{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:02:16Z","timestamp":1793314936113,"version":"4.5.0"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T00:00:00Z","timestamp":1667433600000},"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","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Emory University Research Council Grant"},{"name":"Emory Global Field Experience Program"},{"DOI":"10.13039\/100000002","name":"US National Institutes of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"Introduction<\/jats:title>Rwanda has high unmet need for family planning (FP), especially in the postpartum period when women are advised to space pregnancies at least two years for improved maternal-child health. Despite interest in the copper intrauterine device (IUD), a highly cost-effective method, access and uptake remain low. This study aimed to determine factors associated with postpartum IUD (PPIUD) uptake after postpartum family planning (PPFP) counseling as well as provider perceptions of facilitators and barriers to clients\u2019 PPIUD uptake.<\/jats:p><\/jats:sec>Methods<\/jats:title>Postpartum women who received PPFP counseling and were less than 6 weeks postpartum were recruited for a case-control study in Kigali, Rwanda in 2018. We recruited n = 74 women who had accepted and n = 91 women who had declined the PPIUD. Multivariate logistic regression analyses evaluated associations between women\u2019s socio-demographics, FP knowledge and decision-making, and the outcome of PPIUD uptake. Six focus groups (FGs) were conducted with FP providers (n = 24) and community health workers (n = 17) trained to deliver PPFP counseling to assess perceptions of PPFP counseling and facilitators and barriers to PPIUD uptake. FG discussions were recorded, translated, and analyzed for themes.<\/jats:p><\/jats:sec>Results<\/jats:title>Factors associated (P<\/jats:italic><0.1) with PPIUD uptake included citing its non-hormonal nature, effectiveness, and duration of protection against pregnancy as advantages. Exclusive male partner control over FP decisions (relative to women\u2019s control or joint decision-making) was associated with non-use. Overall, limited knowledge about some aspects of the PPIUD persisted among clients even after counseling. Provider FGs highlighted client concerns, inconsistent FP messaging, and lack of male partner involvement as factors influencing non-use.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Knowledge of the IUD and its benefits was associated with PPIUD uptake. There is need to refine PPFP counseling messages to address remaining knowledge gaps and concerns. Additionally, male partner involvement in FP counseling and decisions with their partners could be a key strategy to increase both PPIUD and FP uptake in Rwanda.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0276193","type":"journal-article","created":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T17:28:56Z","timestamp":1667496536000},"page":"e0276193","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["A mixed-methods study of factors influencing postpartum intrauterine device uptake after family planning counseling among women in Kigali, Rwanda"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9146-1835","authenticated-orcid":true,"given":"Mariama S.","family":"Tounkara","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosine","family":"Ingabire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawn L.","family":"Comeau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Etienne","family":"Karita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Allen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Nyombayire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Parker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa B.","family":"Haddad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Da Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Tichacek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelia","family":"Mazzei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeannine","family":"Mukamuyango","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8547-2004","authenticated-orcid":true,"given":"Kristin M.","family":"Wall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,11,3]]},"reference":[{"issue":"Suppl 1","key":"pone.0276193.ref001","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1111\/j.1728-4457.2013.00557.x","article-title":"Fertility Transition: Is sub-Saharan Africa Different?","volume":"38","author":"J Bongaarts","year":"2013","journal-title":"Popul Dev Rev"},{"key":"pone.0276193.ref002","unstructured":"Guttmacher Institute. Adding It Up: Investing in Contraception and Maternal and Newborn Health, 2017 2017 [cited 2019 March 28]. https:\/\/www.guttmacher.org\/fact-sheet\/adding-it-up-contraception-mnh-2017."},{"key":"pone.0276193.ref003","unstructured":"World Health Organization. Report of a WHO Technical Consultation on Birth Spacing. Geneva, Switzerland: 2005."