Table 2

Postpartum intrauterine device use utilisation and continued use at 3, 6, and 12 months post-insertion

First author, publication year	Study design	Data source standard	Country	Years of data collection	Sample size	IUD type	Delivery type	Utilisation (%)	IUD in at 3 months	IUD in at 6 months	IUD in at 12 months
Higher-Income
Kestler, 201185	Prospective observational	Multicentre (n=34)	Guatemala	2006–2008	63 188	Copper	Caesarean	0	NR	NR	NR
Kestler, 201185	Prospective observational	Multicentre (n=34)	Guatemala	2006–2008	155 468	Copper	Vaginal	0.16	NR	NR	NR
Moniz, 201971	Retrospective	Claims database	USA	2013–2016	396 073	NR	NR	0.06	NR	NR	NR
Whiteman, 201228	Retrospective	Claims database	USA	2001–2008	920	Both	Both	2001–2001: 0.10 per 10 000 deliveries. 2007–2008: 0.55 per 10 000 deliveries P for trend: <0.01	NR	NR	NR
Ritter, 202172	Retrospective	The Kids’ Inpatient Database, HCUP	USA	2016	87 193	NR	NR	1.3% (4.3% had IUD or implant)	NR	NR	NR
Sinkey, 202173	Retrospective	Single centre	USA	2015–2019	159	NR	NR	Pre-LARC programme: 1.6%; post-LARC programme: 10.4%	NR	NR	NR
Cooper, 202031	Non-randomised intervention	Multicentre (n=2)	UK (Scotland)	2017–2019	379	Both	Vaginal	4.7	88%	84%	80%
Wu, 202078	Retrospective	Single centre	USA	2015–2016	9561	Both	Both	6.2	NR	NR	NR
Cole, 201942	Retrospective	Single centre	USA	2016–2017	116 IUDs (out of 1506 deliveries)	Hormonal	Both	7.7	NR	77%	NR
Wallace Huff, 202176	Prospective observational	Single centre	USA	2015	199	NR	NR	12	91.6	87.5	NR
Heller, 201730	Non-randomised intervention	Multicentre (n=2)	UK (Scotland)	2015–2016	877	Both	Caesarean	Consented: 13.7 Inserted: 12.9	At 6 weeks: 111/120 (99%)	99%	72%
Trigueiro, 202190	Retrospective	Single centre	Brazil	2016–2017	828	Copper	NR	27.9 (of women who received IUDs)	NR	NR	NR
Smith, 202127	Cross-sectional	Multicentre (n=NR)	USA	2015–2017	5648	NR	NR	700/5,648=12.4 (note: includes IUDs and implants)	NR	NR	NR
da Silva, 202080	Cross-sectional	Single centre	Brazil	2018	184	NR	Both	46	NR	NR	NR
da Silva Nobrega, 202181	Non-randomised intervention	Single centre	Brazil	2017–2018	997	Copper	Both	70.7	Of 574 at 45–90 days visit: 84.8%	Of 371 at 6–9 months visit: 99.4%	NR
Colwill, 201839	Retrospective	Single centre	USA	2014–2015	210	Copper	Both	NR	At 6 weeks: 89%	NR	NR
Gurney, 201847	Prospective observational	Single centre	USA	2015–2017	200	Copper	Vaginal	NR	75% (112/149 patients who completed visit had IUDs in place and correctly positioned at 6 weeks)	56% (90/162 patients who completed visit had IUD in place and correctly positioned)
Goldthwaite, 201767	Prospective observational	Multicentre (n=2)	USA	2014–2015	55	Copper	Vaginal	NR	93%	NR	NR
Goldthwaite, 201767	Prospective observational	Multicentre (n=2)	USA	2014–2015	68	Hormonal	Vaginal	NR	80%	NR	NR
Levi, 201270	Prospective observational	Multicentre (n=2)	USA	2008–2009	90	Copper	Caesarean	NR	NR (6 weeks: 100%)	100%	NR
Dahlke, 201164	RCT	Single centre	USA	2009–2013	15	Hormonal	Vaginal	N/A	87%	87%	NR
