title: Rates of IUCD discontinuation and its associated factors among the clients of a social franchising network in Pakistan.
abstract: BACKGROUND
  Modern Intrauterine contraceptive device (IUCD) is very safe, highly effective reversible and inexpensive family planning method which offers 5-10 years of protection against pregnancy. The contraceptive use in Pakistan has been merely 30% for over a decade with IUCD being the least used method. Higher discontinuation rates are documented in developing countries; however no such data is available for Pakistan. Marie Stopes Society (MSS) established a social franchise outlets network branded as 'SURAJ' (Sun) in Pakistan to provide quality family planning services. This study attempts to determine IUCD discontinuation rates and its associated risk factors. Using a semi-structured questionnaire, a cross-sectional study was conducted with 3000 clients who availed IUCD services from Suraj provider 6, 12 and 24 month back,. Data were analyzed in SPSS 17.0; adjusted prevalence ratios were calculated to see associations between discontinuation and its risk factors.
  
  
  METHODS
  We found that 22.7% of the IUCD acceptors experienced some health problem; while the overall discontinuation rate was 18.9% with average time of usage of 7.4 (SD ± 5.8) months before discontinuation. Half of them showed health concerns (49.8%); of which a majority (70.2%) returned to Suraj provider for IUCD removal. Women living in Punjab, residing at a travelling time of 30-60 minutes and no previous use of contraceptive are more likely to discontinue IUCD. However, among total women 81.7% still expressed willingness to avail IUCD services from Suraj provider in future, if needed.
  
  
  CONCLUSIONS
  The findings suggest a need for training the providers and field workers to prevent early discontinuation of IUCD among the Suraj clients and by addressing the health concerns through proper counseling, continued follow-up and immediate medical aid/referral in case of complications.
authors.affiliation: Marie Stopes Society, 21-C, Commercial Area, Old Sunset Boulevard, Phase II, Defense Housing Authority, 75500 Karachi, Pakistan.
authors.forename: Syed Khurram
authors.initials: SK
authors.lastname: Azmat
authors.forename: Babar Tasneem
authors.initials: BT
authors.lastname: Shaikh
authors.forename: Waqas
authors.initials: W
authors.lastname: Hameed
authors.forename: Mohsina
authors.initials: M
authors.lastname: Bilgrami
authors.forename: Ghulam
authors.initials: G
authors.lastname: Mustafa
authors.forename: Muhammad
authors.initials: M
authors.lastname: Ali
authors.forename: Muhammad
authors.initials: M
authors.lastname: Ishaque
authors.forename: Wajahat
authors.initials: W
authors.lastname: Hussain
authors.forename: Aftab
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D020878:Device Removal / Q000523:psychology / Q000706:statistics & numerical data*; D005193:Family Planning Services / Q000458:organization & administration* / Q000639:trends; D005260:Female; D006801:Humans; D007434:Intrauterine Devices / Q000009:adverse effects / Q000706:statistics & numerical data*; D008875:Middle Aged; D019982:Organizational Case Studies; D010154:Pakistan; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D012944:Social Support; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult