Effectiveness of prenatal intensive counselling on knowledge, attitude and acceptance of post placental intrauterine contraceptive device among mothers

Introduction: Contraception is a method or device used to prevent pregnancy. In the fi rst year of postpartum period around 65% of women are having unmet need of family planning. Post Placental Intrauterine Contraceptive Device is not only advantageous to the women and couples; even the service providers benefi t from PPIUCD. PPIUCD insertion on the same delivery table saves time and separate clinical procedure is not required.


Introduction
Contraception is a method or device used to prevent pregnancy. CuT-380A is an Intrauterine Contraceptive Device provides contraception up to 10 years. In the irst year of postpartum period around 65% of women are having unmet need of family planning. Lack of information, fear of side effects and complications are the common reasons for unmet need [1]. Family Planning is important not only for population stabilization, but also to improve maternal and child health in our country. According to 2012 report of UNFPA, WHO and World Bank India contributes 20% of maternal deaths worldwide. If couples spaced their pregnancies for at least 2 years apart, family planning can prevent more than 30% of https://www.heighpubs.org/cjog 022 https://doi.org/10.29328/journal.cjog.1001044 maternal deaths and 10% of child mortality [2][3][4]. Due to case load of deliveries, the Government of India has introduced Post Placental Intrauterine Contraceptive Device in the National Family Planning Programme since 2012. Selecting the mother and motivating them during antenatal period is an easier task than asking the mother to visit after 6 weeks for insertion of intrauterine contraceptive device [5].
Counselling for postpartum contraception can be given during prenatal care visits or it can be given after birth or both. Postpartum contraceptive counselling during the prenatal period is usually neglected. Contraceptive counselling during routine prenatal care visits, especially in the third trimester according to the needs of couples might increase the use of postpartum contraception [6][7][8].
In India, approximately 27% birth occur within 24 months of delivery. Intrauterine contraceptive device is one of the good opinion and most effective method for spacing pregnancies. PPIUCD is not only advantageous to the women and couples; even the service providers bene it from PPIUCD. PPIUCD insertion on the same delivery table saves time and separate clinical procedure is not required [9][10][11].
The acceptance of PPIUCD is low due to lack of awareness among the staff and the client. Inpite of making contraception widely available, there is poor acceptance of contraception due to ignorance and fear of complications. Inadequate knowledge about contraceptive method and incomplete information about their use are the main reasons for not accepting the family planning [12,13].

Methodology
The Quantitative Pre-experimental One Group Pre and Post Test research design was used to conduct the research at selected hospital, Puducherry. 70 Antenatal mothers were selected by using Purposive sampling for the study who ful illed the inclusion criteria such as mothers who were primigravida admitted at term pregnancy, multigravida who were not willing for tubectomy, planned for induction, elective caesarean section and willing to participate in the study. The mothers who had multiple pregnancy and who does not know either Tamil or English were excluded from the study. Structured Interview Schedule was used to collect the data. The structured questionnaire comprised of A,B, C and D sections. Section A consist of Demographic and Obstetric Variables. Section B consist of Knowledge questionnaire, Section C comprised of ive point likert scale to assess the Attitude of mothers and Section D consist of checklist to assess the Acceptance of PPIUCD. Written and Oral informed consent was obtained from each mother prior to data collection. Pretest was done to all the mothers during antenatal period who were admitted to antenatal ward. Prenatal Intensive Counselling was given on same day after Pretest which comprised of de inition, misconception, bene its, mechanism of action, side effects and care after insertion of PPIUCD. The researcher followed up all the mothers who accepted for PPIUCD insertion in labour room and witnessed for insertion of PPIUCD during their intranasal period. The Post Test was carried out with the same tool by using Structured Interview Schedule after 7 th day of intervention during postnatal period. The collected data was analyzed by using descriptive and inferential statistics.
In our study majority of the participants were belong to the age group of 21 to 25 years. Except 2 participants all others had formal education. Nearly 93% of participants were home maker. None of the participants had more than two children. Only 1% of participants were used any kind of contraceptive method. Among the participants who were previously heard about the PPICUCD, health personnel were the major source of information.
The post test scores of all parameters studied such as knowledge and Attitude of PPIUCD were higher that pre test score. This clearly states that Prenatal Intensive Counselling can signi icantly improve Knowledge, Attitude and Acceptance of PPIUCD (  (Table 4).
The present study was supported by the author Geetha Katheit, (2013) conducted a Prospective Longitudinal Study on "Evaluation of Post Placental Intrauterine Device (PPIUCD) in terms of awareness, acceptance and expulsion in a tertiary care centre" among 503 women counseled 397 women accepted for PPIUCD insertion [14].  Placental Insertion of Intrauterine Contraceptive Device" among 1944 women visiting antenatal clinic. The result showed that out of 1944 women, only 78(4%) of women were aware of PPIUCD. 25% of women accepted to put PPIUCD and 37% of women had complications [15].
In Post Test, majority of 69(98.6%) mothers had Adequate Knowledge and 1(1.4%) mother had Moderate Knowledge. In Post Test level of Attitude, majority of 68(97.1%) mothers had Positive Attitude and 2(2.9%) mothers had Neutral Attitude. In Post Test Acceptance, majority of 50(71%) mothers not Accepted and 20(29%) mothers Accepted for Post Placental Intrauterine Contraceptive Device insertion. So when the mothers have Adequate Knowledge and Positive Attitude they were ready to Accept for Post Placental Intrauterine Contraceptive Device insertion (PPIUCD). The present study was supported by the author Putu Ayu Ratna Darmayanti, (2018) conducted a randomized controlled trail on "Difference   Comparative study between prenatal intensive counselling and routine family counselling on acceptance of Post Placental Intrauterine Contraceptive Device among Mothers.
In present study, the post test scores of all parameters studied such as knowledge and Attitude of PPIUCD were higher that pretest score. This clearly states that Prenatal Intensive Counselling can signi icantly improve Knowledge, Attitude and Acceptance of PPIUCD. Similar study was supported by the author ManoranjaniGara, (2014) on "Effectiveness of Structured Teaching Programme on PPIUCD among Primigravida Mothers in selected MCH centre, Tripathi" among 55 Primigravida mothers. The inding showed that there was a signi icant difference between Pre and Posttest level of Knowledge [18].

Conclusion
The study result revealed that Effectiveness of Prenatal Intensive Counselling on Knowledge, Attitude and Acceptance of Post Placental Intrauterine Contraceptive Device (PPIUCD) among the Mothers. In Post Test the Mothers gained Adequate Knowledge, developed Positive Attitude and Accepted for Post Placental Intrauterine Contraceptive Device insertion. So, Prenatal Intensive Counselling on Post Placental Intrauterine Contraceptive Device can be given to Antenatal Mothers during their antenatal visits to meet the unmet needs of family planning.