Intrauterine Device Use

Contraception IUD http://intimatehealthhelp.net/wp-content/uploads/2012/09/contraception-IUD-300x213.jpeg

INT
Knowledge, Attitude and Use among Women Seeking Termination of
Pregnancy in Gauteng, South Africa
Ajibola Awotiwon | Stellenbosch University | September 2013

http://i.telegraph.co.uk/multimedia/archive/01450/pregnant_1450316c.jpg

250 million pregnancies globally;

33.3% unintended;
20% undergo induced abortion [1]
In South Africa, 75% of pregnancies are unintended [24] ; 1 in 8 pregnancies ends up in abortion.

IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013

Between 1997 and 2008, approx. 731’193 induced
abortions were reported [8]
125,000 unsafe abortions (out of approximately
200,000 total abortions) are performed annually [9, 10–
13]
Lack of access to contraceptives is the most commonly
cited cause


BC http://peacockwings.files.wordpress.com/2011/07/1309400592-16.jpg?w=300&h=248

Prevalence of contraceptive use in Africa – 20% (WHO)
[28]
In South Africa, 65% of sexually active women use a
method [16]
In Durban, 75% of those seeking abortion had
previously used some form of contraception


5% had some knowledge of emergency contraception
[23].
In Cape Town, 21% reported using contraception when
they became pregnant, most commonly the condom
(53%) or pill (35%). [24]


http://www.surebaby.com/blog/wp-content/v93-15-IUD-300x232.jpg

IUD retains a unique capacity as it can be used
both as an emergency contraceptive method
and a long-acting contraceptive method.

within 5 days of unprotected intercourse.
prevent pregnancy for up to ten years.


The knowledge, usage of and attitude towards
intrauterine device method of contraception(IUD)
among women seeking termination of pregnancy (TOP)
in Gauteng, South Africa
The factors that influence the health seeking
behaviour and practices of women seeking TOP with
regards to the IUD contraceptive method


1. To determine the knowledge and use of IUD for

preventing unintended pregnancy among women
seeking TOP in Gauteng.

2.

To determine the level of awareness and uptake of
IUD by women seeking TOP in Gauteng.

3.

To determine the factors that influence
contraceptive choice, use and non-use by the target
population.


02A1499R http://www.redcresearch.ie/wp-content/uploads/2011/01/F2F-interviewer-199x300.jpg

A cross sectional study of women seeking TOP
With assessment of contraceptive seeking behaviour

through an interviewer-administered structured
questionnaire


http://upload.wikimedia.org/wikipedia/commons/6/68/Hillbrow.JPG

Hillbrow Community Health Centre – a
provincial health facility based in the old
Hillbrow Hospital.
Gauteng has consistently reported the highest
abortion numbers among other provinces over
the years.


25000
21318

The number of abortions reported in South Africa by
province between 1997 and 2011

20000
15000

13497

11928

10000
3796

5000
429

0
Gauteng

1144

Northern Cape

Western Cape


1997
2011

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Inclusion criteria
*Age 18 years or older
*Able to communicate in English/Afrikaans/IsiZulu
*Who have completed informed consent, will be included.
Exclusion criteria
*Less than 18 years old
*Or who do not give consent to participate in the study
*Mentally unstable women, will be excluded.


All consecutively registered women will be screened for
enrollment over a period of 4 months using systematic random
sampling. (Feb – May 2014)
Using a sampling frame of 1600 women over a period of 4
months, the sampling interval k will be 3
(k=N/n = 1600/461 = 3).

A random starting point will then be picked between 1 and k
and every 3rd eligible participant presenting at the community
center will be sampled until the required sample size is
reached.


http://online-behavior.com/sites/default/files/imagecache/cartoon/image_field/ca_image/accurate-measurement.jpg

Outcome variables will include:

1.

Percentage of women seeking TOP who are aware of IUD contraceptive
method.

2.

Percentage of women seeking TOP who use IUD contraceptive method.

Independent variables will include:

1.

Knowledge of IUD contraceptive method using the validated
questionnaire

2.
3.
4.

Attitude to IUD contraceptive method using the validated questionnaire
Socio-demographic and economic characteristics
Reasons for use or non-use of IUD contraceptive method which will be
measured using open-ended and multiple response questions.


