INTRODUCTION

India is now the most populated country in the world, surpassing China, but its rapidly
expanding population is posing problems. With more than 1.4 billion people and an
anticipated 1% yearly growth rate, India's demographic trend has intricated and significant
effects on the country's human development. India's population is expected to reach two
billion by 2050 and surpass 1.5 billion by 2030 due to its unsustainable rate of growth.
Because of the nation's fast population growth, resources and services are under strain, which
exacerbates inequality, poverty, and environmental degradation. Access to high-quality
healthcare is becoming more difficult as the strain on the healthcare system grows.
Urbanization is putting a strain on the infrastructure for basic services, and the education
infrastructure cannot keep up with the demands of a growing population. Environmental
issues result from the depletion of natural resources brought about by a large population.
Additionally, population growth is a contributing factor to the lack of job opportunities.

Family planning strengthens women's voices, lowers poverty, and enhances health.
Nonetheless, about 200 million women in underdeveloped nations now desire to avoid
getting pregnant but do not use a contemporary form of contraception. Many barriers stand in
their way, including misinformation regarding side effects and expenses, resistance from their
husbands and communities, and limited access to health care resources. Over a million infant
deaths, over 79,000 maternal fatalities, and 54 million unwanted pregnancies could be
prevented annually if these challenges could be solved and the demand for family planning
satisfied. Families could start to escape the cycle of poverty by saving more money.
Additionally, communities may spend more on infrastructure, healthcare, and education [1].

The identification of a range of actions for accelerated progress in universal access is made
possible by case studies from seven countries (Brazil, Cambodia, India, Morocco, the United
Republic of Tanzania, Uzbekistan, and Zambia). These case studies illustrate the application
of various strategies to improve access to sexual and reproductive health, lessons learned
during implementation, and results achieved. A comprehensive approach to sexual and
reproductive health is required to meet MDG 5, meaning that programs and efforts must go
beyond addressing maternal health to include family planning, sexual health, and the
prevention of unsafe abortions. Programs should prioritize areas of participation in
accordance with national and regional needs while outlining workable strategies to guarantee
equity by integrating human rights and gender. Globally, there has been unequal and sluggish
progress towards reaching MDG 5. Africa's nations have made the slowest improvement
across nearly all metrics. For instance, the unmet need for family planning remains
unacceptablely high in sub-Saharan Africa, where one in four women who wish to delay or
stop childbearing are not using any family planning method [2], despite increases in
contraceptive prevalence from 52% in 1990 to 60% in 2000 and 62% in 2007 worldwide.
Globally, the rate of adolescent pregnancies is still high, with 52 births for every 1000
women between the ages of 15 and 19 in 2007—a negligible decrease from the 55 in 2000.
Of all the regions on the globe, Sub-Saharan Africa has the greatest rate of adolescent births,
followed by Latin America and the Caribbean.

Over the years, India has experimented with several various strategic methods for family
planning, such as a family planning camp strategy, an incentive-driven program, a policy of
reproductive health and rights, and a coercive target approach. 4.74 million women
underwent sterilization in 2000–2001, according to current statistics [3].

The widespread practice of getting married young, having consecutive pregnancies close
together, and using female sterilization as the only form of contraception was never properly
addressed. Before agreeing to sterilization, the majority of women had never used a form of
birth control, and over 50% of them had permanent sterilization before turning 26. After
giving birth, married teenagers accept the permanent approach as well [4]. Modern spacing
techniques, on the other hand, only make up about 10% of contraceptive use. Ten percent of
pregnancies in 2005–2006 were mistimed (wanted later), while eleven percent were not
wanted. This means that almost twenty percent of pregnancies, or 5.6 million, were unwanted
and/or unplanned [5]. Over half of unintended pregnancies end in dangerous circumstances,
accounting for a sizable number of abortions. In summary, while the program has somewhat
succeeded in reducing fertility, it has not been able to postpone the first pregnancy, encourage
healthy spacing, or increase the use of male contraception. As a result, the population has
continued to grow, despite depressing data on the health of mothers and children. In order to
make the program more responsive to the requirements of the nation, which vary by state and
region, efforts are presently being made to rethink and reposition it [6].
Couples can now act on their natural desires and impulses with lower risks of becoming
pregnant to the invention of modern contraceptive technologies. The technological
advancements in modern contraceptive technologies are intended to overcome biology. In
this sense, contemporary techniques ought to facilitate couples' ability to engage in sexual
activity whenever both parties choose [7]. Three major categories can be used to categorize
contemporary methods of contraception: 1. long-acting reversible contraceptives (LARC),
like hormonal implants and intrauterine devices (IUDs); 2. short-acting contraceptives, like
condoms, spermicides, hormone injections, and oral contraceptive tablets; 3. permanent
methods, like vasectomy or tubal ligation for sterilization. Despite the fact that LARC
techniques are more cost-effective, effective, and well-tolerated than short-acting techniques,
short-acting techniques are more frequently employed in all situations [8]. IUC and
contraceptive implants are examples of long-acting, reversible contraceptive treatments.
These techniques have a half-life of less than three years and are as successful as sterilization
operations.

The alternative emergency contraceptive (EC) approach of inserting a copper intrauterine

device (IUD) quickly after unprotected sexual intercourse was initially described by Lippes et
al. in 1976. According to available research, postcoital insertion of a copper IUD is a highly
effective form of EC that provides more protection than hormonal EC pills. With copper wire
encircling the two arms and the stem of the "T," the copper T380A IUC is a polyethylene T-
shaped frame. With a 0.6% to 0.8% failure rate in the first year, this approach has a minimum
of ten years of high effectiveness [9]. It seems that copper inhibits sperm's capacity to
fertilize the ovum.

Injection used for contraception (Depo-medroxyprogesterone acetate, or DMPA)

Product labels say that starting depo medroxyprogesterone acetate (DMPA) during cycle days
1-4 is best because it stops ovulation quickly and protects against pregnancy right away [10].
An aqueous suspension of 17-acetoxy-6-methyl progesterone is used in the DMPA injection.
150 mg is the intramuscular dose, and 104 mg is the subcutaneous dose. With an optimal
usage failure rate of 0.3% and a normal use failure rate of 3% in the first year, both are
administered every 12 weeks [11]. The main ways that depo-medroxyprogesterone acetate
works are by thickening cervical mucus and inhibiting ovulation. Women who are unable to
utilize combined hormonal contraception because of their high estrogen levels are suitable
candidates. For nursing women, depo-medroxyprogesterone acetate is appropriate. The only
contraindication is breast cancer at this time. Depo-medroxyprogesterone acetate is useful in
treating endometriosis, dysmenorrhea, and haemorrhagic ovarian cysts. Haemorrhagic
ovarian cysts are prevented in women who use anticoagulants. Pain crises are less frequent
and less severe in women with sickle cell disease.

NATIONAL FAMILY HEALTH SURVEY (NFHS-4) 2015-16 INDIA

Demand and need for family planning by union territory and state the present study aims to
determine the proportion of married women aged 15–49 who have not met their family
planning needs, as well as the overall demand for family planning and the satisfied portion of
the need per state and union territory in India between 2015 and 2016.
The percentage of people in Uttar Pradesh, India, who do not currently use family planning
methods is 12.9%, whereas the percentage of people who do use family planning methods is
53.5%. In Uttar Pradesh, this equates to a 66.4% demand for family planning services. In
Uttar Pradesh, on the other hand, the met requirement for family planning is 45.5%, meaning
that the total demand for family planning is 63.5%.

