title: Uptake of the levonorgestrel intrauterine system among recent postpartum women in Kenya: factors associated with decision-making.
abstract: BACKGROUND
  The levonorgestrel intrauterine system (LNG IUS) may become more available in the public sector of resource-poor countries, but it is unclear what product features might be attractive to users and what factors will influence uptake.
  
  
  METHODS
  We recruited 671 women in Kenya who were seeking contraception at 6-12 weeks postpartum and gave them an opportunity to try the LNG IUS. We asked why they did or did not choose it, relative to the alternative options. χ² tests of association were done to examine participant characteristics and decision-making associated with choice.
  
  
  RESULTS
  Participants chose the following methods: LNG IUS (16%), injectable (36%), subdermal implant (30%), progestin-only pills (15%) and copper intrauterine device (IUD) (3%). Reasons for not choosing the LNG IUS included fear of pain/injury/discomfort (34%), modesty issues regarding insertion (33%) and fear of hormonal/health side effects (31%). Nearly a third of LNG IUS acceptors said they would have chosen a short-acting method if the LNG IUS were not available, and only 21% would have chosen the copper IUD.
  
  
  CONCLUSIONS
  The LNG IUS could be an ideal method for increasing uptake of long-acting methods among recent postpartum women. Product attributes and comparisons to other contraceptive options are important factors in decision-making. Even among women comfortable with intrauterine contraception, great distinctions and preferences are apparent. Addressing specific misconceptions and fears with better information can help women make the best personal choices.
authors.affiliation: FHI 360, Durham, NC 27713, USA. dhubacher@fhi360.org
authors.forename: David
authors.initials: D
authors.lastname: Hubacher
authors.forename: Rose
authors.initials: R
authors.lastname: Masaba
authors.forename: Carolyne Kemunto
authors.initials: CK
authors.lastname: Manduku
authors.forename: Valentine
authors.initials: V
authors.lastname: Veena
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003151:Community Health Centers; D003268:Contraception Behavior / Q000208:ethnology; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects; D003657:Decision Making; D004343:Drug Implants; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007435:Intrauterine Devices, Copper / Q000009:adverse effects; D007436:Intrauterine Devices, Medicated / Q000009:adverse effects; D007630:Kenya; D016912:Levonorgestrel / Q000008:administration & dosage / Q000009:adverse effects; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D049590:Postpartum Period; D011372:Progestins / Q000009:adverse effects; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D003278:Contraceptives, Oral, Hormonal; D004343:Drug Implants; D011372:Progestins; D016912:Levonorgestrel