*

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Data collection
Data will be collected by the principal investigator (PI).
Validated interviewer-administered structured questionnaire
Validating questionnaire and interviews

Crede S et al: Is 'planning' missing from our family planning
services?
Data entry, storage and validation
A data dictionary and a relational database will be developed in
EpiData
Data analysis
STATA (version 12)


http://tweakyourbiz.com/marketing/files/Online-Ethics.jpg

Research ethics committee of
Stellenbosch University
Gauteng Province Department of Health
and the management of Hillbrow
Community Health Centre.
Written Informed consent
Confidentiality


Through academic journals and presentation
at relevant conferences.
The funders, Gauteng Province Department
of Health and the Stellenbosch University
Library, Comm. Health Dept.
Secular female health oriented
newspaper/magazine


STUDY TIMELINE /Activity

Protocol development,
Submission of protocol to
ethics for approval and
obtaining funding

Developing forms and piloting

Data collection and entering

Data cleaning and analysis

Manuscript preparation,
submission of thesis and Data
dissemination

Sep
2013

Oct
2013

Nov
2013

x

x

Dec
2013

Jan
2014

x

Feb
2014

Mar
2014

Apr
2014

May
2014

x

x

x

Jun
2014

Jul
2014

Aug
2014

x

x

Sep
2014

Oct
2014

Nov
2014

x

x
x
x
x

x

x


This will be a cross-sectional study that will rely mainly on
participant recall.

Due to the sensitive nature of the study (abortion), recall
bias is likely to occur.
While the study site is likely to be representative of the
Gauteng province and its findings generalizable to other
provinces
It may not be generalizable to other countries


Direct costs

Amount requested

http://notanotherzebra.files.wordpress.com/2012/09/sa_bank_note_r500-back_thumb5.jpg?w=490&h=483
Rand (R)

Personnel Compensation
Research assistantship

6000

Research Travel
Travel to Gauteng

3500

Travel to clinic

4000

Other Direct Costs
Internet and Email

1500

Office supplies

3000

Printing and copying

3000

Staff training

1500

Reimbursement of participants

9220

Publication costs
Publication in electronic/print media

5000

Bursary supplementation

20000

Total Direct costs

56720.00

Total Expenditures

56720.00

Budget motivation
Research assistant: A research assistant (who is fluent in English and Xhosa), most likely a nurse from the study hospital will be trained to obtain consent and interview participants. She will be paid R1500 per month for 4 months.
Research travel includes PI’s airfare (return ticket) to and from Gauteng, South Africa, and fuel cost for traveling to and from study hospital for 4 months.
Office Supplies/Consumables such as stationery, papers, printer cartridges as well as support for communication will be needed.
Printing and copying of data collection forms, manuscript etc.
Reimbursement of participants: 461 participants at R20 per participant.
Publication fees will be required for data dissemination.
Bursary supplementation for the PI to assist with accommodation and cost of living.


http://www.youtube.com/watch?v=YVJu61BKpkI&list=PLh1fAcf0oiNu2GH2J4HV0hi8tmCPL9V9v&feature=player_detailpage
VIDEO | Reducing Unwanted Pregnancies

www.guttmacher.org

1.

WHO and Gutmacher Institute: Facts on induced abortion worldwide. 2007 [http://www.searo.who.int/LinkFiles/Publications_Facts_on_Induced_Abortion_Worldwide.pdf].

2.

Morroni C, Tibazarwa K, Myer L (2006) Combined condom and contraceptive use among South African women. S Afr Med J 96: 620-622.

3.

Morroni C, Moodley J (2006) The role of urine pregnancy testing in facilitating access to antenatal care and abortion services in South Africa. BMC Pregnancy Childbirth 6: 26.

4.

Jewkes R, Abrahams N (2002) The epidemiology of rape and sexual coercion in South Africa: an overview. Soc Sci Med 55:1231-44.

5.

Rees H et al., The epidemiology of incomplete abortion in South Africa, South African Medical Journal, 1997, 87(4):432–437. PubMed

6.

