FACTORS AFFECTING THE UTILIZATION OF INTRAUTERINE DEVICE (IUD)

AMONG WOMEN AGED 15-45 YEARS IN WANDAGO BUYENDE DISTRICT

BY

KIRABO STELLA

UAHEB/109/028/18

A RESEARCH PROPOSAL SUBMITTED TO UGANDA ALLIED HEALTH

EXAMINATION BOARD IN PARTIAL FULFILLMENT

OF THE REQUIREMENT FOR THE AWARD OF A

DIPLOMA IN CLINICAL MEDICINE AND

COMMUNITY

HEALTH MILDMAY

INSTITUTE OF HEALTH

SCIENCES

P.O.BOX 24985

LWEZA, KAMPALA

SEPTEMBER, 2021
 i.

DECLARATION

I, Kirabo Stella, declareStella declare that this is my research proposal, was done out of my

efforts under the guidance of my supervisor Mr. Mukasa Isaac, and is an original version which

has never been submitted for any award of a Diploma in clinical medicine and community

health.

Signature …………………………………. Date…………………………………….

Kirabo Stella (Researcher)

 APPROVAL

I, Mr. Mukasa Isaac affirm that this research proposal was compiled by Kirabo Stella under my

supervision and guidance. I have read it and therefore recommended it for examination of the

research project proposal for the award of diploma in clinical medicine and community health.

Signature………………………………………. Date…………………………………….

Mr. Mukasa Isaac (Supervisor)

 LIST OF ABBREVIATIONS

UBOS: Uganda Bureau of Statistics

UG: Uganda

PMA: Performance Monitoring and Accountability

IUD: Intrauterine device

IUC: Intrauterine contraceptive

WHO: World Health Organization

LARCs: Long acting reversible contraceptives.

WRA: Women of reproductive age.

MMR: Maternal Mortality Rate

 OPERATIONAL DEFINITION OF KEY TERMS

Affecting: Evoking a strong emotional response

Age: The length of time during which a being or thing has existed.

Among: In or through the midst of.

Factors: One of the elements contributing to a particular result or situation.

Utilization: The action of making practical and effective use of something.

 TABLE OF CONTENTS.

DECLARATION i

APPROVAL ii

LIST OF ABBREVIATIONS iii

OPERATIONAL DEFINITION OF KEY TERMS IV

TABLE OF CONTENT v

CHAPTER ONE: INTRODUCTION 1

1.0 Introduction 1

1.1 Background 1

1.2 Statement of the problem 3

1.3 General objective 4

1.4 Specific objective 4

1.5 Research questions 4

1.6 Scope of study 5

1.7 Significance of study 5

CHAPTER TWO: LITERATURE REVIEW 6

2.0 Introduction 1

2.1 The socio-demographic factors affecting the utilization of IUD among women aged 15-45

years 6

2.2 The attitude of women aged 15-45 years towards the utilization of IUD 9

2.3 The client related factors affecting the utilization of IUD among women aged 15-45 years

CHAPTER THREE: METHODOLOGY 16

3.0 Introduction 16

3.1 Study design 16

3.3 Study population 16

3.4 Selection criteria 17

3.4.1 Sample size determination 17

3.4.2 Sampling Technique 17

3.4.3 Inclusion Procedure 17

3.4.4 Exclusion procedure 17

3.5 Definition of Variables 18

Dependent variable: In this study, the dependent variables shall refer to utilization of IUD among

women aged 15-45 years 18

3.6 Research instruments 18

3.7 Data Collection Procedure 18

3.7.1 Data Management 18

3.7.2 Data Analysis 19

3.8 Ethical Consideration. 19

3.9 Study Limitation 19

3.10 Dissemination of results 20

REFERENCES 21

APPENDICES 25

Appendix I: Consent form 25

Appendix II: Questionnaire for clients 26

Appendix IV: Research Budget 35

CHAPTER ONE

INTRODUCTION

1.0 Introduction

This chapter presents the background of the study problem, statement problem, general

objectives, specific objectives, research questions, justification of the study, scope and

significance of the study.

