Intracesarean insertion of the Copper T380A versus 6 weeks postcesarean: a randomized clinical trial

Objectives: To compare rates of Copper T380A intrauterine device (IUD) utilization and satisfaction with immediate versus delayed IUD insertion after cesarean delivery in Kampala, Uganda.

Methods: This study was a randomized clinical trial of women undergoing cesarean section who desired an IUD in Kampala, Uganda. Participants were randomly assigned to IUD insertion at the time of cesarean delivery or 6weeks afterward. The primary outcome was IUD utilization at 6months after delivery.

Results: Among 68 women who underwent randomization, an IUD was inserted in 100% (34/34) of the women in the immediate insertion group and in 53% (18/34) in the delayed group. IUD use at 6 months was higher in the immediate insertion group (93% vs. 50% after delayed insertion; p<.0001). Infection and expulsion were rare and did not differ between groups. When we pooled both groups and looked at IUD users compared to nonusers, 91% (39/43) of IUD users were satisfied or very satisfied with their contraceptive method compared to 44% (11/25) of nonusers (p<.0001). Women who chose not to be in the study or had the IUD removed often did so because of perceived husband or community disapproval.

Conclusion: The 6-month utilization of an IUD after immediate insertion was significantly higher than after delayed insertion without increased complications. Contraceptive satisfaction was significantly higher among IUD users than nonusers. Community and husband attitudes influence IUD utilization and continuation in Kampala, Uganda.

Implications: This work is important because it shows the safety and efficacy of providing IUDs during cesarean section in a setting where access to any healthcare, including contraception, can be extremely limited outside of childbearing and the consequences of an unintended, closely spaced pregnancy after a cesarean section can be life threatening.