According to state/union territory, India, 2015-1691, the percentage of women aged 15- 49
who currently use modern contraceptive methods and for whom the public sector was their
most recent supply of contraceptives, according to the technique and place of residence. Male
sterilization is used at a rate of 90.5%, whereas female sterilization is the most common form
of contraception in India, with a usage rate of 82.2%. Contraceptive pills are used by 27.4%
of the population, but intrauterine contraceptive devices (IUCD/PPIUCD) are used by 58.7%.
Of all people, 27.7% use injectable contraception, while 17.2% use condoms, also known as
"Nirodh" in India. One of the most populous states in India, Uttar Pradesh, has somewhat
different usage rates: 88.4% of women and 86.4% of men undergo sterilization.
Contraceptive pill usage is lower at 15.2% compared to 51.7% for IUCD/PPIUCD. Condom
use is 6.6% of the population, while injectable contraceptives are used by 23.7% of people.

NFHS 5 (2019 2020) LUCKNOW UP (21)

Use of family planning techniques as of right now (MARRIED WOMEN AGE 15-49)
The overall number of unmet demands increased from 14.3 to 15.7 when comparing NFHS 5
to NFHS 4. In particular, there has been a modest increase in the unmet demand for spacing
from 4.9 to 5.1.

The purpose of this study was to examine how accepting rural Indian women are of the use of
DMPA and CuT in particular. Consequently, concentrate on raising awareness of the use of
DMPA and CuT, as well as helping to establish small family standards and lessen population
expansion, maternal illness, and death.

Reference

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programs for the 21st century: rationale and design.
2. National Planning Commission. Millennium Development Goals report 2010.
National Planning Commission, Abuja Nigeria. 2010.
3. Das NP, Mishra VK, Saha PK. Does community access affect the use of health and
family welfare services in rural india?.
4. Santhya KG, Acharya R, Pandey N, Gupta AK, Rampal S, Singh SK, Zavier AJ.
Executive Summary: Understanding the lives of adolescents and young adults
(UDAYA) in Uttar Pradesh, India (2015–16).
5. Rajan SI, James KS. Third national family health survey in India: Issues, problems
and prospects. Economic and Political Weekly. 2008 Nov 29:33-8.
6. Pachauri S. Priority strategies for India's family planning programme. The Indian
journal of medical research. 2014 Nov;140(Suppl 1):S137.
7. Hubacher D, Trussell J. A definition of modern contraceptive methods.
Contraception. 2015 Nov 1;92(5):420-1.
8. Secura GM, Allsworth JE, Madden T, Mullersman JL, Peipert JF. The Contraceptive
CHOICE Project: reducing barriers to long-acting reversible contraception. American
journal of obstetrics and gynecology. 2010 Aug 1;203(2):115-e1.
9. Trussell J, Guthrie K. Choosing a contraceptive: efficacy, safety, and personal
considerations. Contraceptive technology. 2007;19.
10. Petta CA, Faundes A, Dunson TR, Ramos M, Delucio M, Faundes D, Bahamondes L.
Timing of onset of contraceptive effectiveness in Depo-Provera users: Part I. Changes
in cervical mucus. Fertility and sterility. 1998 Feb 1;69(2):252-7.
11. Trussell J, Guthrie K. Choosing a contraceptive: efficacy, safety, and personal
considerations. Contraceptive technology. 2007;19.
 AIMS AND OBJECTIVES

Aim
The aim of this study is to compare copper intrauterine devices and injectable progesterone.
Objectives
1. To assess which among copper intrauterine devices and injectable progesterone is more
acceptable to reproductive age women.

2. To assess factors affecting the compliance of both contraceptive methods

3. To assess effect of counselling on adoption and continuation of both methods

 REVIEW OF LITERATURE

According to Mukherjee et al., (2023), ascertain the rate of acceptability of IUCDs, pinpoint
obstacles to IUCD acceptance, and ascertain the reason for IUCD cessation. Only 20.97% of
potential users were found to be using IUCDs at the time of the survey, while 73.75% had
never used one and 20.1% of women had stopped using them. It had been determined that a
lack of understanding and a number of sociodemographic, obstetrical, and family planning
behaviours were connected to the acceptability of IUCD. The most common excuses for
refusing IUCDs were lack of knowledge about the advantages of the device, husband
opposition, availability of other contemporary contraceptive techniques, fear of negative
consequences, and objections from family members. The desire for another child was the
most frequent cause for ending an IUCD. Compared to other regions of India, Odisha had a
relatively low rate of acceptability for IUCDs; as a result, this study suggests counselling on
family planning techniques that were successful in raising acceptance of IUCD use [1].

According to Gupta et al., (2023), variables influencing PPIUCD acceptance and retention
and investigating the risk factors for PPIUCD discontinuation after six months. 60% of the
300 women who received PPIUCD counselling accepted it. These women were primarily
from metropolitan regions (61.7%), primigravida (61.7%), educated (86.1%), and between
the ages of 25 and 30 (40.6%). At six months, 65.6% of the population had been retained,
compared to 13.9% and 5.6% who had either been removed or expelled. Women declined
PPIUCD for a variety of reasons, including fear of pain and significant bleeding, limited
information, a predisposition towards other procedures, unwillingness, and religious
convictions. The results of the adjusted logistic regression showed that Hinduism, lower-
middle and richest SES, housewife position, better education, and early pregnancy
counselling all contributed to the acceptance of PPIUCD. AUB, infection, and family
pressure accounted for the majority of removals (23.1%). The adjusted hazard ratio showed
that counselling during the latter stages of pregnancy, religion other than Hinduism, and a
vaginal delivery were significant predictors of early removal or expulsion. Higher
socioeconomic levels and education, however, supported retention. PPIUCD is a long-acting,
cost-effective, safe, and practical form of contraception. The acceptance of PPIUCD can be
raised through advocating for it, providing appropriate prenatal counselling, and improving
the insertion method skills of medical staff [2].
Kaplan et al., (2023) investigated the continuation or switch of intrauterine devices (IUDs)
for a maximum of six months following participant-masked randomization to various IUDs.
Compared to 18 (5.5%) of the 328 users of copper IUDs, 7 (2.1%) of the 327 participants
assigned to the levonorgestrel IUD changed their type of IUD by six months (RR: 0.4 [95%
CI: 0.2, 0.9], p = 0.03). Of those who used IUDs, 34 (10.4%) stopped using levonorgestrel,
and 35 (10.7%) stopped using them after six months. When seeking emergency
contraception, people were randomly assigned to an IUD type, and they stuck with it at a high
rate for six months [3].

Nwala et al., (2022) looked at the user population's satisfaction and continuing rate with the
IUS. Three months and twelve months after insertion, the percentage of users who reported
continuing to use the LNG IUS was 96.9% (95% CI: 91.3, 99.3) and 91.8% (95% CI: 82.9,
96.9), respectively. Of the few users who stopped using the method, none reported a method
failure. Menstrual bleeding or amenorrhea (25.0%), method-related pain (18.8%), and partner
complaints regarding strings (16.7%) were the top reasons for discontinuation. There was
high reported satisfaction with the LNG IUS (76.5% at three months and 86.3% at twelve
months after insertion). In comparison to experiencing breast tenderness or pain (50.0%) and
vaginal infection (0.0%), satisfaction with LNG IUS was substantially linked with not having
either at 12 months (p<0.05). It also did not correlate with not having a vaginal bacterial
infection (87.5%) or breast tenderness or pain (88.2%). The positive potential of IUS as a
contraceptive technique in Nigeria was shown by high user satisfaction and continuation rates
[4].

