The present observational, cross-sectional study was conducted in three health centres in Mangalore, Karnataka, India. Mangalore is the headquarters of Dakshin Kannada district [8] and has the highest literacy rate. It’s known as the ‘medical educational hub’ as it has six medical colleges and cumulatively produces one of the highest number of medical graduates in the country. There are more than 25 hospitals in the city itself which provide low cost, good specialty and super specialty care [9,10]. The top of the line healthcare is advocated by the fact that the maternal mortality rate here is 79/100,000 births, while the national rate is 223/1,00,000 births and infant mortality rate is 10.9/1000 births as opposed to the national rate of 48/1000 births [11].

In the present study, study population comprised of married women between the ages of 18 and 45 years who had achieved menarche but not menopause, were using IUDs as a method of contraception, had consented for the study and had visited the outpatient department of the health centres. The sample size was 110, taking the prevalence of IUD users as 1.5%. The sampling method used was convenient sampling and duration of the study was two months, conducted in February and March 2017.

Ethical committee clearance from the IEC of KMC, Mangalore, Karnataka, India was obtained before starting the study. Before conducting the study; the purpose of the study, the meaning of their participation in the study and the contents of the questionnaire were explained to all the women and a written consent was obtained from them. The women were assured that anonymity would be maintained throughout the study and the data would be used for research purposes only.

A semistructured questionnaire was used as the tool for data collection. The questionnaire had two parts, part 1 and 2. The first part dealt with the demographic details of the study participants and contained questions relating to their age, religion, and literacy status. The second part contained questions regarding factors influencing acceptance of IUDs, IUD use and its side effects [12]. The data obtained was analysed by SPSS software version 16.0 and presented in the form of percentages.

A total of 110 women with IUDs inserted took part in this study. [Table/Fig-1,2] deals with their demographic details. The mean age of the study participants was 26.65±4.0 years, 57.3% of which fell under the 25-32 year age group. 60 participants came from rural areas and 68 women possessed BPL cards. Estimating the literacy status showed us that only one participant was illiterate while most had a middle or high school education. Among the husbands, three were illiterate. Most (86.4%) of the participants were housewives. None of them were nulliparous and 78 women wanted more children.

The profile of IUD use among the study participants is reported in [Table/Fig-3]. 78 participants had the IUDs inserted immediately postpartum and 60 participants had their IUDs inserted in the government maternity hospital. Copper T was used by 94 participants.

The source of information of IUDs and the factors which influenced IUD acceptance are discussed in [Table/Fig-4]. 62 patients were motivated to use IUDs as a mutual decision with their husband and 41 were motivated by healthcare providers. For 80.9%, the main source of information of IUDs was the health care provider.

The reasons for acceptance and usage of IUDs among the study participants are depicted in [Table/Fig-5]. More than half of the participants (68.2%) chose IUDs for child spacing. Two (1.8%) women even accept IUDs as they felt that it reduced the incidence of child mortality as compared to other methods of contraception.

Side effects experienced by the study participants are reported in [Table/Fig-6] with 64.5% women experiencing no side effects. Out of the 39 women that did, the main side effects complained of was vaginal bleed. There was no case of IUD rejection or failure.

The three health care centres part of the study is associated with state government which is the first medical institute, part of a public private partnership in India. Lahore General Hospital (LGH) is the oldest hospital in the region, having opened its doors in 1848, catering to a population from the district and neighbouring states. Around 200 deliveries are conducted here monthly, which is approximately 6% of the total deliveries performed in the district [13]. A family welfare councillor presents in LGH councils all the pregnant patients about the benefits of using IUDs. She plays a keyrole in motivating around 30 women to get IUDs inserted here monthly. KMC Attavar is one of the finest tertiary care hospital with super specialty care in most departments. The Obstetrics and Gynaecology Department is one of the most sort after departments catering to the effluent class of patients. The CHC, located in the Moodbidri, Karnataka, India caters to the poor and all services are free of cost. All three healthcare facilities are affiliated to Manipal University that marks the symbol of partnership of government and private university. All three healthcare facilities offer multiloaded as well as Copper T insertions.

The mean age of the study participants was 26.65±4.0 years. This finding is similar to that of a study performed in Hubli by Kittur S et al., where the mean age was 23.75 years and to the finding of a multicentric study by Kumar S et al., where the mean age was 24 years [14,15].

It is observed that literacy plays a major role in contraceptive use. An educated woman may have more of a say regarding the family planning method she practices as opposed to an illiterate woman who is probably ignorant or more easily manipulated. This finding has been advocated in a study by Kunwar S et al., as it was found that literate woman use contraceptives more than illiterate women [16]. For women employing IUDs, some degree of literacy is important as the IUD tail has to be checked by oneself twice weekly and symptoms of infection need to be identified and reported immediately. This study depicted only one illiterate women as opposed to 11% illiterate participants in a study conducted by Gujju RL et al., in AP and 23% illiterate participants in a multicentric study by Kumar S et al., [15,17]. The number of illiterate husbands in this study was also very low. This coincides with the fact that in Dakshin Kannada, the male literacy rate is 93.13% and female literacy rate is 84.13%, more than the national average [18,19].

