knowledge and use of long acting and permanent contraceptive methods by postpartum HIV positive and negative women in Cape Town, South Africa: a cross-sectional study. BMC Public Health 2012 12:197

21. Thonneau P, Almont T: Contraceptive efficacy of intrauterine devices. Am J Obstet Gynecol 2008, 198(3):248.

22. Schunmann C, Glasier A. Measuring pregnancy intention and its relationship with contraceptive use among women undergoing therapeutic abortion. Contraception. 2006; 73:520-4.

23. Adanlawo M, Moodley J. Demograhy and social profile of women requesting termination of pregnancy in King Edward VIII Hospital. The South African Journal of Epidemiology and Infection. 1999; 14(4):99-102.

24. Morroni C, Moodley J. Characteristics of clients seeking first and second trimester terminations of pregnancy in public health facilities in Cape Town. SAMJ. 2006; 96(7):574.

25. Crede S, Harries J, Constant D, Hoke TH, Green M, Moodley J. Is 'planning' missing from our family planning services? SAMJ. 2010;100(9):579-80.

26. Glasier A, Shields WC. Can we improve contraceptive use? Contraception. 2006;73:1-3.

27. Reddy SP, James S, Sewpaul R, Koopman F, Funani NI, Sifunda S, Josie J, Masuka P, Kambaran NS, Omardien RG. Umthente Uhlaba Usamila – The South African Youth Risk Behaviour Survey 2008. Cape Town: South African Medical Research Council, 2010

28. UNFPA 2010. How Universal is Access to Reproductive Health? http://www.unfpa.org/public/home/publications/pid/6526

29. Peter Barron, Dr Yogan Pillay – Contraceptive policy overhauled. http://www.mg.co.za/article/2013-06-13-contraceptive-policy-overhauled


intrauterine device use

Health & Medicine