1.1 Background

Family planning refers to a conscious effort by a couple to limit or space the number of children

they have with contraceptive methods (UDHS, 2016). Contraceptive methods are classified as

modern or traditional methods. Modern methods include female sterilization, male sterilization,

the pill, the Intrauterine Contraceptive Device (IUCD), implants, male condoms, female

condoms, emergency contraception, and Lactation Amenorrhea Method (LAM) (UDHS, 2016).
Globally, 14.3 % of women of reproductive age use intrauterine contraception (IUC), but the

distribution of IUC users is strikingly nonuniform. In some countries, the percentage of women

using IUDIUC is < 2%, whereas in other countries, it is > 40%. Reasons for this large variation

are not well documented. The aims of this review are to describe the worldwide variation in IUC

utilization and to explore factors that impact the utilization rate among women of reproductive

age in different continents and countries. (Kai J Buhling et.al, 2014)

The Copper IUD is safe and effective, but underutilized in Sub-Saharan Africa, in part because

of lack of trained providers. The World Health Organization recommends training mid-

levelmild-level providers including nurses and midwives to insert IUDS, However, the safety of

such task shifting has not been evaluated in Sub-Saharan Africa (Felix G Mhlanga et.al, 2019).

UgandaIn Uganda with a population of 47,442,314 million people, and has one of the highest

population growth rates in the world i.e. 3.6% per year (UBOS 2014). Its total fertility rate of 4.7

children per woman as 0f 2021 which is also one of the highest in the world despite a reduction

of 2.4% in 2020 (World Bank 2016).

About 42.6% of recent births were unintended, thatunintended that is to say, 27.7% of women

wanted a child later and 14.9% did not want another child (UBOS 2012, PMA 2015).

An almost –equal share of current contraceptives users in the country obtain their methods from

public and private sectors: 47% from public facilities, which provide free family planning

services and 45% from private providers. Public facilities tend to offer more contraceptive

methods than private providers for example, in 2015 39% of public-sector facilities had

IUDsfacilities IUDs in stock, compared with 7 % of private providers, and 48% and 12%

respectively had implants in stock (UBOS 2012).

In the past five years the unmet need for family planning in Uganda decreased modestly from

34% of women of reproductive age (WRA) ages 15-45 in 2011 to 30% in 2015. Use of modern

contraceptive methods increased from 26% to 32% during the same period, and the use of long-

acting reversible contraceptives (LARCs) comprising of implants and the intrauterine device

(IUD) which increased from 6% to 9% of total modern method use (PMA 2015)

…………………………………………………………

Worldwide, about 830 women die from pregnancy- or childbirthchild birth related

complications every day (World Health Organization, 2018). Out of these 99% occur in

developing countries including Uganda (WHO, 2018). Although the risk of women dying during

childbirthchild birth is declining around the world, in Sub-Saharansub-Sahara maternal mortality

and morbidity is still high (WHO 2015).

Globally, one of the major causes of maternal mortality is abortion which is estimated to be at

7.9% (Global health, 2014). Lack of family planning leads to unintended pregnancies which in

turn result into unsafe abortions (Dragoman et al., 2014).

Family planning reduces women’s health risks as a result of abortion, hemorrhage, uterine

perforation, cervical injury, medical complications which lead to death and infections due to

incomplete abortion. This helps in reduction of maternal morbidity, mortality and slows

population growth. However, only 14.3% of women of reproductive age are using intra uterine

contraceptivescontraceptive worldwide. It is lower in developed countries which stands with

only 7.6% and in Africa Intra Uterine Device (IUD) use is only at 4% of women of reproductive

age and this distribution is still reasonably very low as compared to the number Women of

Reproductive Age (WRA) (Buhling, Zite, Lotke, & Black, 2014).

Much as efforts is put through different programs about Long Acting Reversible Contraceptive

(LARC) family planning methods to increase their uptake (WHO, 2015). In Uganda IUD use is

still low, it was 0.2% in 2006 slightly increased to 0.4% in 2011, and there is a gradual increase

from 0.6 % in 2014 to 1.1% in 2016 (UDHS, 2016). Although there is a slight increase, IUD use

is still very low despite its effectiveness, long lasting and need no mother‟s adherence. And this

has reduced thereduced on the numbers of maternal morbidity and mortality rate through

avoiding unintendedun intended pregnancy (Rowe, Farley, Peregoudov, Piaggio, & Boccard,

2016). A study done by (Twesigye, Buyungo, Kaula, & Buwembo, 2016) showed most women

reported negative attitudes, misconceptions and misinformation about IUD as compared to

positive attitudes. Therefore, in this qualitative study there is need to understand why there is low

uptake of IUD

contraceptives by listening to women's experienceswomen experiences while using IUDs and

what exactly preventsprevent them from using them.

