Socio Demographic Characteristics of the Study Participants
In this study total of 13 study participants were included: eleven short term contraceptive use mothers, one health centre head and one health extension workers /community health workers/. The age of the study participants were in range of 19-32. All of the study participants were house wives and married. Regarding to religion of study participants, six short term contraceptive users were protestant, five six short term contraceptive users were Orthodox and one six short term contraceptive users were Muslim. All short term contraceptive users had at list one child. Regarding the educational status of short term contraceptive users, six short term contraceptive users were illiterate (can’t write and read), three short term contraceptive users had finished secondary school and two short term contraceptive users were above secondary school. Among short term contraceptive users; five of them were injectable contraceptive users, three of them were pills users, and two of them were implant users. At the time of in-depth interview, three themes were emerged.
Theme 1: Poor Knowledge of Study Participants about Benefits of IUD
Women know about benefits of short term contraceptives such as pills, injectable, condom but they have poor knowledge about the benefits of IUD. The source of information was Mass media and urban health extension workers (community workers) at the community. This idea was supported by three short term contraceptive user women, by the head of health centre and by the health extension worker.
One of injectable contraceptive user mother stated that:
“I knew most of the contraceptive methods by name including pills, injectable, condoms, and a contraceptive which are inserted on the upper arms. And I knew well about the benefits of these contraceptives except IUD. These short term contraceptives have benefits for child spacing, for child limiting and health of the mother and her child, it saves the unnecessary expenses of the households and the country. I heard this information from different sources including TV, Radio and Brushers from Health centre and NGOs. Additionally, urban health extension workers (community workers) gave me some information about contraceptives methods”
Moreover, one pills user women and mother of three children stated:
“Using short term contraceptive method has several benefits; among those benefits, it helps me to have a small family size. If we have a small family size we would teach and rear our children properly without financial constraint. Another benefit of using these contraceptives is to have sexual intercourse without any stress that means we will not worry about whether I will be pregnant or not. Now, I don’t want to have more than two children in my lifetime.”
Injectable contraceptive user mother stated:
“I heard about IUD from Television as it’s inserted into Womb. It is only removed by health professionals when I want to remove it. My friend was used IUD and she complained as she faced health problem and she became obese “bokach’ means ‘being fat’ then she discontinued. And she advised me to use IUD and she advised me to use an injectable contraceptive method.”
Additionally, this finding was supported by the head of Hossana health centre. Low utilization of IUD was lack of awareness and knowledge about the benefits of IUD. He stated:
“In our health centre, the short term contraceptive utilization coverage is greater than 90% except for IUD, the reasons for low utilization of IUD was lack of awareness about IUD, lack of knowledge about benefits of IUD, misconception about IUD and fear of side effects are the reasons for not utilization of IUD”
Moreover, one of urban health extension worker (community health worker) agreed on the above reasons which given by the head of health centre. She worked as /urban health extension worker/ community health workers for seven years and she stated:
“…only our effort is not enough to create sufficient awareness and knowledge about IUD. I think it good to integrate our effort with different stakeholders at the community. We are not delivering strong health education about IUD as expected from us at the community level; hence the level of awareness and knowledge of the community about IUD is very low”
Theme 2: Inadequate Counselling and Giving the Informed Choices about IUD
Adequate counselling is important for utilization of IUD as well as for the utilization of other contraceptive methods. As stated by one injectable and one IUD contraceptive users:
“I am coming to this health centre every three months to receive the injectable contraceptive/Dipoprivara/ method but I haven’t received any counselling about the benefits of contraceptive you are asking /IUD/. After they gave me the injection, they give me an appointment to come back after three months on appointment date”
Misconception or misunderstanding was the result of poor counselling as stated by IUD user mother for three months and she explained the reasons of discontinue after five year utilization was. As she stated:
“I used IUD for the last three months. After I have started using this method my behaviour was completely changed ‘yanagergnal’, ‘yabesachegnal’ means it makes me ‘talkative’ and ‘irritable’. Moreover, I feel some discomfort around my abdomen. Then I went to a clinic to get advice from Health personals, the health care provider pressured me to change another type of contraceptive methods without telling the reasons of those problems (behavioural change and discomfort around the abdomen) but I didn’t agree with health personal advice then I went to a private clinic near to my home. And the health personals in privet clinic removed IUD and I started using the injectable contraceptive method. After starting the injectable method my behaviour and my health is improved rapidly”
As explained by one of new injectable contraceptive user mother
“I am a new user for short term contraceptive method/injectable/ and I got some information from my friend she was previously IUD user and I had never got counselling from the health personals about benefits of IUD. She told me to use another type of contraceptive methods, she told me as it causes infertility as well as it is not easy to remove from the womb as another contraceptive methods and it’s not comfortable at the time of sexual intercourse’ ”
To increase utilization of IUD, counselling should be focused on side effects and related factors. As pills user mother explained:
“I decided to not use this type (IUD) of contraceptive method because of I afraid of the side effects, it might be not comfortable to have sexual intercourse. Frequent checking of IUD tread is boring and I have a fear of it might change the position at the time of hard works. At the time when I want to remove, I could face several problems to remove it such as the absence of trained health personals and absence necessary equipment’s to remove it.”
Among the activities to increasing utilization of IUD is providing the informed choice for the available contraceptive methods including IUD. As explained one injectable contraceptive user women:
“…….for your surprise, on my first visit to this Health centre, I asked the health personal about what would be better for me? But the health personals told me to use injectable contraceptive method without telling about any available contraceptives in the health centre.”
Further these ideas were expressed by implant user women. She stated:
“I want to the health centre to know the types of available contraceptives to choice and I have asked one of the health officers in the health centre about currently available contraceptive methods and its benefits. He told me about all available contraceptive methods and their benefits. Then, I preferred to use Implant rather than IUD because I scared of solid device insertion in my Womb then I think it might have health problems including genital area infection and I could bleed at the time of insertion.”
Theme 3: Absence of trained health personals and shortage of supplies
Supplies of IUD and absence of trained health personals for insertion and removal of IUD are among the reasons for not utilization of IUD. As explained by a pills user mother and a Implant user mother:
“I heard the benefits of IUD from TV in my home and my neighbour told me about the benefits of IUD then I decided to use IUD and I want to the health centre. But they said no IUD device and no trained health personnel for insertion of IUD. And they told me to use another type of contraceptive method”
“After I heard the benefits of IUD from radio then I went to the health centre to use IUD but Nurse in family planning unit says in our health centre, the IUD insertion equipment has been stocked out before three months and the trained nurse for insertion of IUD left to her Master's education. Hence, to not have unwanted pregnancy I decided to use short term contraceptive methods”