Rates of IUCD discontinuation and its associated factors among the clients of a social franchising network in Pakistan

We found that 22.7% of the IUCD acceptors experienced some health problem; while the overall discontinuation rate was 18.9% with average time of usage of 7.4 (SD ± 5.8) months before discontinuation. Half of them showed health concerns (49.8%); of which a majority (70.2%) returned to Suraj provider for IUCD removal. Women living in Punjab, residing at a travelling time of 30-60 minutes and no previous use of contraceptive are more likely to discontinue IUCD. However, among total women 81.7% still expressed willingness to avail IUCD services from Suraj provider in future, if needed.The findings suggest a need for training the providers and field workers to prevent early discontinuation of IUCD among the Suraj clients and by addressing the health concerns through proper counseling, continued follow-up and immediate medical aid/referral in case of complications.Modern Intrauterine device (IUCD) is very safe, highly effective (99%) during first year [1] and inexpensive family planning method [2]. It is reversible, requires little effort on the part of the user once inserted, and offers 5-10 years of protection against pregnancy. IUCD's wider use would reduce the overall number of unintended pregnancies more than any other method. Globally, after sterilization (19%), approximately 13% of all women of reproductive age use the IUCD, making it the second most popular contraceptive [3].However, it has a bad reputation in some countries with its adverse effects exaggerated and the advantages often under-stated [4]. Fears about side effects, concerns about infection and infertility, lack of technical training for providers, and the time and costs involved in providing services combine to discourage use of IUCDs in many countries [5]. Some studies revealed that up to 80 percent of IUCD users complain of increased menstrual bleeding and pain. However, research conducted by FHI in 23 developing countries, indicates that Copper T IUCD-related bleeding disturbances tend to decrease