1.2 Statement of the problem

Uganda is one of the countries with a highwith high Maternal Mortality Rate (MMR) of 336

maternal deathsdeath per 100,000 live births. This could be due to unintended pregnancies hence

leading to major complications like abortion and hemorrhage.

However, efforts have been made to scale up family planning through training of healthcare

providers and providing long acting reversible contraceptives (LARCs) method to improve on

the acceptability of IUD services.

Despite the comprehensive efforts by MOH to increase IUD uptake, it has continued to be very

low 1.1% with about 10% of early discontinuation in the first 90 days of insertion (UDH, 2016).

With the health system effort in perspective, there is a needis need to understand different

barriers, socio-demographic and client related factors affecting IUD utilization.

……………………………………………………..

The fertility rate in Uganda 5.71 children born per woman (UBOS, 2017) and the maternal

mortality rate of 343 deaths per 10,000 live births (UNICEF, 2015). The high mortality rate

could be due to unwanted pregnancies, short birth intervals and a high risk of obstetric

complications associated with low contraceptive use (Nalwadda et al 2010). Uganda

demographic and health survey showed high level of unintended pregnancies (44%) with unsafe

abortion estimated to be 62 per women of age between 15-45 years which accounts for 26% of

maternal deaths in Uganda.

Like other districts in the country, Buyende district through the Ministrythrough Ministry of

Health (MOH) has availed efforts scaling up family planning in reaction to unwanted

pregnancies. Different strategies have been established in the publicin public sector as

interventions through training providers per selected facility. In addition, one reproductive health

focal person per district in IUD service delivery and use of community extension workers have

also been recognized to help those not accessing the IUD services due to economic, social and

geographical areas (MOH,2014).

Despite the comprehensive efforts by the MOH to increase IUD uptake, it has continued to be

very low i.e. 1.1% with about 10% early discontinuation in the first 90 days of insertion (UDHS,
2016). With this health system effort in perspective, there is a needis need to understand the

factors hindering the utilization of IUD among women aged 15-45 years in wandago Buyende

district.

…………………………

Uganda is one the countries with the high Maternal Mortality Rate (M R) of 336 maternal

deathsdeath per 100,000 live births. This could be due to unintended pregnancies hence leading

to major complications like abortion and hemorrhage.

However, interventions have been made to reverse the high maternal death, such as the long

acting reversible contraceptive (LARC) such as IUD has been proposed in developing countries.

Despite providing the necessary contraceptives, Uganda still has low use of IUD among women

of reproductive age at 0.6% and the discontinuation rate in the first 3 months of use is high.

This is due to myths associated with the use of IUD where most women in Uganda are aware of

its existence however they have incorrect information about IUD. Some women think that it can

damage their wombs or make them infertile whereas others think that it reduces sexual pleasure

and it can also cause cancer.

Also some women didn’t think that this method was available in the nearby health facilities.

Therefore there is a need for this study to be carried out becausecarried because the use of IUD

in Uganda is increasing but still low, so to further increase access to and use of IUD, couples

need accurate information about the benefits and risks of IUD. The information can come

through interpersonal communication, through trained providers and in mass media in order to

protect women's healthwomen`s health in Uganda and promotepromoting the demand for their

safety and effective contraceptive method in context of wide method choice as the priority.
1.3 General objective

The purpose of this study is to assess factors influencing the utilization of IUD among women

aged 15-45 years in Wandago Buyende District.

1.4 Specific objectives.

1) To find out the socio-demographic factors affecting the utilization of IUD among women aged

15-45 years in Wandago Buyende District.

2) To identify barriers to utilization of IUD among women aged 15-45 years in Wandago

Buyende District.

3) To assess client related factors affecting the utilization of IUD among women aged 15-45

years in Buyende District.

1.5 Research questions.

1) What are the socio-demographic factors affecting the utilization of IUD among women aged

15-45 years in Wandago Buyende District?

2) What are the barriers influencing the utilization of IUD among women aged 15-45 years in

Wandago Buyende District?

3) What are the client related factors affecting the utilization of IUD among women aged 15-45

years in Wandago Buyende District?

1.6 Significance of the study

The study findings will be helpful to health care providers in mobilizing and sensitizing women

aged 15-45 years on facts concerning IUD.

The study findings will be essential to the district health team in rationalization and coordinating

activities to improve on utilization of antenatal care service

The study outcomes will be useful to the ministry of health for policy making and

implementation of all matters associated with utilization of IUD in the country as a whole.

It is also assumed that the findings will provide literature for future researchers who will want to

carry out similar studies.

