Introducing the Hormonal Intrauterine Device in Madagascar, Nigeria, and Zambia: Results From a Pilot Study
Abstract Background: The hormonal Intrauterine Device (IUD) is a highly effective contraceptive option growing in popularity and availability in many countries. The hormonal IUD has been shown to have high rates of satisfaction and continuation among users in high-income countries. The study aims to understand the profiles of clients who choose the hormonal IUD in low-and middle-income countries (LMICs) and describe their continuation and satisfaction with the method after 12 months of use. Methods: A prospective longitudinal study of hormonal IUD acceptors was conducted across three countries—Madagascar, Nigeria, and Zambia—where the hormonal IUD had been introduced in a pilot setting within the context of a broad mix of available methods. Women were interviewed at baseline immediately following their voluntary hormonal IUD insertion, and again three and 12 months following provision of the method. A descriptive analysis of user characteristics and satisfaction with the method was conducted on an analytic sample of women who completed baseline, three-month, and 12-month follow-up questionnaires. Kaplan-Meier cumulative hazard models were used to estimate method continuation rates up to 12 months post-insertion.Results: Each country had a unique demographic profile of hormonal IUD users with different method use histories. Across all three countries, women reported high rates of satisfaction with the hormonal IUD (67-100%) and high rates of continuation at the 12-month mark (91-93%).Conclusions: Rates of satisfaction and continuation among hormonal IUD users in the study suggest that expanding method choice with the hormonal IUD would provide a highly effective, long-acting method desirable to many different population segments, including those with high unmet need.