},{"key":"pone.0276193.ref004","unstructured":"USAID, MCHIP. Family Planning Needs during the First Two Years Postpartum in Rwanda. 2010."},{"key":"pone.0276193.ref005","volume-title":"Unintended Pregnancy and Induced Abortion in Rwanda: Causes and Consequences","author":"P Basinga","year":"2012"},{"key":"pone.0276193.ref006","unstructured":"FHI360. Assessing the Feasibility of Postpartum IUD Provision in Rwanda. 2013."},{"key":"pone.0276193.ref007","unstructured":"FP2020. Rwanda FP2020 Core Indicator Summary Sheet: 2017\u20132018 Annual Progress Report Rwanda: 2017."},{"issue":"2","key":"pone.0276193.ref008","doi-asserted-by":"crossref","first-page":"e32","DOI":"10.1097\/AOG.0000000000001587","article-title":"Committee Opinion No. 670: Immediate Postpartum Long-Acting Reversible Contraception","volume":"128","author":"American College of Obstetricians and Gynecologists [ACOG]","year":"2016","journal-title":"Obstetrics and gynecology"},{"key":"pone.0276193.ref009","doi-asserted-by":"crossref","first-page":"211","DOI":"10.2147\/IJWH.S6914","article-title":"Long-term safety, efficacy, and patient acceptability of the intrauterine Copper T-380A contraceptive device","volume":"2","author":"B Kaneshiro","year":"2010","journal-title":"International Journal of Women\u2019s Health"},{"issue":"4","key":"pone.0276193.ref010","article-title":"Copper containing, framed intra-uterine devices for contraception","author":"R Kulier","year":"2007","journal-title":"The Cochrane database of systematic reviews"},{"key":"pone.0276193.ref011","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1089\/jwh.2008.1160","article-title":"Knowledge, Use, and Concerns about Contraceptive Methods among Sero-Discordant Couples in Rwanda and Zambia","author":"K Grabbe","year":"2009","journal-title":"Journal of Women\u2019s Health"},{"key":"pone.0276193.ref012","article-title":"Cost per insertion and couple year of protection for postpartum intrauterine devices and implants provided during service scale-up in Kigali, Rwanda","author":"KM Wall","year":"2020","journal-title":"Gates Open Research"},{"issue":"38","key":"pone.0276193.ref013","article-title":"Evaluation of a multi-level intervention to improve postpartum intrauterine device services in Rwanda [version 2; referees: 1 approved, 2 approved with reservations]","volume":"2","author":"R Ingabire","year":"2018","journal-title":"Gates Open Research"},{"issue":"6","key":"pone.0276193.ref014","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.CD003036.pub3","article-title":"Immediate postpartum insertion of intrauterine device for contraception","author":"LM Lopez","year":"2015","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"pone.0276193.ref015","unstructured":"FHI360. Research Findings: Integration of Postpartum Family Planning with Child Immunization Services in Rwanda. 2013."},{"issue":"1","key":"pone.0276193.ref016","doi-asserted-by":"crossref","first-page":"73","DOI":"10.9745\/GHSP-D-15-00291","article-title":"Meeting Postpartum Women\u2019s Family Planning Needs Through Integrated Family Planning and Immunization Services: Results of a Cluster-Randomized Controlled Trial in Rwanda","volume":"4","author":"LS Dulli","year":"2016","journal-title":"Global health, science and practice"},{"key":"pone.0276193.ref017","article-title":"Postpartum long-acting contraception uptake and service delivery outcomes after a multilevel intervention in Kigali, Rwanda","author":"J Espey","year":"2020","journal-title":"BMJ Sexual & Reproductive Health"},{"issue":"3","key":"pone.0276193.ref018","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1177\/1558689809334210","article-title":"On Quantitizing","volume":"3","author":"M Sandelowski","year":"2009","journal-title":"J Mix Methods Res"},{"issue":"3","key":"pone.0276193.ref019","doi-asserted-by":"crossref","first-page":"e34338","DOI":"10.1371\/journal.pone.0034338","article-title":"Regression with empirical variable selection: description of a new method and application to ecological datasets","volume":"7","author":"AE Goodenough","year":"2012","journal-title":"PLoS One"},{"key":"pone.0276193.ref020","unstructured":"WHO, USAID, MCHIP. Programming strategies for Postpartum Family Planning. Geneva: 2013."},{"key":"pone.0276193.ref021","unstructured":"MCHIP, PSI. PPIUD Services: Start-Up to Scale-Up Regional Meeting Burkina Faso: February 3\u20135, 2014 Meeting Report. Washington, DC: 2014."