The research study is a partial requirement for award of a diploma in clinical medicine and

community health.

1.6 Justification

This study adds to the understanding of the barriers to utilization of IUD

contraceptivescontraceptive and factors responsible for the highfor high rate of premature

removal inremoval of in Uganda as well as experiences being faced by women using them.

Exploring both positive and negative experiences might contribute to development of appropriate

programs, health talks or out reaches to strengthen IUD use since most of the women largely

depend on opinions and experiences of friends and family when making reproductive health

decisions (Gedeon et al, 2015)

There is a great need to reduce the high mortality rate of 336 deaths per 100,000 live births and

infant mortality rate of 54 deaths per 1000 live births. This can bebeen done by reducing the high

unmet need of family planning currently at 28%, unplanned pregnancies of 44% and total

fertility rate of 5.8% to a reasonable percentage among women aged 15-45 years. IUD is a long
term method, highly effective, safe and convenient to use. However, there is need to address

unintended pregnancy that leads to abortion and its complications.

1.7 Scope of the study

This study will be limited to factors affecting the utilization of IUD among women aged 15-45

years, it will be carried out in Wandago community located in eastern Uganda in Buyende

district and it will be conducted for three month

CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

This section will review the literature of other authors in relation to the objectives as socio-

demographic and women`s attitude towards the utilization of IUD between ages 15-45 years.

2.1 The socio-demographic factors affecting the utilization of IUD among women aged 15-

45 years.

Uganda is the third fastest growing country in the world. Contraceptive use is low and the unmet

need for family planning is high. A study to find out the unmet need in Uganda from 1995 to

2016 used data from three consecutive rounds of the Demographic and Health Surveys (UDHS,

2016). This study gives levels, trends and factors associated with the unmet need as well as

reasons for contraceptive nonuse and the likely impact of reducing unmet want. The result shows

that the unmet want is highest among currently married women and women in rural areas.
The unmet want was hiking among the all women age group including married women, sexually

active women plus never married but sexually active women (Bradley, 2012). The report further

showed that the unmet need had remained steady at low levels among never married women and

formerly married women. The unmet need for spacing is more prevalent than for limiting.

Women with unmet need for spacing and limiting both tend to have more than two living

children (United Nations Population (UNPD, 2005).

Women with unmet need for spacing are more likely to lack employment compared to women

with unmet need for limiting who tend to be older and live in rural areas. The total unmet need is

associated with higher parity, thatparity that is two or more children livingchildren and living in

the northernin northern region. Substantial proportions of women don’t use and don’t intend to

use contraception in future due to the fear of side effects and opposition from the husband or

partner. Based on the statistical models, modest declines in unmet need and increases in

contraceptive prevalence in Uganda can substantially reduce the country's total`s total fertility

rate (UNPD, 2005).

2.2 Barriers influencing utilization of IUD among women aged 15-45 years in wandago

Buyende district.

Numerous studies have been conducted in several parts of the world to examine the different

obstacles associated with IUD use in WRA. Through these studies, it is revealed that many

obstetricians-gynecologists still do not considercontemplate the IUD as an appropriate

contraceptive method for some groups of women such as adolescent and nulliparous (Luchowski

et al.,2018). Unintentional pregnancies are more observed in adolescents and even their
knowledge and experience towards postpartum insertion is limited (Luchowski et al., 2018). Yet

in another study it was discovered that most clinicians advocated for those with high efficacy but

these had unpredicted irregular bleeding which happened in the first year of insertion (Weisberg,

Bateson, McGeechan & Mohapatra, 2014)

In a study steered among homeless young women showed narrow knowledge about LARC

methods. Pain, complications and reproductive pressure were also a big problem (Dasari et al,

2016). Nevertheless, it was observed that the main concerns were; women professed providers

deliberately choose to leave out some key information about the side effects or likely

complications in order to entice them to select the contraceptive and women had no clear

information about the early discontinuation of LARC. Women also exhibited a strong desire in

visual aids to help them understand better which should be accompanied by verbal counseling

done by health providers (Dasari et al, 2016)

A study conducted on female undergraduates at a large mid-western university in USA revealed

that women`s perceived knowledge was as low as compared to measured knowledge (Stidham et

al., 2018). This indicated misperceptions about side effects, pain, serious health problems and

how eligible the method is. Most women were not aware of the presence of LARC and also

women preferred having a self-controlled method and never wanted a foreign object in their

bodies (Stidham et al., 2018).