Dahlke, 201164	RCT	Single centre	USA	2009–2013	15	Hormonal	Vaginal	N/A	93%	93%	NR
Gunardi, 202183	Prospective observational	Single centre	Indonesia	2018–2019	94	Copper	Both	NR	93.1	98.6	NR
Levi, 201537	RCT	Single centre	USA	2012–2014	112	Both	Caesarean	N/A	NR	83%	NR
Hinz, 201949	Prospective observational	Single centre	USA	2016–2018	114	Both	Both	NR	NR	94%	NR
Cohen, 201656	Prospective observational	Single centre	USA	2010–2011	82	Both	Both	NR	NR	71% (49/69 patients with 6 month follow-up)	76% (51/67 patients with 12 month follow-up)
Eggebroten, 201765	Prospective observational	Single centre	USA	2013–2016	88	Copper	Both	NR	NR	83%	NR
Eggebroten, 201765	Prospective observational	Single centre	USA	2013–2016	123	Hormonal	Both	NR	NR	81%	NR
Woo, 201577	Prospective observational	Single centre	USA	2011–2012	133	NR	NR	NR	NR	91%	81%
Gonzalez, 202068	Prospective observational	Multicentre (n=2)	USA	2013–2017	93	Both	Caesarean	NR	NR	NR	76%
Chen, 201063	RCT	Single centre	USA	2007–2008	51	Hormonal	Vaginal	N/A	NR	74%	NR
Soon, 201874	RCT	Single centre	USA	2013–2015	6	Hormonal	Vaginal	N/A	NR	67%	NR
Whitaker, 201455	RCT	Single centre	USA	2007–2011	42	Hormonal	Caesarean	N/A	NR	70%	60%
Stuart, 201538	RCT	Single centre	USA	2012–2013	17	Hormonal	Vaginal	N/A	NR	NR	29% (within 8 months)
Zaconeta, 201992	Prospective observational	Single centre	Brazil	2012–2013	100	Copper	Caesarean	NR	At 6 weeks: 91%	84%	NR
Çelen, 201158	Non-randomised intervention	Single centre	Turkey	2006–2008	245	Copper	Caesarean	NR	NR (6 weeks: 93%)	82%	62%
Sucak, 201589	Non-randomised intervention	Single centre	Turkey	2009–2012	51	Copper	Caesarean (planned)	NR	NR	NR	87%
Sucak, 201589	Non-randomised intervention	Single centre	Turkey	2009–2012	62	Copper	Vaginal	NR	NR	NR	77%
Sucak, 201589	Non-randomised intervention	Single centre	Turkey	2009–2012	47	Copper	Caesarean (emergent)	NR	NR	NR	84%
Unal 201891	RCT	Single centre	Turkey	2016–2017	70	Copper (IUD inserter)	Caesarean	N/A	NR	At median 96 days: 88%	NR
Unal 201891	RCT	Single centre	Turkey	2016–2017	70	Copper (sponge-holding forceps)	Caesarean	N/A	NR	At median 96 days: 79%	NR
Laporte, 202086	RCT	Single centre	Brazil	2018–2019	70	Copper	Both	N/A	Vaginal delivery: 44% Caesarean delivery: 65%	NR	NR
Laporte, 202086	RCT	Single centre	Brazil	2018–2019	70	Hormonal	Both	N/A	Vaginal delivery: 60% Caesarean delivery: 89%	NR	NR
Braniff, 201561	RCT	Single centre	Australia	2011–2012	25	Hormonal	Caesarean	N/A	NR	96%	NR
Lower income
Makins 201833	Non-randomised intervention	Multicentre (n=6)	Nepal	2016–2017	119 844	Copper	Both	2.1	6 weeks: 93%	NR	NR
Puri, 2020166	RCT (same data source as Huber-Krum, 2020)	Multicentre (n=6)	Nepal	Sep 2015–Mar 2017	75 571	Copper	Both	2	81.5	NR	68.8
Huber-Krum, 2020123	RCT (same data source as Puri, 2020)	Multicentre (n=6)	Nepal	2016–2018	69 210	NR	Both	2.2	NR	NR	NR
Makins 201833	Non-randomised intervention	Multicentre (n=NR)	Sri Lanka	2015–2017	291 861	Copper	Both	2.7	6 weeks: 96%	NR	NR
Makins 201833	Non-randomised intervention	Multicentre (n=6)	Tanzania	2015–2017	81 456	Copper	Both	3.2	6 weeks: 92%	NR	NR