},{"issue":"9","key":"pone.0276193.ref022","doi-asserted-by":"crossref","first-page":"e75353","DOI":"10.1371\/journal.pone.0075353","article-title":"Unintended pregnancy among HIV positive couples receiving integrated HIV counseling, testing, and family planning services in Zambia","volume":"8","author":"KM Wall","year":"2013","journal-title":"PloS one"},{"issue":"5","key":"pone.0276193.ref023","doi-asserted-by":"crossref","first-page":"705","DOI":"10.2105\/AJPH.83.5.705","article-title":"Pregnancy and contraception use among urban Rwandan women after HIV testing and counseling","volume":"83","author":"S Allen","year":"1993","journal-title":"American journal of public health"},{"issue":"4","key":"pone.0276193.ref024","first-page":"50","article-title":"Reasons for Intrauterine Device Use, Discontinuation and Non-Use in Malawi: A Qualitative Study of Women and their Partners","volume":"19","author":"AG Bryant","year":"2015","journal-title":"Afr J Reprod Health"},{"issue":"1","key":"pone.0276193.ref025","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s12905-017-0382-2","article-title":"Factors influencing use of long-acting versus short-acting contraceptive methods among reproductive-age women in a resource-limited setting","volume":"17","author":"L Tibaijuka","year":"2017","journal-title":"BMC Women\u2019s Health"},{"key":"pone.0276193.ref026","unstructured":"National Institute of Statistics of Rwanda (NISR), Ministry of Health (MOH), International I. Rwanda Demographic and Health Survey 2014\u201315. Rockville, Maryland, USA: Maryland, USA: NISR, MOH, and ICF International.: NISR, MOH, and ICF International., 2015."},{"key":"pone.0276193.ref027","doi-asserted-by":"crossref","unstructured":"Huber-Krum S, Leigh Senderowicz L, Hackett K, Pearson E, Shah I, Siril H. Women\u2019s Perspectives and Experiences Using Postpartum Intrauterine Device in Tanzania. In: America PAo, editor. 2019.","DOI":"10.1111\/sifp.12106"},{"issue":"1","key":"pone.0276193.ref028","first-page":"32","volume":"11","author":"S Kumar","year":"2014","journal-title":"Women\u2019s experience with postpartum intrauterine contraceptive device use in India"},{"key":"pone.0276193.ref029","doi-asserted-by":"crossref","first-page":"e11","DOI":"10.1016\/j.ijgo.2013.07.005","article-title":"Getting to 70%: Barriers to modern contraceptive use for women in Rwanda","volume":"123","author":"A Brunie","year":"2013","journal-title":"International Journal of Gynecology & Obstetrics"},{"issue":"6","key":"pone.0276193.ref030","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/j.contraception.2017.03.009","article-title":"The promotion of intrauterine contraception in low- and middle-income countries: a narrative review","volume":"95","author":"J Cleland","year":"2017","journal-title":"Contraception"},{"issue":"1","key":"pone.0276193.ref031","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.contraception.2012.10.004","article-title":"Fertility goal-based counseling increases contraceptive implant and IUD use in HIV discordant couples in Rwanda and Zambia","volume":"88","author":"NH Khu","year":"2013","journal-title":"Contraception"},{"issue":"1","key":"pone.0276193.ref032","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1186\/s12913-017-2144-0","article-title":"Understanding low uptake of contraceptives in resource-limited settings: a mixed-methods study in rural Burundi","volume":"17","author":"M Ndayizigiye","year":"2017","journal-title":"BMC Health Serv Res"},{"issue":"2","key":"pone.0276193.ref033","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1080\/07399332.2014.946511","article-title":"Barriers to Intrauterine Device Uptake in a Rural Setting in Ghana","volume":"37","author":"N Robinson","year":"2016","journal-title":"Health Care Women Int"},{"issue":"1","key":"pone.0276193.ref034","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s12905-018-0539-7","article-title":"Determinants of family planning use among married women in bale eco-region, Southeast Ethiopia: a community based study","volume":"18","author":"A Gonie","year":"2018","journal-title":"BMC Womens Health"},{"key":"pone.0276193.ref035","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/1742-4755-10-34","article-title":"Factors influencing the intention of women in rural Ghana to adopt postpartum family planning","volume":"10","author":"S Eliason","year":"2013","journal-title":"Reproductive health"},{"issue":"3","key":"pone.0276193.ref036","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1097\/QAI.0000000000001138","article-title":"Implementation and Operational Research: Evolution of Couples\u2019 Voluntary Counseling and Testing for HIV in Rwanda: From Research to Public Health Practice","volume":"73","author":"E Karita","year":"2016","journal-title":"Journal of acquired immune deficiency syndromes (1999)"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0276193","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T05:51:03Z","timestamp":1728280263000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0276193"}},"subtitle":[],"editor":[{"given":"Kehinde Sharafadeen","family":"Okunade","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,11,3]]},"references-count":36,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11,3]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0276193","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,3]]}}}