Another study in Uganda showed that some of the negative factors that affect contraceptive use

among young people were irregular contraceptive stocks, poor service organization, and the

limited number of trained personnel, high costs and unfriendly service. This study showed that

most providers were not competent enough to provide long acting methods, misconceptions

about the contraceptives, negative attitude towards the provision of contraceptives to young
people but hadh ad no evidence based on age restrictions and consent requirements which

revealed that most providers were not prepared and were just not in position to render young

people contraceptives. Again in theon the same study, short acting methods were considered

acceptable for young married women and those with children instead of LARCs (Nalwadda,

Mirembe, Tumwesigye, Byamugisha & Faxelid, 2011).

A different study done in France reported very women with future childbearing being current

users of IUD, this was because of fear to return quickly fertility as a misconception and also the

need to always see a health worker for insertion and removal was alarming and even the

physician themselves being reluctant in providing IUD to nulliparous women (Moreau, Bohet,

Hasson, Ringa & Bajos, 2014).

Despite their safety and efficacy, IUD utilization in Uganda is still low at 1.1% (UDHS, 2016)

due to high discontinuation rates in the first three months at 10% and 4.5% being

expelledexpelled out (Reiss, Nantayi, Odongo & Ngo, 2012). Furthermore, another study done in

Rubaga division showed that women had higher knowledge about LARCs but it was more about

myths and misconception which shows a gapgape in knowledge and this reveals that very low

uptake and so more studies need to be carried out since this study was done in just a portion of

urban area and thus the results are not reliable (Anguzu et al, 2014). In addition, previous studies

carried out in USA indicated myths and side effects as the major barriers to LARC methods

(Nelson & Massoudi, 2016) however, these studies were not specific for IUDs use in Uganda

thus more qualitative studies are needed to understand deeply what really cause the low uptake.

2.3 The client related factors affecting utilization of IUD among women aged 15-45 years in

wandago Buyende district.

General information on family planning

In the whole world, there was an increase in contraceptive use from 1990-2010 as (54.8%

63.3%) and the unmet need for family planning decreased from 1990-2010 i.e. 15.4%-12.3%

(Alkema, Kantorova, Menozzi, & Biddlecom, 2013). The same study showed small increases in

contraceptive use in Africa and Uganda as 17.4%-30.9% ,6.9% -28.4% respectively but this is

stillthis still very low.

Worldwide, about 26% of WRA die as a result unwanted pregnancy due to major complications,

unsafe abortion being one of them and this accounts for 39 abortions per 1000 in women aged

15-49(UNICEF, 2015). This implies that there is a high unmet need for family planning (FP) as

well as high contraceptive discontinuation rate which contribute to the high fertility rates that in

part are due to unplanned pregnancies (Kibira, Muhumuza, Bukenya, & Atuyambe, 2015).

Studies show that in Sub-Saharansub-Sahara almost all maternal deaths can be prevented

(UNICEF DATA, 2017), emphasizing LARC which includes IUDs has been proved to be highly

effective method of contraceptive which does not depend on woman‟s motivation and

adherence, allows rapid return to fertility, prevent against endometrial cancer (Stoddard, 2013).

Experiences of using IUD

A recent quantitative study carried out to examine the qualities of a contraceptive that make

them attractive or unattractiveun attractive to the users revealed that most LARC users were

satisfied with their chosen method at 3 and 6 months follow up; however, increased cramping,

bleeding volume and bleeding frequency was associated with decreased short-term satisfaction

(Diedrich et al., 2018) similarly , in another study (Coombe, Harris, & Loxton, 2016) pain ,

bleeding problems, expulsions, and the where its located in the body were commonly reported
as negative effects , more women continued to use IUD at one year however several of these

women discontinued due to the side effects and pregnancy with the IUD in place. Women who

had removed IUD in addition to the above effects cited symptoms like; vaginal discharge, yeast

infections, UTI, cramping and these didn’t match their expectations because they were more

severe, lasted for so long than expected (Amico, Bennett, Karasz, & Gold, 2016)

It was also found that Nulliparous women were less likely to use an IUD despite of their

efficacy, not interrupting sex ,being cost effective and discrete (Coombe et al., 2016) majority of

women were interested in IUD self-removal ,and having this option increased their likelihood of

recommending the method to others (Diana et al., 2014; Foster et al., 2014), these studies are

more like other results which revealed less advocate for IUD use in nulliparous women who are

more likely to keep IUD in as compared to the multipara women whom discontinue earlier

(Dickerson et al., 2013). Women were also unclearun clear about where within the reproductive

tract an IUD was placed and whether the partners would be able to feel it during intercourse

(Ferguson et al., 2015). This study evidenced the low knowledge about IUDs and interest in this

method was not greatly improved by the provision of information (Fleming et al., 2010).

