title: The levonorgestrel intrauterine system: cohort study to assess satisfaction in a postpartum population in Kenya.
abstract: BACKGROUND
  The levonorgestrel intrauterine system (LNG IUS) may become the next long-acting contraceptive to be introduced in public sector programs of resource-poor countries. Whereas service provision for subdermal implants and intrauterine devices is growing, little is known about how the LNG IUS might fit in.
  
  
  METHODS
  We conducted a cohort study of 313 women in Kenya who were 6-12 weeks postpartum when they started using these methods: subdermal implant (205), LNG IUS (93), and copper intrauterine device (15). Participants returned for visits at 6 and 12 months to share information on bleeding patterns, side effects, satisfaction, and continued use of the products. We used Kaplan-Meier techniques to estimate method continuation rates and chi-square tests of association to identify differences in experiences with the methods.
  
  
  RESULTS
  The 12-month continuation rate for the LNG IUS was 89.1 (95% confidence interval [CI] = 86.9-94.9) and statistically equivalent to that of the subdermal implant (91.8: 95% CI = 80.6-94.0). Nearly 87% of LNG IUS users were very satisfied with the method at 6 months compared to 75% of implant users; this gap closed somewhat at 12 months as satisfaction levels of implant users rose. At 12 months 78% of LNG IUS users felt that their bleeding pattern was highly acceptable compared with about 66% of implant users.
  
  
  CONCLUSIONS
  This study found that the LNG IUS compared favorably to the subdermal implant in terms of satisfaction levels and continued use. The LNG IUS will provide another long-acting option for postpartum women.
  
  
  CONCLUSIONS
  The LNG IUS may soon be purchased by international donor agencies for use in public sector programs in sub-Saharan Africa and other resource-poor countries. The results of this study suggest that the product will be successful in future introduction activities.
authors.affiliation: FHI 360, Durham, NC 27701. Electronic address: dhubacher@fhi360.org.
authors.forename: David
authors.initials: D
authors.lastname: Hubacher
authors.affiliation: FHI 360, P.O. Box 38835-00623, Nairobi, Kenya.
authors.forename: Rose
authors.initials: R
authors.lastname: Masaba
authors.affiliation: FHI 360, P.O. Box 38835-00623, Nairobi, Kenya.
authors.forename: Carolyne Kemunto
authors.initials: CK
authors.lastname: Manduku
authors.affiliation: FHI 360, Durham, NC 27701.
authors.forename: Mario
authors.initials: M
authors.lastname: Chen
authors.affiliation: FHI 360, P.O. Box 38835-00623, Nairobi, Kenya.
authors.forename: Valentine
authors.initials: V
authors.lastname: Veena
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D004343:Drug Implants; D005260:Female; D006801:Humans; D007435:Intrauterine Devices, Copper; D007436:Intrauterine Devices, Medicated; D007630:Kenya; D016912:Levonorgestrel / Q000627:therapeutic use*; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D049590:Postpartum Period; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants; D016912:Levonorgestrel
keywords: Acceptability; Africa; Comparison; Continuation rates; Levonorgestrel intrauterine system; Long-acting reversible contraception