The study population consisted of 86.4% housewives. One may assume that empowerment and financial independence do not necessarily have a direct impact on the implementation of family planning via IUDs. Primiparas constituted 63.6% of the women. This is similar to the findings of the study in Hubli where 70.5% women were primiparas [14]. However, it differs from a study by Udgiri R et al., where it was found that family planning increased with parity. They postulated that if one’s family is complete, one has a higher chance of using contraception [20]. It is possible that in this study setting, women who completed their families resort to more permanent methods of sterilization rather than using IUDs.

78 participants desired more children, which tells us that a greater number of the subjects were using this as a temporary method of contraception as opposed to 29.1% who were perhaps using this as a long term method.

More than half of the participants had their IUD inserted in the government maternity hospital as opposed to 24.5% in the private tertiary care centre and 21% in the CHC. This could be attributed to the role the family welfare counsellor in LGH played in spreading awareness about this method of contraception.

Almost 71% of the women in this study had had their IUD inserted immediately postpartum which is similar to 82% of the subjects in Kumar S et al., study [15]. This perhaps may be attributed to the fact that insertion is easier at this point, the woman is likely to be highly motivated to accept contraception and she can be persuaded effectively [14]. This is very useful in India as the frequency of these subjects, especially those from a rural setup, to be counselled about family planning after they are discharged postdelivery, is not very high.

A study done in Pondicherry, Tamil Nadu, India states that all men have a favourable attitude towards family planning [21]. This is necessary, as only then can a mutual decision be taken between the couple to effectively use contraceptives; therefore, the wife doesn’t have to try to assert her authority in a male dominated society by fighting for contraceptive use or bear the burden of unplanned pregnancies. In present study, for more than half of the participants, the decision to use IUDs was taken mutually with their husbands. However, we observe that 9.1% still disapproved contraceptive usage. Also, 15.5% of the families were unfavourable towards the same. This shows that there is still some generation gap, with the elders probably not aware of the usefulness of family planning. Out of the 15 women who didn’t discuss IUD usage with their husbands before insertion, 40% were aware that their husband disapproved contraceptive use. Perhaps the reason that they took the decision independently was to avoid disagreement. We can thus speculate that woman emancipation is on the rise. They didn’t depend on their husband’s permission before taking decisions for them and perhaps they understood the importance of contraceptive use for their own well being.

Apart from serving as an effective means of convincing people (37.3% of the participants of this study) to use this method of contraception, health care providers also served as a source of information for 80.9% of the population. This is similar to the findings of a study conducted by Whitaker AK et al., which states that 53.5% of the participants had a favourable attitude towards IUD use, post an educational intervention [22]. We can thus assume that counselling increases awareness and acceptance of family planning and if doctors in all the health care facilities regularly counsel, especially the postpartum patients, the prevalence of contraceptive use would increase.

When the women were questioned about the reasons for use of IUDs, a variety of responses came up, maximum i.e., 75 (68.2%) being for child spacing. This is understandable since IUDs are the most effective long term temporary method of contraception [6]. The other major reason for acceptance was prevention of pregnancy: 32 subjects (29.1%). This was the exact number of subjects who did not desire more children. This suggests that perhaps all these women consider IUD a reliable, long term mean of contraception. The multicentric study by Kumar S et al., showed that 54% of the subjects used the method for child spacing and 46% used it though they did not want any more children [15]. 22% chose it due to the low price and 87.6% preferred it due to its long acting nature.

Majority of the women in this study did not experience any side effects. Of those who did, 61.5% experienced vaginal bleed and 25.6%, abdominal pain. Similar results were found in the study by Gujju RL et al., where 2.1% experienced side-effects, of which 43% was abdominal pain and 12% was vaginal bleed [17]. 38% had string problems as well. The fact that majority of the women experienced no side effects gives us another benefit of choosing IUDs for contraception, over other harmful methods. There was no failure or rejection of IUD reported in this study but this could be due to the fact that only 28.1% of the total participants had their IUD inserted more than six months back.

The present study is confined to only Mangalore city of Dakshin Kannada, Karnataka, India. Present study does not determine why non users have not accepted IUDs as a method of contraception, nor does it take into account the women who had their IUDs removed convenience sampling may lead to selector’s bias.

IUDs are being accepted as an effective method of contraption in Mangalore, mostly since it’s a less cumbersome means of child spacing. Health care providers play an effective role in spreading awareness and convincing women to choose this method. The benefits have so far outweighed the risks. Side effects experienced are few, most common being vaginal bleeding. As the literacy rate in our country increases, and if more health care providers council patients, there is a probability that this contraceptive method will be more prevalent.