Anant et al., (2021) evaluated patients' knowledge, attitudes, habits, and preferences, as well
as their ability to comprehend and dispel myths about LARC. Respondents reported high
rates of teenage pregnancies (44%), marriages (64%), and unintended pregnancies (41%). In
the 15 questions about LARC procedures, 66.7% of respondents had low knowledge scores,
26.66% had intermediate knowledge scores, and just 6.66% got high level >80% scores. A
significant portion (59%) had a negative attitude toward the use of LARC in the future,
despite 41% having a positive attitude. This was attributed to various beliefs about genital
tract infections, discharges, and cancer, as well as changes in menstrual flow patterns,
delayed conception after cessation, and altered sexual functions. Just 0.5% of women who
had a positive attitude selected contraceptive implants, compared to 21% who preferred
intrauterine devices and 19.5% who preferred injectables. Just 5% of women reported using
LARC at the moment, compared to 24.5% who had used them in the past. Because
childbearing spacing was not maintained, the study demonstrates the enormous unmet
demand for spacing contraceptive techniques. Regarding LARC techniques, there were a lot
of misconceptions as well as a lack of accurate information and awareness [5].

Svahn et al., (2021) investigated whether or not women use contraceptives on a regular
basis, evaluated concerns regarding hormonal contraception and copper intrauterine devices
(Cu-IUDs), and identified factors linked to these concerns. 30.4% of respondents used long-
acting reversible contraceptives (LARC), 28.0% used short-acting reversible contraceptives
(SARC), and 16.4% did not use any kind of birth control during their most recent sexual
activity. Four out of ten (41.2%) people expressed concerns about using HC, and 52.3% did
the same for using Cu-IUD. Concerns about HC were most frequently expressed in relation to
unclear side effects, hormone anxiety, and depressive symptoms; for Cu-IUD, they were
primarily concerned about increased bleeding and menstrual pain. The prevalence of induced
abortion experiences was twice as high among individuals who expressed worries. Women
who were unconcerned about HC were more likely to use combined oral contraceptives
(COC). It's normal to had concerns about utilizing HC with Cu-IUD. When providing
contraceptive counselling, this must be taken into account [6].

Gupta et al., (2021) evaluated the effectiveness and safety of post-placental IUCD insertion
(Cu-T 380A) in women who were scheduled for a vaginal delivery or caesarean section, as
well as their adherence to the procedure. Over the course of a year, 300 women received
counselling. Sixty percent of the ladies agreed to PPIUCD. The bulk of PPIUCD acceptors
were between the ages of 25 and 30 (40.6%), primigravida (61.7%), educated (86.1%), and
living in metropolitan areas (61.7%). At six weeks, three months, and six months, the follow-
up rates were 93%, 90%, and 81%, respectively, while the continuation rate was 80% at six
months. During follow-up, irregular uterine bleeding, infections, and missing threads were
the most prevalent complications. No instance of PPIUCD failure or perforation was
reported. A total of 14% of women had their PPIUCD removed, and 5% of women were
expelled. PPIUCD is a long-acting, cost-effective, safe, and practical form of contraception.
Increasing the acceptance of PPIUCD can be achieved through advocating for it, providing
appropriate prenatal counselling, and improving the skills of healthcare staff in insertion
techniques [7].

Brunie et al., (2021) analysed the traits, justifications for technique choice, and experiences
of Nigerian users of hormonal IUDs, copper IUDs, implants, and injectables. The
participants' sociodemographic features and contraception history showed minimal variations
based on the strategy employed. The main justifications given by consumers for selecting a
long-acting, reversible approach were: feeling that the treatment was "right for my body,"
duration, provider recommendation, friend or family recommendation, few or manageable
adverse effects, and high effectiveness. Of those who used hormonal IUDs, 17% reported less
bleeding (including lighter, shorter, or non-existent periods), and 16% reported relief from
painful or heavy periods. Qualitative information validated these conclusions. Between 25%
and 33% of survey participants stated that if the method they were given had not been
available, they would not had selected any other approach. According to both quantitative
and qualitative data, partner support can influence the use of contraceptives. In-depth
interviews revealed that women generally required permission from their partners to use
contraception, while males had less of an impact on method selection. Giving more women in
Nigeria access to hormonal IUDs as part of a comprehensive technique mix presents a chance
to increase their options for contraception. The government was about to implement the
procedure on a larger scale; therefore, the findings were timely [8].

Nabhan et al., (2021) evaluated the safety and efficacy of self-injection versus subcutaneous
depot medroxyprogesterone acetate provided by a physician in order to enhance the
continuation of contraceptive use. Three randomized trials were found (9 reports; 1264
participants). With the exception of performance bias and detection bias of participant-
reported outcomes in unmasked trials, the included studies had a minimal risk of bias.
Contraceptive use was more likely to be continued when administered by oneself as opposed
to by a healthcare professional (risk ratio 1.35; 95% confidence ranges 1.10–1.66); evidence
of intermediate certainty. When compared to women 25 years of age and older, as well as to
women residing in low- and middle-income nations as opposed to high-income ones, self-
injection seems to had a greater effect on continuing for younger women. By type of care
provider (community health worker vs. clinic-based clinician), there was no difference in
subgroups. Subcutaneous depot medroxyprogesterone acetate injections performed by oneself
most likely enhance adherence to contraceptive use. Due to the extremely low certainty of the
findings, the consequences for other outcomes were still unknown [9].

Kochar et al., (2020) determined whether DMPA injections were effective for contraception
during the postpartum phase. In the current study, there was mild irregular bleeding in 21, 35,
and 38 instances at the first visit, three months later, and six months later, respectively. Eight
instances had moderate irregular bleeding at the initial visit, 27 cases at the three-month
mark, and 18 cases at the six-month mark. At the three- and six-month marks, respectively,
there was severe irregular bleeding in 37 and 43 cases. 89, 10, and 1 case had blood sugar
levels of 120 at baseline; at 3 months' follow-up, 94, 6, and 0 cases had blood sugar levels of
120; and at 6 months' follow-up, 97, 3, and 1 cases had blood sugar levels of 200. For
lactating women, injection DMPA was a suitable method of contraception because it was
safe, effective, reversible, and did not had any negative metabolic consequences. It also
doesn't require special training to administer. Keywords: postpartum period, irregular
bleeding, depot medication Roxy progesterone acetate [10].

According to Dorney et al., (2020), the copper-intrauterine device (Cu-IUD) is the only
method that provides continuing contraception and the most effective emergency
contraception (EC); yet, its use was underutilized in Australia. 64.5% of the 470 clients had
used EC before. Merely 12.7% of respondents were aware that the Cu-IUD was a type of EC,
and 2% of them had actually used one. Given details about the Cu-IUD's costs, side effects,
and effectiveness, 46.8% of respondents said they would give it some thought for EC. But
40% saw costs and potential drawbacks as obstacles. Time constraints were cited as the
primary obstacle by 55% of the 58 doctors polled who discussed Cu-IUD as EC with clients,
as opposed to 94% who discussed oral EC. Low client awareness and little clinician
discussion of the device highlighted a greater need for education and promotion strategies for
the Cu-IUD as EC. The need for this alternative can rise as knowledge grows. Procedures to
guarantee prompt access to insertions will be needed for this [11].

