{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T08:39:42Z","timestamp":1769071182560,"version":"3.49.0"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,3,18]],"date-time":"2020-03-18T00:00:00Z","timestamp":1584489600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,3,18]],"date-time":"2020-03-18T00:00:00Z","timestamp":1584489600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Reprod Health"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Postpartum intrauterine device (PPIUD) use remains very low in Nepal despite high levels of unmet need for postpartum family planning and the national government\u2019s efforts to promote its use. This study investigates reasons for continuing or discontinuing PPIUD use among Nepali women.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted in-depth interviews (IDIs) with 13 women who had discontinued PPIUD use and 12 women who were continuing to use the method 9\u2009months or longer following the insertion. All interviews were audio recorded, transcribed, translated into English, and analyzed using a thematic approach.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Women discontinued PPIUD for several reasons: 1) side effects such as excessive bleeding during menstruation, nausea, back and abdominal pain; 2) poor quality of counselling and, relatedly, mismatched expectations in terms of device use; and 3) lack of family support from husbands and in-laws. In contrast, women who were continuing to use the method at the time of the study stated that they had not experienced side-effects, had received appropriate information during counselling sessions, and had the backing of their family members in terms of using PPIUD.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Experiencing side-effects or complications following PPIUD insertion and poor quality of family planning counselling were the two main reasons for discontinuation. Family members appeared to play a major role in influencing a woman\u2019s decision to continue or discontinue PPIUD suggesting that counseling may need to be expanded to them as well. Improving quality of counselling by providing complete and balanced information of family planning methods as well as ensuring sufficient time for counselling and extending PPIUD service availability at lower level clinics\/health posts will potentially increase the uptake and continued use of postpartum family planning, including PPIUD, in Nepal.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12978-020-0892-5","type":"journal-article","created":{"date-parts":[[2020,3,18]],"date-time":"2020-03-18T03:03:16Z","timestamp":1584500596000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Exploring reasons for discontinuing use of immediate post-partum intrauterine device in Nepal: a qualitative study"],"prefix":"10.1186","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2913-1480","authenticated-orcid":false,"given":"Mahesh C.","family":"Puri","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saugat","family":"Joshi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aayush","family":"Khadka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin","family":"Pearson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasaswi","family":"Dhungel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iqbal H.","family":"Shah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,3,18]]},"reference":[{"issue":"4","key":"892_CR1","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1016\/j.contraception.2009.03.024","volume":"80","author":"N Kapp","year":"2009","unstructured":"Kapp N, Curtis KM. Intrauterine device insertion during the postpartum period: a systematic review. Contraception. 2009;80(4):327\u201336.","journal-title":"Contraception"},{"key":"892_CR2","volume-title":"Programming strategies for postpartum family planning","author":"World Health Organization","year":"2013","unstructured":"World Health Organization. Programming strategies for postpartum family planning. Geneva, Switzerland: World Health Organization; 2013. Available from: http:\/\/apps.who.int\/iris\/handle\/10665\/93680."},{"issue":"3","key":"892_CR3","doi-asserted-by":"publisher","first-page":"309","DOI":"10.4103\/2224-3151.207027","volume":"1","author":"S Thapa","year":"2012","unstructured":"Thapa S. Early discontinuation of intrauterine device in Nepal\u2013a retrospective study. WHO South-East Asia J Public Health. 2012;1(3):309.","journal-title":"WHO South-East Asia J Public Health"},{"key":"892_CR4","volume-title":"Nepal Demographic and Health Survey 2016","author":"Ministry of Health and Population (MOHP) [Nepal], New ERA, and Macro International Inc","year":"2016","unstructured":"Ministry of Health and Population (MOHP) [Nepal], New ERA, and Macro International Inc. Nepal Demographic and Health Survey 2016. Kathmandu, Nepal: Ministry of Health and Population, New ERA, and Macro International Inc; 2016."},{"key":"892_CR5","volume-title":"The status of family planning and RH in Nepal","author":"A Tamang","year":"2010","unstructured":"Tamang A, Subedi G, Packer C. The status of family planning and RH in Nepal. Kathmandu, Nepal: Center for Research on Environment Health and Population Activities; 2010."