Kay BJ et al., An analysis of the cost of incomplete abortion to the public health sector in South Africa—1994, South African Medical Journal, 1997, 87(4):442–447. PubMed

7.

South African Government, Choice on Termination of Pregnancy, Act No. 92, Nov. 12, 1996, art. 2(b).

8.

Department of Health South Africa. Choice of Termination in South Africa (Draft). Statistical Notes Available at http://wwwdohgovza/facts/indexhtml. 2009.

9.
Organization, 2011.

Aahman E and Shah I, eds., Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2008, sixth ed., Geneva: World Health

10.

Epidemiology and Surveillance Directorate, Statistical Notes: Choice on Termination in South Africa, Pretoria, South Africa: National Department of Health, 2009.

11.

Blaauw D and Penn-Kekana L, Maternal health, in: Fonn S and Padarath A, eds., South African Health Review, Durban, South Africa: Health Systems Trust, 2010, pp. 3–28.

12.

Daulaire N et al., Promises to Keep: The Toll of Unintended Pregnancies on Women’s Lives in the Developing World, Washington, DC: Global Health Council, 2002.

13.

Statistics South Africa, Mid-Year Population Estimates, 2010, Pretoria, South Africa: Statistics South Africa, 2010.

14.

Mookodi, G., Ntshebe, O. & Taylor, I. (2003). Contraception, Abortion, and Population Planning 93. http://www.kinseyinstitude.org.ccies/bw.php

15.
Tamire, W. & Enqueselassie, F. (2007). Knowledge, attitude, and practices on emergency contraceptives among female university students in Addis Ababa, Ethiopia. Ethiopia Journal of
Health Development, 21(2), 111–116.
16.

Department of Health, Medical Research Council, South Africa: Demographic and Health Survey 2003, Pretoria: Department of Health; 2007.

17.

Ross J, Hardee K, Mumford E, Eid S: Contraceptive Method Choice in Developing Countries. Int Fam Plan Perspect 2002, 28(1): 32-40

18.

Delvaux T, Nostlinger C: Reproductive choice for women and men living with HIV: contraception, abortion and fertility. Reprod Health Matters 2007, 15(29 suppl):S46-S66

19.

Pariani S, Heer DM, Van Arsdol MD: Does Choice Make a Difference to Contraceptive Use? Evidence from East Java. Stud Fam Plann 1991, 22(6):384.

20.
Crede et al: Factors impacting knowledge and use of long acting and permanent contraceptive methods by postpartum HIV positive and negative women in Cape Town, South Africa: a
cross-sectional study. BMC Public Health 2012 12:197
21.

Thonneau P, Almont T: Contraceptive efficacy of intrauterine devices. Am J Obstet Gynecol 2008, 198(3):248.

22.

Schunmann C, Glasier A. Measuring pregnancy intention and its relationship with contraceptive use among women undergoing therapeutic abortion. Contraception. 2006; 73:520-4.

23.
Adanlawo M, Moodley J. Demograhy and social profile of women requesting termination of pregnancy in King Edward VIII Hospital. The South African Journal of Epidemiology and
Infection. 1999; 14(4):99-102.
24.

Morroni C, Moodley J. Characteristics of clients seeking first and second trimester terminations of pregnancy in public health facilities in Cape Town. SAMJ. 2006; 96(7):574.

25.

Crede S, Harries J, Constant D, Hoke TH, Green M, Moodley J. Is 'planning' missing from our family planning services? SAMJ. 2010;100(9):579-80.

26.

Glasier A, Shields WC. Can we improve contraceptive use? Contraception. 2006;73:1-3.

27.
Reddy SP, James S, Sewpaul R, Koopman F, Funani NI, Sifunda S, Josie J, Masuka P, Kambaran NS, Omardien RG. Umthente Uhlaba Usamila – The South African Youth Risk Behaviour Survey
2008. Cape Town: South African Medical Research Council, 2010
28.

UNFPA 2010. How Universal is Access to Reproductive Health? http://www.unfpa.org/public/home/publications/pid/6526

29.

Peter Barron, Dr Yogan Pillay – Contraceptive policy overhauled. http://www.mg.co.za/article/2013-06-13-contraceptive-policy-overhauled


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