Elkhateeb et al., (2020) evaluated the acceptability of IUD use in nulliparous women by
Egyptian healthcare practitioners and the women themselves. The majority of nulliparous
women who sought contraception (96.2%) said they had a bad opinion of the IUD technique.
82.5% of doctors shared this mindset. Among nulliparous women, fear of bleeding (37.7%)
and infection (52.8%) was the main reason for refusing an IUD. 51.9% of women also worry
about being infertile in the future. According to the providers, problematic insertion (52.5%)
came in second place after increased pelvic inflammatory disease (PID), which accounted for
the largest percentage of non-acceptability (70%) When 90 women who had agreed to use an
IUD were reassessed six months later, 94.4% were still utilizing the technique, and 77.8%
were satisfied with the outcome. The primary obstacles impeding the adoption of IUDs in
nulliparous women are the doctors' lack of understanding and attitude toward their patients.
excellent client guidance. Increased usage of such safe and effective methods would be
facilitated by providing physicians with high-quality training to enhance their expertise [12].
According to Sims et al., (2020), the relationship between obesity and depot
medroxyprogesterone use was connected to weight gain and alterations in bleeding patterns.
87.9% of the 240 women who took part in the study were African American; 3.3% were
underweight, 30.8% were normal weight, 23.3% were overweight, 15% were class I obese,
9.6% were class II obese, and 17.9% were class III obese. While taking DMPA, women
gained 2.40 kg (95% confidence interval 1.34–3.45), which was inversely correlated with age
at initial injection (β coefficient -0.13; p =.02) even after controlling for confounding
variables. The most often reported alteration in the pattern of bleeding was amenorrhea.
Regardless of their starting BMI, women who began using DMPA earlier in life acquired the
greatest weight over time. All BMI categories had comparable incidences of amenorrhea
[13].

Turok et al., (2020) evaluated the safety, tolerability, and effectiveness in parous and
nulliparous women of a novel, low-dose intrauterine copper (175 mm2) contraception with a
flexible nitinol frame supplied in a preloaded applicator. 2,866 women in all supplied 5,640
cycles that could be used to evaluate pregnancy. The patients' average age was 27.1 years.
Women who were nulliparous made up 60.8% of the patients. In the course of a 36-month
surveillance period, they detected 10 major adverse events and two pregnancies (Pearl Index
0.46 [95% CI 0.06–1.67]); none of them were connected to the trial. 283 participants (99.0%)
had a successful placement. The continuation times were, on average, 2.7 years (range: 0-
3.4). There was one case of pelvic inflammatory illness, no uterine perforations, and five
expulsions (1.8%). Thirty women (10.6%) stopped using the medication early in the first year
due to adverse effects; twenty-three (8.1%) stopped because of discomfort, bleeding, or both.
A total of 107 people (37.8%) finished using the device for 36 months. From 7.6 in cycle 1 to
5.2 in cycle 13, the mean number of bleeding days per cycle fell. In this phase 2 U.S. Food
and Drug Administration experiment, the innovative, low-dose copper and nitinol IUD
showed good efficacy and safety, and it merits more in-depth investigation in a phase 3
clinical trial [14].

According to Davis et al., (2019), maternal mortality was a major focus of health care
initiatives, particularly in India. Although there is an improvement in the numerical measures
of maternal health, this improvement can only be maintained if women's knowledge,
attitudes, and practices change. The overlooked area of health care policy was gender
empowerment, and it was important to evaluate how Indian women, who were the real
change agents, were perceived. The author conducted interviews with 956 women. 58.36% of
the ladies had never used any kind of contemporary contraception. Of the women who had
used intrauterine contraceptives, 76.12% had stopped using them. Although there were many
misconceptions about emergency contraception, 49.89% of the women were aware of the
concept. Induced abortions were performed as a family planning method; almost ninety
percent of the women had used over-the-counter abortifacients. The majority of women
showed interest in long-acting contraceptives other than IUCDs and were open to using
contraception. This study sheds light on Indian women's conceptions about family planning.
This could influence family planning laws [15].

Beasley et al., (2018) investigated the viability, acceptability, continuance, and blood levels
of self-administered subcutaneous depot medroxyprogesterone acetate (DMPA). 137 (55%)
of the 250 women who were invited to participate actually enrolled. Ninety-one of them were
given the task of self-administering DMPA, and ninety-one of them were able to do so
successfully. 87% of individuals completed the follow-up. There was no discernible
difference between the groups' DMPA usage at the one-year mark (p = 0.47); 71% of the self-
administration group and 63% of the clinic-administered group used DMPA. At one year, the
self-administration and clinic-administered groups had 47% and 48% of continuous DMPA
users, respectively (p = 0.70). By using serum analysis, it was possible to find comparable
therapeutic trough levels and mean DMPA levels in both groups. Sixty-three percent of
women said that they would like to self-administer, and almost all of the eligible participants
were able to do so, even in a randomized experiment. Both clinic-administered and self-
administered DMPA had similar rates of continuation and serum DMPA levels. This showed
that self-injecting DMPA under the skin was not only possible, but may also appeal to many
women [16].

Situmorang et al., (2017) assessed the post-placental IUCD's acceptability, efficacy, and
side effects following vaginal delivery at Dr. Cipto Mangunkusumo Hospital (RSCM) six
months following insertion. In all, 234 women were included in the trial, with a 19.2%
follow-up loss rate. There was no discernible difference between the study's subjects'
characteristics and those who were lost to follow-up. 5.1% of subjects (total expulsion 4.1%
and partial 1%) and 7.5% of subjects (total expulsion 0.6% and partial 6.9%) suffered
expulsion at the first visit, which took place 40–42 days, and the second visit, which took
place six months later, respectively. On the first and second visits, the IUCD was removed
from 9.3% of the individuals. Sixty-one percent of the individuals who requested or received
expulsion had their IUCD removed, and they were all willing to undergo reinsertion. The
IUCD was 100% effective, and 68.9% of the participants continued to breastfeed. Vaginal
discharge (23%), dysmenorrhea (4–21%), and spotting (2–10%) were the adverse effects.
After six months, the post placental IUCD's acceptability and efficacy were, respectively,
86.8% and 100%. The most frequent adverse effects were dysmenorrhea, spotting, and
vaginal discharge, with a cumulative ejection rate of 12.6% [17].

Hofmeyr et al., (2016) compared the changes in endometrial cell mitotic activity, serum
levels of progesterone and estradiol, and Ki67 in women who used copper intrauterine
devices (Cu-IUDs) with those who used DMPA nine months later. At the initial visit, the
mean glandular mitotic index for IUD users was 1.69 ± 0.39, whereas for injectable
contraceptive users it was 1.1 ± 0.69. At the second visit, which occurred after nine months, it
was 0.57 ± (0.34) and 0.25 ± (0.11), respectively. In a similar vein, the Ki-67 count in the
glands was 4.20 ± (0.24) compared to 2.27 ± (0.65) at the second appointment, and 11.79 ±
1.59 for IUD users vs. 12.03 ± 0.58 for injectable contraception users at the first visit. After
the stroma, Ki67 dropped after 9 months for IUD users from a mean of 0.85–0.05 to 0.92–
0.02. It was suggested that women who use injectable contraceptives, or IUDs, for longer
than nine months had a statistically significant decrease in proliferative and mitotic indices in
the endometrium. IUD users saw no significant changes in their serum hormone levels;
however, injectable contraception users saw a large increase in their serum progesterone level
and a negligible change in their serum estrogen level. When a copper intrauterine device or
an injectable birth control method is used for more than nine months, endometrial
proliferative or cell mitotic activity drops by a large amount. The use of DMPA raised blood
progesterone levels without changing serum estradiol levels; however, copper IUDs had no
effect on either of these hormones [18].