},{"issue":"1","key":"892_CR6","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1093\/humupd\/dmq026","volume":"17","author":"PD Blumenthal","year":"2011","unstructured":"Blumenthal PD, Voedisch A, Gemzell-Danielsson K. Strategies to prevent unintended pregnancy: increasing use of long-acting reversible contraception. Hum Reprod Update. 2011;17(1):121\u201337. https:\/\/doi.org\/10.1093\/humupd\/dmq026.","journal-title":"Hum Reprod Update"},{"key":"892_CR7","unstructured":"JSI Research & Training Institute. Expanding IUCD & Norplant services: Nepal family health program technical brief #7. Boston: JSI Research & Training Institute; n.d."},{"key":"892_CR8","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1186\/s12978-019-0738-1","volume":"16","author":"E Pradhan","year":"2019","unstructured":"Pradhan E, Canning D, Shah IH, Puri M, Pearson E, Thapa K, Bajracharya MM, Maharjan DC, Bajracharya L, Shakya G, Chaudhary P. Integrating postpartum contraceptive counseling and IUD insertion services into maternity care in Nepal: results from stepped-wedge randomized controlled trial. Reprod Health. 2019;16:69. https:\/\/doi.org\/10.1186\/s12978-019-0738-1.","journal-title":"Reprod Health"},{"issue":"3","key":"892_CR9","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/j.contraception.2018.04.019","volume":"98","author":"PD Blumenthal","year":"2018","unstructured":"Blumenthal PD, Lerma K, Bhamrah R, Singh S. Comparative safety and efficacy of a dedicated postpartum IUD inserter versus forceps for immediate postpartum IUD insertion: a randomized trial. Contraception. 2018;98(3):215\u20139.","journal-title":"Contraception"},{"issue":"4","key":"892_CR10","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1016\/j.contraception.2018.12.003","volume":"99","author":"S Kumar","year":"2019","unstructured":"Kumar S, Srivastava A, Sharma S, Yadav V, Mittal A, Kim YM, Nash-Mercado A, Reijneveld SA, Sood B. One-year continuation of postpartum intrauterine contraceptive device: findings from a retrospective cohort study in India. Contraception. 2019;99(4):212\u20136.","journal-title":"Contraception"},{"key":"892_CR11","first-page":"1","volume":"20","author":"M Khalifa","year":"2019","unstructured":"Khalifa M, Abdelaziz W, Metwally S, Sakr E. The recent increase in contraceptive discontinuation in Egypt. J Biosoc Sci. 2019;20:1\u20134.","journal-title":"J Biosoc Sci"},{"key":"892_CR12","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/s12913-015-0701-y","volume":"15","author":"NM Chakraborty","year":"2015","unstructured":"Chakraborty NM, Murphy C, Paudel M, Sharma S. Knowledge and perceptions of the intrauterine device among family planning providers in Nepal: a cross-sectional analysis by cadre and sector. BMC Health Serv Res. 2015;15:39.","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"892_CR13","doi-asserted-by":"publisher","first-page":"26","DOI":"10.2307\/3088272","volume":"28","author":"KR Katz","year":"2002","unstructured":"Katz KR, Johnson LM, Janowitz B, Carranza JM. Reasons for the low level of IUD use in El Salvador. 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J Dental Med Sci. 2018;17(4):18\u201320.","journal-title":"J Dental Med Sci"},{"issue":"6","key":"892_CR16","doi-asserted-by":"publisher","first-page":"2299","DOI":"10.18203\/2320-1770.ijrcog20182339","volume":"7","author":"R Chethan","year":"2018","unstructured":"Chethan R, Anitha GS, Savitha C. Study on post-partum intrauterine contraceptive device practices and causes for discontinuation of PPIUCD at follow up in a tertiary hospital. Int J Reprod Contracept Obstet Gynecol. 2018;7(6):2299\u2013303.","journal-title":"Int J Reprod Contracept Obstet Gynecol"}],"container-title":["Reproductive Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12978-020-0892-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12978-020-0892-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12978-020-0892-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,18]],"date-time":"2021-03-18T00:27:15Z","timestamp":1616027235000},"score":1,"resource":{"primary":{"URL":"https:\/\/reproductive-health-journal.biomedcentral.com\/articles\/10.1186\/s12978-020-0892-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,18]]},"references-count":16,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["892"],"URL":"https:\/\/doi.org\/10.1186\/s12978-020-0892-5","relation":{},"ISSN":["1742-4755"],"issn-type":[{"value":"1742-4755","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,18]]},"assertion":[{"value":"9 August 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 March 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 March 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study was approved by the Ethical Review Board of the Nepal Health research Council, Nepal (#51\/2015). The Harvard T. H Chan School of Public Health Office of Human Research Administration granted exempt status to the study as Harvard only received de-identified data. All women were first informed of the purpose of the study and what their participation may entail before seeking their consent. Only women who consented to participate were interviewed and included in this study.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"41"}}