Acceptance and determinants of immediate postpartum intrauterine contraceptive device use among women in Ethiopian public health facilities: A systematic review and meta-analysis.

BACKGROUND

Immediate postpartum intrauterine contraceptive device insertion is a safe, effective, and reversible long-acting contraceptive method that can reduce unintended pregnancies and short interpregnancy intervals. Despite its benefits, acceptance of PPIUCD remains low in Ethiopia, and national evidence has not been synthesized.

OBJECTIVES

To estimate the pooled prevalence of PPIUCD acceptance and identify factors associated with its acceptance among women in Ethiopian public health facilities.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES AND

METHODS

A systematic search of PubMed, Scopus, ScienceDirect, the Cochrane Library, Google Scholar, and other relevant databases was conducted to identify eligible studies. Data were extracted using Microsoft Excel and analyzed using STATA version 11. A random-effects model was used to estimate the pooled prevalence and pooled odds ratios (PORs) with 95% confidence intervals (CIs). Statistical heterogeneity was assessed using Cochran's Q test and the I2 statistic.

RESULTS

Six studies were included in the meta-analysis. The pooled prevalence of PPIUCD acceptance was 21.64% (95% CI: 11.55, 31.74). Women who received counseling on PPIUCD were more likely to accept the method (POR = 7.24, 95% CI: 4.91, 10.67). A positive attitude toward PPIUCD (POR = 8.11, 95% CI: 5.54, 11.87), no intention to have more children (POR = 2.16, 95% CI: 1.39, 3.37), and completion of antenatal care follow-up (POR = 2.22, 95% CI: 1.53, 3.23) were also significantly associated with acceptance.

CONCLUSION

Approximately one in five women accepted PPIUCD in Ethiopian public health facilities. Counseling, antenatal care follow-up, positive attitudes toward PPIUCD, and future fertility intentions were significant determinants of acceptance. Strengthening counseling and integrating postpartum family planning into routine maternal healthcare services may improve PPIUCD uptake.