According to Beesham et al., (2016), women enrolled in the Evidence for Contraceptive
Options and HIV Outcomes (ECHO) Trial from a single trial site provided information on
their choices for contraception as well as their reasons for stopping. Among women utilizing
their randomized form of contraception (n = 757), 21% stopped using the copper-IUD, 20%
stopped using the LNG implant, and 20% stopped using the DMPA-IM at the final ECHO
Trial visit. Roughly 25% of each group stopped because of bleeding issues. Of the 597
women who were still using randomized contraceptives at the trial's end, 25% stopped using
DMPA-IM within six months of the study's conclusion, 8% stopped using LNG implants, and
4% stopped using copper IUDs. At randomization, 33% of women stated they would want to
be assigned to DMPA-IM, 20% to the LNG implant, and 18% to the copper-IUD. The ECHO
Trial departure and 6-month post-trial follow-up showed low dropout rates for all three
methods, despite the fact that some women had preferences on which contraceptive they
might be assigned to [19].

Envall et al., (2016) evaluate the usage of an efficient form of contraception six months after
the placement of a copper intrauterine device (Cu-IUD) vs. ulipristal acetate (UPA)
consumption for emergency contraception (EC). Compared to 18/31 (58.1%) women who
chose UPA, 30/36 (83.3%) women who chose Cu-IUD for EC used an effective method of
contraception six months after their initial visit (p = 0.03). In the Cu-IUD group, 31/36 (86%)
said they would suggest the Cu-IUD to others as an EC method, and 28/36 (77.8%) were still
using the device after six months. At the 6-month follow-up, a significantly higher percentage
of women who selected the Cu-IUD for EC also utilized a reliable form of contraception. The
study's findings were in Favor of using Cu-IUDs for EC more frequently [20].

Ekiz et al., (2016) evaluated the pregnancy outcomes and risk factors associated with using a
copper (Cu)T380A IUD during pregnancy. There were found to be 77 intrauterine
pregnancies and 4 ectopic pregnancies. Twenty-six pregnancies (33.76%, 26/77) were ended
in accordance with the wishes of the mother. The group of patients who had their IUDs
removed consisted of 25 (32.46%, 25/77), while the group of patients who had their IUDs left
in situ was made up of the remaining 26 patients. In comparison to the IUD left in situ group,
the term pregnancy rates in the removed IUD group were significantly higher (76% vs.
20.8%, p = 0.002). In the IUD Left in Place Group, abortion rates were found to be
considerably higher (16% vs. 53.84%, p = 0.008). The primary finding of our investigation
was that there was a substantial risk of a poor perinatal outcome during pregnancy when
CuT380A was present in situ. It appears that modifying the planned follow-up appointments
to check the IUD was crucial to avoiding unintentional pregnancy [21].

Rowe et al., (2016) compared rates of unplanned pregnancy, method continuation, and
removal reasons among women who use the copper T 380 A (TCu380A) or the 52-mg
levonorgestrel (daily release 20 microg) levonorgestrel IUD (LNG-IUD). The cumulative
method discontinuation rates at 7 years were 70.6 (1.2) and 40.8 (1.3) per 100, respectively.
The cumulative 7-year pregnancy rate of the LNG-IUD was 0.5 (standard error 0.2) per 100,
much lower than 2.5 (0.4) per 100 of the TCu380A. Amenorrhea (26.1 [1.3] per 100) and
decreased bleeding (12.5 [1.1] per 100), notably in Chinese women, were the main causes of
stopping the LNG-IUD. For the TCu380A, increased bleeding (9.9 [0.9] per 100), mainly in
non-Chinese women, was the main reason. For both intrauterine devices, the removal rates
for pain were comparable (IUDs). The cumulative removal rates for symptoms associated
with hormonal side effects for the LNG-IUD and TCu380A were 5.7 (0.7) and 0.4 (0.2) per
100, respectively. At the 7-year follow-up, the cumulative losses were 26.0 (1.4) and 36.9
(1.3) per 100, respectively. Both the TCu380A and the LNG-IUD had extremely high
contraceptive efficacy, while the LNG-IUDs was much greater. LNG-IUD users had greater
overall rates of IUD removals than TCu380A users. Amenorrhea removals seemed to be
related to culture [22].

Ozgoli et al., (2015) presented in 2013 to health centres connected to Shahid Beheshti
University of Medical Sciences in Tehran, Iran, attempted to compare the sexual function of
women using DMPA with women using Cyclofem. The study found that there was no
significant difference in sexual function between the Cyclofem and DMPA groups. However,
there was a significant difference (p < 0.05) in the sexual desire and pain perception of the
DMPA group compared to the Cyclofem group. Health professionals should highlight the
negative consequences of hormonal contraception techniques on sexual function while
introducing them. The use of Cyclofem and DMPA by women should come with warnings
about potential changes in libido and sexual pain [23].

Achilles et al., (2015) evaluated the viability of assigning women at random to the kind of
intrauterine device (IUD). For 54 out of 55 (98%) of the women who tested, the IUD-type
randomization was accepted. All 32 participants that were enrolled finished the follow-up.
Two women asked to had their IUDs removed (one LNG-IUD, one Cu-IUD), and two
swapped their IUDs (one Cu-IUD to an LNG-IUD). In total, 88% of people kept their
prescribed IUD. It was possible to randomize the kind of IUD, and a few women switched to
a different variety [24].

Jiménez et al., (2014) evaluate the acceptability of progestin-only pills, combined oral
contraceptives, and copper-releasing intrauterine devices in women with systemic lupus
erythematosus and any side effects unrelated to disease activity. The COC, POP, and IUD
groups showed significantly different cessation rates for non-medical reasons (11%, 31%, 4%
(p<0.05)) and for any cause (35%, 55%, 29% (p<0.01)). The most common conditions
among COC users were nausea; among IUD users, dysmenorrhea; and among POP users,
acne and hirsutism. The average blood pressure did not change. Over time, all treatment
groups experienced gradual increases in body weight. The majority of women expressed
satisfaction with the allocated method of contraception. When counselling and specialist
medical attention were given, oral contraceptives and IUDs were acceptable birth control
methods for people with lupus; POP's acceptability seems to be lower. It was not usually
necessary to stop using contraceptive techniques due to side effects unrelated to lupus disease
activity [25].

Veisi et al., (2013) compared the adverse effects of two types of injectable contraceptives
(Cyclofem and depo-medroxyprogesterone acetate). In contrast to the Cyclofem group, which
experienced irregular bleeding (65.60%), headache (14.4%), and breast sensitivity (20%), the
DMPA group experienced significant adverse effects, including weight gain (48%), irregular
bleeding (93.60%), bone pain (24%), and vaginal dryness (10.40%). The primary issue that
caused our participants to stop using both forms of contraception was changes in their
bleeding patterns. The study's findings indicated that the main issue in both groups was a
change in their bleeding patterns. Appropriate guidance from a qualified specialist lowers the
high discontinuation and failure rates [26].

Marvi et al., (2013) investigate women's opinions about three contemporary contraceptive
items in a low-income neighbourhood in Karachi, Pakistan, using an emic technique. The
level of family planning awareness was high. Women explained various treatment modalities
and said that, on the whole, they liked contemporary medication for contraception because it
was the most effective and fastest. They claimed that fear of certain contraceptive items,
especially injections and IUDs, affected their decision-making. Women described how the
heating effects of contraceptives could result in undesired side effects such as weight gain,
weakness, and irregular menstruation, which could ultimately lead to illness. Despite their
desire for family planning, most women were not happy with the effects of the contraceptives
that were then on the market. Women stated that they used modern medication to get
pregnant, but when describing how contraceptives affected their health, they tended to use the
hot-cold explanation of traditional medicine [27].