Dasanayake, 2020167	Retrospective	Single centre	Sri Lanka	2014–2019	14 051	NR	Both	3.4	NR	NR	80%
Weerasekera 2018152	Non-randomised intervention	Multicentre (n=18)	Sri Lanka	2014–2017	184 433	NR	Both	3.7%	NR (4–6 weeks: 93%)	NR	NR
Pfitzer, 2015137	Cross-sectional	Multicentre (n=NR)	Ethiopia	2012–2013	16 389	Copper	Both	3.8	NR	NR	NR
Dewan, 201936	Retrospective	Single centre	India	2010–2017	208 210	NR	Both	2010: 4.7 2011: 5.03 2012: 6.7 2013: 7.6 2014: 13.4 2015: 17.2 2016: 17.7 2017: 21.4	NR	NR	NR
Melkie, 2021162	Cross-sectional	Multicentre (n=4)	Ethiopia	2019	423	NR	Both	4.0	NR	NR	NR
Agrawal, 202195	Non-randomised intervention	Single centre	India	2019–2020	NR	NR	NR	4.5–35% over a year and a half time of a PPIUD quality improvement initiative to increase the PPIUD coverage	NR	NR	NR
Wayessa, 2020165	Non-randomised intervention	Multicentre (n=NR)	Ethiopia	2017	No PPIUD counselling: 471 PPIUD counselling: 237	NR	NR	No PPIUD counselling: 4.8 PPIUD counselling: 12.4	NR	NR	NR
Karra, 2017127	Cross-sectional	Multicentre (n=NR)	Sri Lanka	2015–2015	13 731	NR	NR	4.9	NR	NR	NR
Makins 201833	Non-randomised intervention	Multicentre (n=48)	Sri Lanka, India, Nepal, Bangladesh, Tanzania, Kenya	2014–2017	725 647	Copper	Both	Consent: 5.1 Inserted: 5.0	6 weeks: 96%	NR	NR
Thapa, 2020149	Cross-sectional	Multicentre (n=7)	Nepal	2018–2019	29 072	NR	NR	5.4	NR	NR	NR
Rwegoshora, 2020142	Non-randomised intervention	Multicentre (n=6)	Tanzania	Dec 2017–Apr 2018	20 276	Copper	Both	5.5	NR	NR	86 (note: only 46% of sample available at 1 year)
Muganyizi 2018134	Prospective observational	Multicentre (n=6)	Tanzania	2016–2017	40 470	Copper	Vaginal	5.8%	NR (6 weeks: 94%)	NR	NR
Fatima 2018113	Non-randomised intervention	Multicentre (n=6)	Bangladesh	2017	16 359	Copper	NR	Inserted: 6.5 Consent: 9.5	NR (4–6 weeks: 98.2%)	NR	NR
Pleah 201635	Cross-sectional	Multicentre (n=5)	Benin, Ivory Coast, Niger, Senegal, Togo	2014–2015	15 394	NR	Both	2014: 8.6 2015: 22.7	NR	NR	NR
Nigam 2018135	Non-randomised intervention	Single centre	India	2013	550	Copper	Both	9.1	NR	NR	NR
Pradhan, 201925	RCT	Multicentre (n=6)	Nepal	2015–2017	15 607	NR	Both	10.8	NR	NR	NR
Pfitzer, 2015137	Cross-sectional	Multicentre (n=NR)	Guinea	2011–2013	20 699	Copper	Both	11.8	NR	NR	NR
Butt, 2020102	Prospective observational	Single centre	Pakistan	2016–2018	324	Copper	Both	15.4	NR	NR	88.8
Qazi, 2020140	Prospective observational	Single centre	Pakistan	2018–2019	6283	Copper	Both	15.9	NR	NR	NR
Omona, 2020164	Retrospective	Single centre	Uganda	2018	202	Copper	Both	16.3	NR	NR	NR
Mishra, 2014133	Non-randomised intervention	Single centre	India	2012–2013	564	Copper	Both	17.6	NR	81	NR
Halder, 2016120	Non-randomised intervention	Single centre	India	2012–2013	100	Copper	Caesarean	17.9	NR (6 weeks: 99%)	97%	96%
Yadav, 2020154	Retrospective	Single centre	India	2013–2019	20 418	Copper	Both	18.4	NR	NR	NR
Halder, 2016120	Non-randomised intervention	Single centre	India	2012–2013	10	Copper	Vaginal	Inserted: 18.2 Consent: 32.7	NR	NR	NR
