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BMJ Sexual and Reproductive Health. 2018 Jan; 44(1):66-68.Following publication of the author's trial on the effects of postnatal depot medroxyprogesterone acetate (DMPA) compared with the copper intrauterine device (IUD) on postnatal depression in this journal in July 2016, they have sought to evaluate contraceptive discontinuation in our study sample. Postnatal contraception is promoted as part of the WHO strategy to reduce the unmet need for family planning in low- and middle-income countries (LMICs) and to reduce preventable maternal and child mortality. However, little is known about discontinuation rates associated with postnatal contraception use in these settings. From the trial, 75 of 242 participants were contactable two or more years after randomisation and 54 consented to a follow-up interview, which was conducted by a Masters student from the University of Fort Hare (NDY). Twenty-three women had received DMPA and 31 women an IUD. In the DMPA and IUD arms, respectively, 48% (11/23) and 42% (13/31) had discontinued their contraceptive methods by the time of the interview. All participants who discontinued did so within the first year, 10 within 3 months of allocation (DMPA=4, IUD=6), and 17 within 6 months (DMPA=7, IUD=10). Six of the participants allocated to DMPA (26%) and five allocated to the IUD (16%) became pregnant following discontinuation.
PID risk for IUD users highest in first 20 days after insertion; risk then falls sharply and remains low.
Family Planning Perspectives. 1992 Sep-Oct; 24(5):235-6.Researchers analyzed data on 22,908 women obtained from randomized WHO studies from 23 countries to determine whether the IUD increases the risk of pelvic inflammatory disease (PID). 35% of the women used the TCu220C IUD, 39% other copper releasing IUDs, 16% a hormonal IUD, and 9% the Lippes Loop. The overall PID incidence rate was 0.4% of all IUD insertions or 1.6 cases/1000 woman years. The incidence was greatest during the 1st 20 days after insertion (9.7 cases/1000 women years) and then declined to 1.4/1000 woman years. In fact, the risk of PID was >6 times greater within 20 days after insertion than it was >20 days after insertion. This high risk immediately after insertion was evident in every region where PID existed, at all insertion times, and in all age groups. The higher risk within the 20 days after insertion was attributed to contamination of the uterus during insertion. Women who had an IUD inserted after 1980 experienced PID 50% less often than those who had had it inserted earlier, e.g., the rate ratio for 1977-80 was 1.5 but was 0.5 for 1981-83 and 0.34 for 1984 and after. This may have been due to physicians being more aware of contraindications for IUD use, particularly past infection with sexually transmitted diseases )STDs). The rate ratio was higher in Africa (2.6) than it was in Europe (1) but lower in Asia (0.46) and in the Americas (0.39). None of the subjects in China experienced PID. Older women were at lower risk of PID than 15-24 year olds (0.44 for 25-29 year olds, 0.38 for 30-34 year olds, and 0.35 for =or> 35 year olds). The researchers believed the higher risk life styles of the younger group accounted for this difference. Risk of PID decreased with family size (2.5 for 0 children, 0.56 for 2 children, and 0.39 for at least 4 children). The risk of PID did not differ with IUD type. The researchers concluded that the major determinant of PID is exposure to an STD rather than type of IUD.
[Unpublished] 1979. 6 p.The 2 primary IUDs distributed by IPPF have been the Saf-T-Coil and Lippes Loop. Since 1976 they have also supplied the Copper T. They are currently considering use of the Soonawalla Y and the Nova T, which is similar to the Copper T. The Copper Ts distributed were: in 1976, 37,200; in 1977, 58,200; in 1978, 22,780; and in 1979, 156,9000 to date. Latin American countries have received the largest shipments. Chile received 5000 in 1978, 58,000 in 1979. Colombia received 500 in 1976, 25,000 in 1977, and 60,000 in 1979. Other countries receiving 5000 or more in any 1 year are Pakistan (5000/1976), India (10,000/1977), Egypt (5000/1979), Barbados (5000/1976), Costa Rica (7000/1977), and Ecuador (5000/1977). A complete listing of IUDs supplied to specific countries is attached.
Personal communication. 1979 Mar 23; 12.Tables show total purchases direct from manufacturers, in quantities and dollar values, of IUDs, condoms, injectables, and spermicides, out of UNFPA, WHO, Population Council, IPPF, and UNICEF Funds for individuals years from 1974 to 1978 for 40 countries in Africa, Asia, and Latin America. Th 2 types of IUDs that were mainly purchased were the Lippes Loop and the CuT200, both of which are aggregated into a single figure. Figures are given both for total value of purchases, total amounts purchased, and reimbursable procurement.