Katheit et al., (2013) evaluated the knowledge, acceptance, and expulsion rates of post-
placental intrauterine contraceptive devices during a 6-week follow-up in vaginal deliveries,
taking into account factors such as age, parity, education, residency, and expulsion rates.
When comparing interval IUCD to post-placental IUCD, awareness of the latter was
substantially lower (5.79% versus 73.55%). The age category of clients who were 21–25
years old (50.88%), para-2 (35.76%), and educated (65%) had greater acceptance rates for
PPIUCD. 10.5% of the people were expelled. Perforation or any other significant
consequence was not present. IUCD (post-placental insertion) was a long-acting, safe, and
reasonably priced method of contraception. The ejection rates can be lower if skilled medical
professionals implant the IUCD high up at the fundus [28].

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28. Katheit G, Agarwal J. Evaluation of post-placental intrauterine device (PPIUCD) in
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 METHODOLOGY

To determine the acceptability and compliance of injectable progesterone versus copper

intrauterine contraceptive devices (IUCDs) among women in North India, a comparison study
comparing the two was conducted as part of the approach. The research will probably include
a mix of qualitative and quantitative techniques, including focus groups, interviews, and
surveys. Participants who are typical of the target population will be identified by sampling
techniques, and data collection instruments will be created to collect information on variables
such as adherence to the selected contraceptive method, willingness to use each method, and
experiences with side effects. The acceptability and compliance rates of the two contraceptive
methods will probably be compared using statistical analysis, which will provide important
information about their suitability and effectiveness for women in the area.

1.1 Study Design

That study was conducted as a prospective cohort study.

1.2 Study Duration

The study duration was one year.

1.3 Sample size calculation

Formula

A proposed sample size of 146 (rounded to 150) with a 95% confidence interval and a 5%
margin of error was suggested. With a 10% dropout rate, the sample size was 160, or 80
people per group. (Z stands for statistical confidence level, P for expected prevalence, and D
for margin of error.).

1.4 Study Subjects

Women in the reproductive age range were seeking contraception at the Obstetrics and
Gynecology Department.
1.5 Inclusion criterion
1. Reproductive age women 18 to 45 years of age.

2. Women more than 6 weeks postpartum.

3. Women immediate post-abortion.

4. Women who have consented for the study.

1.6 Exclusion criterion

1. Irregular vaginal bleeding.

2. Severe coagulation disorder.

3. Severe liver disease (LFTs >2× upper limits of normal at time of randomization).

4. History of breast Cancer.

5. History of severe clinical depression.

6. Diabetes mellitus

7. Pregnancy

8. Puerperal sepsis or immediate post septic abortion

9. Distorted uterine cavity (congenital or acquired)

10. Unexplained vaginal bleeding

11. Suspected genital malignancy

12. High-risk candidate for STI

13. Genital tuberculosis

14. Active Pelvic Inflammatory Disease

15. Women who have not consented

1.7 Procedure
A prospective cohort study was conducted to compare the tolerability of injectable
progesterone against copper IUCD. Women seeking contraception in the interim period,
postpartum, after an abortion, or attending the family planning unit at the Prasad Institute of
Medical Sciences (Lucknow) were the subjects of a prospective study that lasted a year. The
women received counseling regarding long-acting contraceptive methods such as DMPA and
any potential side effects. Depending on their needs, women were also given the option to
choose from any of the contraceptives in the basket, and those who would like anything other
than injectable MPA were accommodated.

Approximately 150 women chose to use injectable DMPA contraceptives over the first nine
months of the research. A thorough physical, gynecological, and historical examination was
performed. Blood pressure and body weight were monitored at baseline and then every three
months after that. Pre-administration counseling should include information on the benefits of
both contraceptives and non-contraceptives, as well as particular side effects such as changes
in weight, bleeding patterns, and fertility.

The regimen calls for injections to be administered by day five for women who were
menstruating, by day seven for women who had abortions, and by week six for women who
had just given birth.

For women who were menstruating, day seven was the deadline for administering injections,
and week six was the deadline for women who had just given birth.

The Indian government issued the MPA Card, which contained information on the patients'
weight, blood pressure, obstetric and menstrual history, sociodemographic characteristics,
and inquiries about their use of contraception and compliance. Three monthly intervals were
used for subsequent injections. Women who failed to show up for their scheduled doses were
urged over the phone to return for another treatment; if they refused, the reasons were
recorded on their MPA card. The study examines sociodemographic factors, acceptance,
compliance, and a range of negative outcomes, including changes in weight, menstruation
problems (bleeding more or less), amenorrhea, headaches, and bone pains. It also examines
other issues, such as the motivations behind the methods' use or non-use.

1.8 Investigation
1.8.1 Body weight
To measure a Women weight using a Body weight measuring machine, first, ensure you had
an appropriate scale for pediatric use. Place the scale on a flat surface and zero it before use.
Prepare the Women, whether it's placing an infant on a women scale or assisting an older
woman onto the scale. Make sure the women was centered and standing still, ideally in light
clothing. Record the stable weight displayed on the digital scale, and note the date and time
of the measurement. Interpret the results by comparing them to growth charts or reference
values for the women's age and sex. Consistency and regular monitoring were key to tracking
a women growth effectively.

1.8.2 Blood pressure

During the research methodology, women were instructed to relax for 15 to 20 minutes. The
blood pressure cuff was evenly placed around the arm above the antecubital fossa, and the
stethoscope bell was positioned over the brachial artery to capture the strongest pulse sounds.
The cuff was gradually pumped while monitoring the sphygmomanometer readings until the
pulse sound was no longer detected, indicating the diastolic pressure. Subsequently, the cuff
was slowly released until the pulse sounds returned, and this value was recorded as the
systolic pressure.

1.9 Data Analysis:

The data were characterized for categorical variables using descriptive statistics, frequency
analysis, and percentage analysis. For continuous variables, mean, standard deviation (SD),
and standard error of mean’ (SE) were employed. The statistical analysis utilized "SPSS"
Statistics Software (version 21.0) and Statistics Software version 19.1.3.
 OBSERVATION AND RESULTS

Distribution of age of patients (Years)

AGE No. of cases Percentage

< 25 36 22.5%
26-30 60 37.5%
31-35 39 24.4%
> 35 25 15.6%
Age (Mean ± SD) 30.1 ± 5.67

Present study included 160 females. Majority of study population was below 30 years of age
(96 cases, 60.7%), followed by 51 patients (32.2%) of age 31 to 40 years and 6.9% (11 cases)
were above 40 years of age.
Youngest patient enrolled was 20 years old while oldest one was 44 years old. Mean age of
all patients was 30.06±5.7 years.

15.6%
22.5%

< 25
24.4% 26-30
31-35
37.5%
> 35
 Copper T 380A Inj DMPA 150mg
Chi-square
Total p-value
value
No. of cases %age No. of cases %age
< 25 12 16.7% 24 27.3% 36
26-30 26 36.1% 34 38.6% 60
AGE
31-35 23 31.9% 16 18.2% 39 5.134 0.162
> 35 11 15.3% 14 15.9% 25
Total 72 100.0% 88 100.0% 160

This p-value indicates that there is no statistically significant difference in the age distribution
of users between Copper T 380A and Inj DMPA 150mg. Both contraceptive methods are
most commonly used by individuals in the 26-30 age group.