Halder, 2016120	Non-randomised intervention	Single centre	India	2012–2013	90	Copper	Vaginal	19.2	NR (6 weeks: 97%)	94%	92%
Jairaj, 201654	Non-randomised intervention	Single centre	India	2015–2015	370	NR	Both	19.7	NR (at 6 weeks: 43.5%)	NR	NR
Nisar, 2020136	Retrospective	Single centre	Pakistan	2014–2016	8003	NR	Both	25.1	NR	NR	NR
Divakar, 2019106	Non-randomised intervention	Multicentre (n=6)	India	2015–2017	66 508	Copper	Both	25.5	NR	NR	NR
Geda, 2021158	Cross-sectional	Multicentre (n=13)	Ethiopia	2019	286	NR	Both	26.6	NR	NR	NR
Espey, 2021157	Non-randomised intervention	Multicentre (n=6)	Rwanda	2017–2018	12 068	Copper	Both	27.9	NR	NR	NR
Kanakuze, 2020160	Cross-sectional	Single centre	Rwanda	2019–2019	383	Copper	Both	28.1	NR	NR	NR
Ingabire, 2018159	Non-randomised intervention	Multicentre (n=2)	Rwanda	2017–2018	9020	Copper	Both	28.5	NR	NR	NR
Ghafoor, 2020114	Cross-sectional	Single centre	Pakistan	2019–2019	108	NR	NR	32.5	NR	NR	NR
Fatema, 2018112	Non-randomised intervention	Single centre	Bangladesh	2013–2013	370	NR	Both	35.7	NR	NR	NR
Bhadra 201899	Prospective observational	Single centre	India	2015–2017	19 170	NR	Both	37.4	NR (at 6 weeks: 93.7%)	NR	NR
Wasim, 2018151	Non-randomised intervention	Single centre	Pakistan	2015–2017	8000	Copper	Both	37.6	NR	NR	NR
Kant, 2016126	Retrospective	Multicentre (n=2)	India	2014–2014	611	Copper	Vaginal	38.9	NR	NR	NR
Eluwa 2016111	Cross-sectional	Multicentre (n=11)	Nigeria	2014–2015	728	Copper	NR	41	NR	NR	NR
Ndegwa, 201434	RCT	Single centre	Kenya	NR	127	NR	NR	45.7	NR (6 weeks: 98.3%)	NR	NR
Vishwakarma, 2020150	Non-randomised intervention	Single centre	India	2016–2019	1029	Copper	Caesarean	NR	NR (6 weeks: 98.3%)	88.7	NR
Lerma, 202033	Cross-sectional	Multicentre (n=5)	India	2015–2016	93	Copper	Vaginal	NR	NR (6–8 weeks: 83%)	NR	NR
Lerma, 202033	Cross-sectional	Multicentre (n=5)	India	2015–2016	467	Copper	Vaginal	NR	NR (6–8 weeks: 77%)	NR	NR
Ngonzi, 2021163	Prospective observational	Single centre	Uganda	2014–2015	167	Copper	Vaginal	NR	NR (6–8 weeks: 91%)	NR	NR
Khurshid, 2020129	Prospective observational	Single centre	India	2015–2016	238	Copper	Vaginal	NR	NR (at 6 weeks: 96%)	97%	94%
Jakhar, 2019125	Prospective observational	Single centre	India	2013–2014	200	Copper	Caesarean	NR	NR (at 6 weeks: ‘wanted to continue’: 89%)	‘Wanted to continue’: 82%	NR
Blumenthal, 2018100	RCT	Multicentre (n=5)	India	2015–2016	239	Copper (Kelly’s forceps)	Vaginal	N/A	NR (6–8 weeks: 84%)	NR	NR
Blumenthal, 2018100	RCT	Multicentre (n=5)	India	2015–2016	241	Copper (IUD inserter)	Vaginal	N/A	NR (6–8 weeks: 72%)	NR	NR
Mishra, 201748	Retrospective	Single centre	India	2010–2012	736	Copper	Both	NR	NR (at 4 weeks: 94%)	NR	79%
Chakheni, 2017103	Non-randomised intervention	Single centre	India	2013–2014	50	Copper (manual insertion)	Caesarean	NR	94%	NR	NR
Chakheni, 2017103	Non-randomised intervention	Single centre	India	2013–2014	50	Copper (Kelly’s forceps)	Caesarean	NR	92%	NR	NR
Singh, 2016146	Non-randomised intervention	Multicentre (n=2)	India	2015–2015	80	NR	Vaginal	NR	NR (6–8 weeks: 76.3%)	NR	NR
