An IUD study to assess follow-up needed for removal or reinsertion.

This 1988 study followed up IUD users in order to estimate the number of women needing removal and reinsertion of TCU-200 to determine the best approach to locating women and providing them with services for IUD removal and reinsertion and to assess the level of counseling and follow-up needed. The study assessed the knowledge of clients service providers and field workers about IUD lifespan effectiveness and side effects. The sample included 3678 clients 263 service providers and 150 field workers from 75 upazilas in Bangladesh. Upazilas were selected proportionately to the number of IUD users. The sample was obtained by two-stage stratified cluster sampling techniques. The client sample included 68% from rural areas and 32% from urban areas. 49.2% of the client sample was located and interviewed. Addresses were missing for many clients. 79% of cases were located through field workers. 3.8% of users still had IUDs in place at the time of the interview even though the IUD expiration date had been reached. 34.9% of clients had IUDs removed due to menstrual problems. IUD failure resulted in 23 pregnancies. The cumulative termination rates were 27% at the end of 6 months and 40% at the end of 1 year. 19% terminated use at the end of the year due to menstrual problems. Other reasons were side effects expulsion and personal reasons. 72.8% of insertions occurred in clinical settings. About 55% of clients reported receipt of follow-up services which usually occurred within the first month after insertion. This client report differed from the reports of providers who reported 100% follow-up. Only 30.4% of providers informed clients about the lifespan of IUDs and only 7.9% informed clients about the need for removal of expired IUDs. About 95% of FWVs and 88% of field workers knew about the 3-4 year lifespan of IUDs. The authors recommend improvements in counseling.