Introducing the hormonal Intrauterine Device in Madagascar, Nigeria, and Zambia: results from a pilot study

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 of a broad mix of available methods. Women were interviewed at baseline immediately following their voluntary hormonal IUD insertion, and again 3 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, 3-month, and 12-month follow-up questionnaires. Kaplan-Meier time-to-event models were used to estimate the cumulative probability of 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 (82-90%). 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. Plain language summary The hormonal IUD is a popular contraceptive method choice where it is available. While the method has been around for decades it remains out of reach for many populations in low- and middle-income countries. The hormonal IUD offers both highly effective protection from pregnancy as well as non-contraceptive benefits that appeal to users in the US and Europe, but there is limited evidence available to explore the acceptability and use of this method among users in lower resource settings. This research looks at the profile of users who chose to use the hormonal IUD during a pilot introduction in Madagascar, Nigeria, and Zambia. Over a period of 12 months, researchers followed up with these users to understand who continued to use the method over time and their satisfaction with the method. Findings show that the hormonal IUD was broadly appealing in these settings among users from multiple demographic segments, including among users who had not used other methods of contraception in the past. When followed-up at 3 and 12 months, satisfaction with the method was high and most users in all three countries were still using the method. The findings suggest that the hormonal IUD could be well received and may contribute to greater uptake of voluntary modern contraception in lower resource settings.