Dias, 2016105	Prospective observational	Single centre	Sri Lanka	2012–2013	60	Copper	Vaginal	NR	NR (at 6 weeks: 75%)	NR	NR
Dias, 2016105	Prospective observational	Single centre	Sri Lanka	2012–2013	31	Copper	Caesarean	NR	NR (at 6 weeks: 74%)	NR	NR
Singal, 2014144	Prospective observational	Single centre	India	2012–2012	300	Copper	Caesarean	NR	98%	96%	91%
Khan, 202050	RCT	Single centre	Pakistan	2019–2020	152	Copper	Both	NR	NR	97	NR
Bryant, 2013156	RCT	Single centre	Malawi	2010–2011	12	Copper	Vaginal	N/A	83%	NR	NR
Shukla, 2012143	Prospective observational	Single centre	India	1995–2000	1317	Copper	Both	NR	NR (4–6 weeks: 80%	NR	NR
Bhutta, 201145	Cross-sectional	Single centre	Pakistan	2006–2007	50	Copper	Caesarean	NR	92% (willingness to continue)	82% (willingness to continue)	NR
El Beltagy, 2011107	RCT	Single centre	Egypt	NR	150	Copper	Vaginal	N/A	At 6 weeks: 97%	At 6 months: 94%	NR
El Beltagy, 2011107	RCT	Single centre	Egypt	NR	150	Hormonal	Vaginal	N/A	At 6 weeks: 98%	At 6 months: 94%	NR
Elsedeek, 2015110	Non-randomised intervention	Single centre	Egypt	2006–2011	80	Hormonal	Caesarean	NR	NR (at 6 weeks, centrally placed: 54%)	NR	NR
Elsedeek, 2015110	Non-randomised intervention	Single centre	Egypt	2006–2011	63	Copper	Caesarean	NR	NR (at 6 weeks, centrally placed: 65%)	NR	NR
Singal, 2021145	Cross-sectional	Multicentre (n=20)	India	2019	4012	NR	NR	NR	78.5	74.5	70.7
Zaman, 2020155	Non-randomised intervention	Single centre	Pakistan	2015	140	Copper	NR	NR	NR	84	NR
Elshamy, 2021108	Non-randomised intervention	Single centre	Egypt	2018–2019	1100	Both	Vaginal	NR	NR	88	NR
Rani, 2015141	Non-randomised intervention	Single centre	India	NR	99	Copper	Both	NR	NR	92.9	NR
Elsedeek, 2012109	Non-randomised intervention	Multicentre (n=3)	Egypt	2007–2009	65	Hormonal	Caesarean	NR	NR	NR	97%
Elsedeek, 2012109	Non-randomised intervention	Multicentre (n=3)	Egypt	2007–2009	75	Copper	Caesarean	NR	NR	NR	88%
Bhat 201640	Non-randomised intervention	Single centre	India	2011–2014	680	Copper	Both	N/A	NR	86%	NR
Abro 201893	Non-randomised intervention	Single centre	Pakistan	2016–2017	220	NR	NR	NR	NR	91%	NR
Bhat, 201640	Non-randomised intervention	Single centre	India	2011–2014	339	Copper	Caesarean	NR	NR	96%	NR
Bhat, 201640	Non-randomised intervention	Single centre	India	2011–2014	130	Copper	Vaginal	NR	NR	78%	NR
Bhat, 201640	Non-randomised intervention	Single centre	India	2011–2014	211	Copper	Vaginal	NR	NR	75%	NR
Blumenthal, 2016101	Prospective observational	Single centre	Zambia	2010	305	NR	NR	NR	NR	94%	NR
Lester, 2015161	RCT	Single centre	Uganda	2011	34	Copper	Caesarean	N/A	NR	ITT: 79%; with 6 month follow-up data: 93% (7/29)	NR
Kumar, 2019131	Retrospective	Multicentre (n=12)	India	2015	844	Copper	Both	NR	NR	NR	63% (60–68% depending on subgroup)

ITT, intent-to-treat; IUD, intrauterine device; LARC, long-acting reversible contraception; N/A, not applicable; NR, not reported; PPIUD, postpartum intrauterine device; RCT, randomised controlled trial.