40.0%
35.0%
30.0%
Percentage

25.0%
Copper T 380A
20.0%
15.0% Inj DMPA 150mg
10.0%
5.0%
0.0%
< 25 26-30 31-35 > 35

Distribution of means of height, weight and BMI of patients

N Minimum Maximum Mean SD

Height 160 148.00 167.00 156.54 5.01
weight 160 44.00 74.00 57.66 7.69
BMI 160 20.00 31.20 24.39 2.53

Mean values of height, weight and BMI were 156.54 Cm, 57.66 Kg and 24.39 Kg/m2
respectively.
Distribution of BMI

BMI No. of cases Percentage

18.5-25 101 63.1%
25-30 53 33.1%
> 30 6 3.8%
BMI (Mean ± SD) 24.4 ± 2.53

Average BMI of patients was 24.4 Kg/m2. BMI was grouped into normal (101 cases, 63.1%,
majority population), overweight (53 cases, 33.1%) and obese (6 cases, 3.8%) respectively.

3.8%

33.1%
18.5-25
63.1% 25-30
> 30

Distribution based on obstetrics history

Parity

Parity No. of cases Percentage

1 25 15.6%
2 75 46.9%
3 38 23.8%
4 18 11.3%
5 4 2.5%
Total 160 100.0%

The above table represents distribution of parity among patients. The table shows majority of
women gave birth twice (75 cases, 46.9%) and thrice (38 cases, 23.8%). A smaller population
(4 cases, 2.5%) have had 5 births.
 PARITY

75

38
25
18

1 2 3 4 5

No. of patients (N)

Abortion
Abortion No. of cases Percentage
0 73 45.6%
1 55 34.4%
2 27 16.9%
3 5 3.1%
Total 160 100.0%

Fifty five (34.4%) patients had aborted for 1 time, 27 (16.9%) had done twice and 5 (3.2%)
patients had undergone abortions more than twice. Seventy three (46.2%) patients did not
undergo abortion at all.
 Number of Abortions
80
73
70
60 55

50
40
30 27

20
10
5
0
1
2
>2
None

Living children
Living Children No. of cases Percentage
1 34 21.3%
2 81 50.6%
3 32 20.0%
>4 13 8.1%
Total 160 100.0%

Majority population had two to four living children (113 cases, 70.6%); followed by 34
patients (21.3%) with only one living child. Thirteen (8.1%) patients had more than 4 alive
children.

8.1%

21.3%
20.0% 1
2
3
50.6%
>4
History of previous use of contraception
Contraception use No. of patients (N) Percentage (%)
Yes 55 34.4
No 105 65.6
Total 160 100

Fifty three (34.4%) patients confirmed using contraception on the past.

Previous use of contaception

YES
NO

Type of contraception used

Type No. of patients (N) Percentage (%)
Condom 32 20
Copper T 1 0.6
Inj DMPA 150 2 1.3
OCP 12 7.5
None 113 70.6
Total 160 100
Out of 47 patients using contraception, 32 (20%) used condom, 12 (7.5%) used oral
contraceptive pills while 2 (1.3%) patients used inj. DMPA. Cu T was used in only 1 patient.
No history of contraception was recorded in 113 (70.6%) patients.

Type of contraceptiv used

32
35
30
25
20
15 12

10
1 2
5
0
No. of patients

Condom Cu T 380A Inj. DMPA 150 mg Oral Contraceptive Pills

Type of contraception agreed to use

Type No. of patients (N) Percentage (%)
Copper T 380A 72 45
Inj. DMPA 150 mg 88 55
Total 160 100

Patients were counselled and encouraged for using contraception. Upon counselling, 72
(45%) patients agreed to use Copper T IUD and 88 (55%) patients agreed upon inj. DMPA.
Counselling had a major effect on convincing patients to use contraception. The percentage
of patients using contraception was increased from 34.4% to 100% patients agreeing to use
either Copper T or inj. DMPA.
 Type of Contraceptive agreed upon

72 Copper T 380A

88 Inj. DMPA 150 mg

Distribution of complaints in patients

Complaints No. of cases Percentage
None 121 75.6%
Amenorrhoea 8 5.0%
Amenorrhoea, Lack of
2 1.3%
sexual acitivity
Lack of sexual acitivity 3 1.9%
Lack of sexual acitivity,
1 0.6%
Pain abdomen
pain abdomen 14 8.8%
Thread not felt 5 3.1%
Mennorhagia 4 2.5%
Explusion 2 1.3%
Total 160 100.0%

Out of 160 patients, 39 had various complaints. Abdominal pain or backache, amenorrhoea,
amenorrhoea with lack of sexual activity, lack of sexual activity, pain in abdomen, thread not
 felt and expulsion were seen in 8 (5%), 2 (1.3%) 3 (1.9%), 14 (8.8%), 5 (3.1%) and 2 (1.3%)
respectively.

75.6%
80.0%
70.0%
60.0%
Percentage

50.0%
40.0%
30.0%
20.0% 8.8%
5.0% 1.9% 3.1% 2.5%
10.0% 1.3% 0.6% 1.3%
0.0%

Association of complaints and type of method adopted

Copper T 380A Inj DMPA 150mg Chi-square
Total p-value
No. of cases %age No. of cases %age value

None 45 62.5% 76 86.4% 121 12.157 0.001

Amenorrhoea 1 1.4% 9 10.2% 10 5.247 0.022
Lack of
sexual 1 1.4% 5 5.7% 6 2.009 0.156
acitivity
Complaints Pain
14 19.4% 0 0.0% 14 18.635 0.001
abdomen
Thread not
5 6.9% 0 0.0% 5 6.269 0.012
felt
Mennorhagia 4 5.6% 0 0.0% 4 4.923 0.026
Explusion 2 2.8% 0 0.0% 2 2.459 0.117

The table presents the complaints or side effects experienced by patients using two different
contraceptive methods: Copper T 380A and Inj. DMPA 150 mg. The table also includes the
total number of patients and the p-value, which indicates the statistical significance of the
differences between the two groups.
This table enlists the various complaints or side effects reported by the patients, including
abdominal pain/backache, amenorrhea, lack of sexual activity, and non-specific symptoms.
Abdominal pain/backache and non-specific symptoms were more common in the Copper T
380A group, while amenorrhea and lack of sexual activity were more common in the Inj.
DMPA 150 mg group.
The differences in the complaint profiles between the two contraceptive methods were
statistically significant.

90.0%
80.0%
70.0%
60.0%
Percentage

50.0%
40.0%
30.0% Copper T 380A
20.0% Inj DMPA 150mg
10.0%
0.0%

Distribution of compliance in patients

Compliance No. of patients (N) Percentage (%)
Good 138 86.2
Bad 22 13.8
Total 160 100

Good compliance was seen in 138 (86.2%) patients while in 22 (13.8%) patients bad/non-
compliance was reported.
 Compliance

22

138

Good Bad

Association of compliance and type of method adopted

Copper T 380A Inj DMPA 150mg Chi-
No. of No. of Total square p-value
%age %age
cases cases value
Bad
16 22.2% 6 6.8% 22
compliance
Compliance
Good 7.923 0.006
56 77.8% 82 93.2% 138
compliance
Total 72 100.0% 88 100.0% 160

The table presents the compliance or adherence of patients to two different contraceptive
methods: Copper T 380A and Inj. DMPA 150 mg. The table also includes the total number of
patients and the p-value, which indicates the statistical significance of the differences
between the two groups.
The key findings from the table are:
The majority of patients in both groups had good compliance.
The differences in the compliance between the two contraceptive methods were statistically
significant, as indicated by the p-value of 0.006.
Inj DMPA 150mg shows significantly better compliance compared to Copper T 380A.
A higher percentage of users with Copper T 380A have bad compliance (22.2%) compared to
those using Inj DMPA 150mg (6.8%).

