Original research article| Volume 88, ISSUE 1, P97-102, July 2013

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Uptake of the levonorgestrel intrauterine system among recent postpartum women in Kenya: factors associated with decision-making



      The levonorgestrel intrauterine system (LNG IUS) may become more available in the public sector of resource-poor countries, but it is unclear what product features might be attractive to users and what factors will influence uptake.

      Study design

      We recruited 671 women in Kenya who were seeking contraception at 6���12 weeks postpartum and gave them an opportunity to try the LNG IUS. We asked why they did or did not choose it, relative to the alternative options. ��2 tests of association were done to examine participant characteristics and decision-making associated with choice.


      Participants chose the following methods: LNG IUS (16%), injectable (36%), subdermal implant (30%), progestin-only pills (15%) and copper intrauterine device (IUD) (3%). Reasons for not choosing the LNG IUS included fear of pain/injury/discomfort (34%), modesty issues regarding insertion (33%) and fear of hormonal/health side effects (31%). Nearly a third of LNG IUS acceptors said they would have chosen a short-acting method if the LNG IUS were not available, and only 21% would have chosen the copper IUD.


      The LNG IUS could be an ideal method for increasing uptake of long-acting methods among recent postpartum women. Product attributes and comparisons to other contraceptive options are important factors in decision-making. Even among women comfortable with intrauterine contraception, great distinctions and preferences are apparent. Addressing specific misconceptions and fears with better information can help women make the best personal choices.


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        • Conde-Agudelo A.
        • Belizan J.M.
        Maternal morbidity and mortality associated with interpregnancy interval: cross sectional study.
        BMJ. 2000; 321: 1255-1259
        • Cleland J.
        • Conde-Agudelo A.
        • Peterson H.
        • Ross J.
        • Tsui A.
        Contraception and health.
        Lancet. 2012; 380: 149-156
      1. The Millennium Development Goals report. New York: United Nations; 2010.
        ([cited 2011 March 3, 2011]; Available from:)
        • WHO
        Family planning handbook: a global handbook for providers. Baltimore and Geneva: Department of Reproductive Health and Research Johns Hopkins Bloomberg School of Public Health Center for Communication Programs INFO Project; 2011.
        ([cited 2012 January 30]; Available from:)
      2. World Health Organization medical eligibility criteria for contraceptive use. 3rd ed. WHO, Geneva2004 ([cited 2010]; Available from:)
      3. World contraceptive use 2011. United Nations.
        ([8 November 2012]; Available from:)
      4. International Contraceptive Access (ICA) Foundation home page. International Contraceptive Access (ICA) Foundation.
        (Available from:)
        • Kaunitz A.M.
        • Bissonnette F.
        • Monteiro I.
        • Lukkari-Lax E.
        • Desanctis Y.
        • Jensen J.
        Levonorgestrel-releasing intrauterine system for heavy menstrual bleeding improves hemoglobin and ferritin levels.
        Contraception. 2012; 86: 452-457
      5. Medicines360. Available from:

      6. A study of a levonorgestrel-releasing intrauterine system for long-term, reversible contraception.
        (Available from:)
      7. Hormonal IUD. Uteron Pharma; Available from:

        • Allen R.H.
        • Bartz D.
        • Grimes D.A.
        • Hubacher D.
        • O'Brien P.
        Interventions for pain with intrauterine device insertion.
        Cochrane Database Syst Rev. 2009; ([Review]): CD007373
        • Hubacher D.
        • Lopez L.
        • Steiner M.J.
        • Dorflinger L.
        Menstrual pattern changes from levonorgestrel subdermal implants and DMPA: systematic review and evidence-based comparisons.
        Contraception. 2009; 80: 113-118
        • Sivin I.
        • el Mahgoub S.
        • McCarthy T.
        • Mishell Jr., D.R.
        • Shoupe D.
        • Alvarez F.
        • et al.
        Long-term contraception with the levonorgestrel 20 mcg/day (LNg 20) and the copper T 380Ag intrauterine devices: a five-year randomized study.
        Contraception. 1990; 42: 361-378
        • Andersson K.
        • Odlind V.
        • Rybo G.
        Levonorgestrel-releasing and copper-releasing (Nova T) IUDs during five years of use: a randomized comparative trial.
        Contraception. 1994; 49: 56-72