{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T04:49:58Z","timestamp":1792039798712,"version":"4.4.0"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2021,9,29]],"date-time":"2021-09-29T00:00:00Z","timestamp":1632873600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-008333"],"award-info":[{"award-number":["INV-008333"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Despite the positive characteristics of the levonorgestrel-releasing intrauterine device (IUD)\u2013a long-acting, highly effective contraceptive with important non-contraceptive attributes\u2013the method has not been widely available in low- and middle-income countries. This study of hormonal IUD, copper IUD, implant and injectable users in Nigeria compares their characteristics, reasons for method choice, and experiences obtaining their method.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted a phone survey with 888 women who received a hormonal IUD, copper IUD, contraceptive implant or injectable from 40 social franchise clinics across 18 states in Nigeria. We analyzed survey data descriptively by method and assessed factors associated with hormonal IUD use through multivariate logistic regression models. Follow-up in-depth interviews conducted with 32 women were analyzed thematically.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>There were few differences by method used in the socio-demographic profiles and contraceptive history of participants. Among users choosing a long-acting, reversible method, the top reasons for method choice included perceptions that the method was \u201cright for my body,\u201d long duration, recommended by provider, recommended by friends\/family, few or manageable side effects, and high effectiveness. Among hormonal IUD users, 17% mentioned reduced bleeding (inclusive of lighter, shorter, or no period), and 16% mentioned treatment of heavy or painful periods. Qualitative data supported these findings. Among survey respondents, between 25% and 33% said they would have chosen no method if the method they received had not been available. Both quantitative and qualitative data indicated that partner support can affect contraceptive use, with in-depth interviews revealing that women typically needed partner permission to use contraception, but men were less influential in method choice.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Expanding access to the hormonal IUD as part of a full method mix provides an opportunity to expand contraceptive choice for women in Nigeria. Findings are timely as the government is poised to introduce the method on a wider scale.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0257769","type":"journal-article","created":{"date-parts":[[2021,9,29]],"date-time":"2021-09-29T18:40:29Z","timestamp":1632940829000},"page":"e0257769","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Factors affecting uptake of the levonorgestrel-releasing intrauterine device: A mixed-method study of social franchise clients in Nigeria"],"prefix":"10.1371","volume":"16","author":[{"given":"Aur\u00e9lie","family":"Brunie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony Adindu","family":"Nwala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayla","family":"Stankevitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Lydon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2681-9834","authenticated-orcid":true,"given":"Kendal","family":"Danna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayode","family":"Afolabi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7015-5073","authenticated-orcid":true,"given":"Kate H.","family":"Rademacher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,9,29]]},"reference":[{"issue":"4","key":"pone.0257769.ref001","doi-asserted-by":"crossref","first-page":"532","DOI":"10.9745\/GHSP-D-15-00178","article-title":"The levonorgestrel intrauterine system: reasons to expand access to the public sector of Africa","volume":"3","author":"D Hubacher","year":"2015","journal-title":"Glob Health Sci Pract"},{"issue":"5","key":"pone.0257769.ref002","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.contraception.2010.05.005","article-title":"Non-contraceptive health benefits of intrauterine hormonal systems","volume":"82","author":"IS Fraser","year":"2010","journal-title":"Contracept"},{"issue":"4","key":"pone.0257769.ref003","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.contraception.2012.09.025","article-title":"Hemoglobin and serum ferritin levels in women using copper-releasing or levonorgestrel-releasing intrauterine devices: a systematic review.","volume":"87","author":"RF Lowe","year":"2013","journal-title":"Contracept"},{"key":"pone.0257769.ref004","author":"World Health Organization","year":"2018","journal-title":"Family planning: a global handbook for providers. 3rd ed. Baltimore and Geneva: CCP and WHO"},{"key":"pone.0257769.ref005","article-title":"Long-acting reversible contraceptive (LARCs) methods","author":"L Bahamondes","year":"2019","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"issue":"4","key":"pone.0257769.ref006","doi-asserted-by":"crossref","first-page":"635","DOI":"10.9745\/GHSP-D-18-00383","article-title":"A global learning agenda for the levonorgestrel intrauterine system (LNG IUS): addressing challenges and opportunities to increase access","volume":"6","author":"KH Rademacher","year":"2018","journal-title":"Glob Health Sci Pract"},{"issue":"4","key":"pone.0257769.ref007","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1363\/43e5217","article-title":"Expanding method choice in Africa with long-acting methods: IUDs, implants or both?.","volume":"43","author":"L Benova","year":"2017","journal-title":"Int Perspect Sex Reprod Health"},{"issue":"4","key":"pone.0257769.ref008","doi-asserted-by":"crossref","first-page":"538","DOI":"10.9745\/GHSP-D-15-00330","article-title":"The levonorgestrel intrauterine system: a pragmatic view of an excellent contraceptive","volume":"3","author":"R Jacobstein","year":"2015","journal-title":"Glob Health Sci Pract"},{"issue":"1","key":"pone.0257769.ref009","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.contraception.2013.03.001","article-title":"Uptake of the levonorgestrel intrauterine system among recent postpartum women in Kenya: factors associated with decision-making","volume":"88","author":"D Hubacher","year":"2013","journal-title":"Contracept"},{"key":"pone.0257769.ref010","doi-asserted-by":"crossref","DOI":"10.31899\/rh13.1004","volume-title":"Acceptability and promotion strategies for LNG-IUS in Ghana: a public health assessment","author":"P Nyarko","year":"2009"},{"issue":"4","key":"pone.0257769.ref011","doi-asserted-by":"crossref","first-page":"680","DOI":"10.9745\/GHSP-D-18-00242","article-title":"Experiences with the levonorgestrel intrauterine system among clients, providers, and key opinion leaders: a mixed-methods study in Nigeria","volume":"6","author":"G Eva","year":"2018","journal-title":"Glob Health Sci Pract"},{"issue":"4","key":"pone.0257769.ref012","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1080\/13625187.2018.1499892","article-title":"Experiences with the levonorgestrel-releasing intrauterine system in Kenya: qualitative interviews with users and their partners","volume":"23","author":"G Nanda","year":"2018","journal-title":"Eur J Contracept Reprod Health Care"},{"key":"pone.0257769.ref013","author":"U.S. Agency for International Development","year":"2020"},{"key":"pone.0257769.ref014","author":"National Population Commission","year":"2019"},{"issue":"2","key":"pone.0257769.ref015","doi-asserted-by":"crossref","first-page":"179","DOI":"10.9745\/GHSP-D-16-00135","article-title":"Leading with LARCs in Nigeria: the stars are aligned to expand effective family planning services decisively","volume":"4","author":"JD Shelton","year":"2016","journal-title":"Glob Health Sci Pract"},{"key":"pone.0257769.ref016","unstructured":"International Contraceptive Access Foundation. 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