100.0%
90.0%
80.0%
70.0%
Percentage

60.0%
50.0% Copper T 380A
40.0% Inj DMPA 150mg
30.0%
20.0%
10.0%
0.0%
Bad compliance Good
compliance

Time of placement

Copper T 380A Inj DMPA 150mg

Total
No. of No. of
%age %age
cases cases
POST
59 81.9% - - 59
PARTUM
Time of POST
8 11.1% 60 68.2% 68
placement ABORTAL
AFTER 6
5 6.9% 28 31.8% 33
WEEK
Total 72 100.0% 88 100.0% 160

 Copper T 380A is predominantly placed post partum (81.9%). This suggests that it is
commonly used shortly after childbirth.
  Inj DMPA 150mg is mainly placed post abortal (68.2%) or after 6 weeks (31.8%).
This indicates that it is often used after an abortion or at a later point following
delivery.
 There are no cases of Inj DMPA 150mg being used post partum, highlighting a
distinct difference in placement timing preferences between the two methods.

This data indicates that the choice of contraceptive method may influence the timing of
placement based on the patient's circumstances. Copper T 380A is more commonly chosen
for immediate post-partum use, while Inj DMPA 150mg is more commonly used after an
abortion or at a later time.

90.0%
80.0%
70.0%
60.0%
Percentage

50.0%
Copper T 380A
40.0%
Inj DMPA 150mg
30.0%
20.0%
10.0%
0.0%
POST POST AFTER 6
PARTUM ABORTAL WEEK
 DISCUSSION

Study Population Demographics

Our study included 160 women, with a majority (60.7%) being below 30 years of age, and a
mean age of 30.1±5.67 years. This demographic distribution is comparable to the study by
(1)
Mohit Singh Mann et al. , where the average age in Group A was 28.9 years and in Group
B was 26.5 years. The similarity in age distributions across these studies ensures our study's
(2)
relevance and comparability. Additionally, the study by Maricianah Onono et al. found a
median age of 23 years among African women, highlighting that our study participants are
slightly older on average.

Height, Weight, and BMI

The mean height, weight, and BMI of our participants were 156.54±5.01 cm, 57.66±7.69 kg,
and 24.39±2.53 kg/m² respectively. These physical characteristics are consistent with the
general population data available for women in North India, indicating a representative
sample.

Obstetric History

The parity distribution showed that 50.6% of women had given birth twice, and 20% had
three births. The abortion history revealed that 34.4% had one abortion and 16.9% had two.
These findings reflect typical reproductive patterns observed in the region and are consistent
(1)
with other studies on similar demographics. For instance, in Mohit Singh Mann et al. 's
study, Group A had a significant proportion of parous women who had conceived due to
contraception failure, primarily using natural methods.

Previous Contraceptive Use

In our study, 34.4% of women had previously used contraception, with condoms being the
most common method (20%). This pattern of contraceptive use aligns with the study by
(1)
Mohit Singh Mann et al. , where a significant proportion of women in Group A conceived
due to the failure of contraception, primarily the natural method (coitus interruptus).
Furthermore, the study by Maricianah Onono et al. (2) reported that about 51% of women had
previously used DMPA-IM, while only 0.8% had used an IUD and 6.4% an implant,
indicating varying contraceptive preferences across different regions.

Acceptance of Contraceptive Methods

Post-counseling, 44.4% of women opted for Copper T 380A, while 53.7% chose Injectable
DMPA. The significant effect of counselling observed in our study, where contraceptive use
increased from 34.4% to 100%, underscores the importance of effective counselling in
(1)
contraceptive acceptance. Similarly, Mohit Singh Mann et al . Noted that, in Group A,
48.6% of primiparous and second parous women opted for long-acting reversible
contraception (LARC) such as IUCD, while 66% of multiparous women chose permanent
sterilization at the time of abortion.

Side Effects and Complaints

Our study identified that abdominal pain/backache was more common in the Copper T group
(19.4%), whereas amenorrhea was more prevalent in the Injectable DMPA group (10.2%).
(3)
These side effect profiles are consistent with those reported by G. Justus Hofmeyr et al. ,
who found that women in the IUD group were more likely to discontinue use due to
abdominal pain or backache, while those in the IPC group were more likely to discontinue
(2)
due to oligo- or amenorrhoea and lack of sexual activity. Maricianah Onono et al. also
observed varying reasons for discontinuation among users of different contraceptive methods.
(4)
Additionally, David K Turok et al . reported adverse events requiring medical attention in
5.2% of participants in the levonorgestrel IUD group and 4.9% in the copper IUD group,
highlighting the importance of monitoring side effects across different contraceptive
methods.
Compliance

Good compliance was observed in 13.8% of participants, with significant difference between
the Copper T (22.2%) and Injectable DMPA (6.8%) groups (p=0.006). These compliance
rates reflect positive adherence to Inj. DMPA contraceptive method, similar to findings in
other studies where high compliance rates were observed with proper follow-up and support.
G. Justus Hofmeyr et al. (3) reported compliance rates of 74.2% for the IUD group and 83.1%
for the IPC group at the final follow-up interview, indicating high adherence among users of
both methods.

Continuation Rates

The continuation rates at 3 months were 88.6% for Copper T and 90.9% for Injectable
DMPA. At 6 months, these rates were 84.8% and 87.3%, respectively. These high
continuation rates suggest good long-term acceptability of both methods, corroborating
findings from Aurélie Brunie et al., who reported high continuation rates for hormonal
intrauterine devices, copper intrauterine devices, and implants in Nigeria and Zambia. In the
(5)
study by J.N. Sanders et al. , the continuation rates did not differ significantly between
Copper T380A IUD users (60%) and LNG 52 mg IUD users (70%) at 12 months, indicating
the effectiveness and acceptability of both devices for long-term contraception following
emergency contraception use.
 CONCLUSION

Our study provides comprehensive insights into the acceptability, compliance, and
continuation rates of Copper IUCD and Injectable Progesterone among women in North
India. The findings are consistent with previous studies, underscoring the importance of
personalized counseling and continuous support to improve compliance and acceptance of
contraceptive methods. The manageable side effect profiles and high continuation rates of
both methods suggest their suitability for long-term use in reproductive-age women. The
comparative analysis with studies by Mohit Singh Mann et al., Aurélie Brunie et al., G. Justus
Hofmeyr et al., Maricianah Onono et al., David K Turok et al., J.N. Sanders et al., and
Ramanadhan S et al. highlights the robustness and relevance of our study's findings within
the broader context of contraceptive research. Further research is needed to address the
uncertainties in pregnancy rates, side effects, and comparative acceptability of different
contraceptive methods for emergency contraception.
References –

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women undergoing first and second trimester abortion at a tertiary care centre. Indian Journal
of Obstetrics and Gynecology Research. 2024.
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of pregnancy incidence among African women in a randomized trial of intramuscular depot
medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUDs) or a
levonorgestrel (LNG) implant for contraception. Contraception: X. 2020;2:100026.
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