In some other study Perceived benefit of using LARCs was protection against pregnancy for a

long period of time but this did not stop them from raising concerns like discomfort with the IUD

inside, lack of self-control over it as its only depended on health work during insertion and

removal, wondering where exactly the IUD is placed all expressed the gap in knowledge (Rubin

& Winrob, 2010).

Although women were concerned with the potential side effect, There was a number one benefits

noted by women; ease to use; they would not have to think about these contraceptive methods

every time or remember to take them every day like pills, were able go back to their regular
periods or not having periods at all and having no worries that one is pregnant (Spies, Askelson,

Gelman, & Losch, 2010) while another study showed women’s concerns being pelvic

discomfort, heavy bleeding ,spotting and irregular periods, cramping, and so many others had

tempted to remove the IUD by themselves yet others who were satisfied and preferred a

professional worker to remove it (Foster et al., 2014).

CHAPTER THREE

METHODOLOGY
3.0 Introduction

This chapter presents the method that will be used by the researcher to collect data, it comprises

of the research design, study population, sample size, study setting and rationale, sampling

techniques, data collection method, definition of variables, data management, data analysis,

ethical consideration, study limitation and dissemination of results.

3.1 Study design.

The researcher intends to use cross-sectional design employing a quantitativeemploying

quantitative approach. The cross-section design is appropriate for this study because of the short

time provided for conducting research at this level of education.

3.2 Study area

The study will be conducted in Wandago parish, Bugaya sub county in Buyende district along

Kamuli-Namwendwa road which is 98.1km away from Kampala.

3.3 Study population

The study population consistsconsist of women aged 15 -45 years who use IUD in wandago

Buyende district.

3.4 Selection criteria

3.4.1 Inclusion criteria

All women aged 15-45 years in wandago community and consent to participate will be enrolled.

All mothers aged 15-45 years

Women eligible for IUCD insertion according to medical eligibility Criteria.

3.4.2 Exclusion criteria

All women aged 15-45 years in wandago community who don’t consent.

3.5 Definition of variables

3.5.1 Independent Variables

In this study, the independent variables shall refer to factors affecting utilization of IUD among

women aged 15-45 years.

3.5.2 Dependent variable: In this study, the dependent variables shall refer to utilization of IUD

among women aged 15-45 years.

3.6 Sample size determination

The sample size was calculated using Yamane (1967) for descriptive studies where a fraction of

the accessible population is considered.

N
N=
1+ N ( e ) 2
Whereby

N= is the population size of women aged 15-45 years who utilize IUD on average (120) women

in wandago, Buyende district.

e= precision (5%)

120
N=
1+ 120 ( 0.05∗0.05 )
120
=N=
1+ 12O∗0.0020
120
=N¿
1+ 0.24
 120
= N=
1.24
= 96.77

Therefore, the sample size of 97 respondents will be considered

3.7 Sampling Technique

The respondents will be selected using a simpleusing simple random sampling method whereby

97 small equal sized papers will be labeled 1 to 97 and the remaining 23 papers will not be

numbered. The papers will be folded and each participant will be allowed to pick without

replacing until completing days for data collection. Those who will pick non-numberednone

numbered papers will not be interviewed.

3.8 Reliability and validity of the tools

The researcher intends to use pretest questionnaires and training of the participants on how the

research is to be conducted.

3.9 Data collection methods

39.1 Data collection procedures

The permission letter will be written by the Principal Mildmay Institute of Health sciences to be

delivered to the chairman LC1 busooko-bubale in wandago community, Bugaya sub-county in

Buyende district. The chairman LC1 will thereafter write an authorization letter to the researcher,

which later will be presented to the participants seeking for their consent to conduct a study on

factors affecting utilization of IUD among women aged 15-45 years in wandago Buyende

district.
The researcher will clarify ethical issues of the study and seek for their consent to contribute in

the study and after consent eligibly selected participants will be interviewed.

3.9.2 Data collection tools

A semi-structured questionnaire will be used for collecting data consistingcomprising of both

open and closed ended questions that will be answered by women aged 15-45 years.

3.10 Data quality control

The questionnaire will be pretested among few respondents to check the follow of questions and

minimize ambiguity. One on one interviewsinterview will be conducted after a thorough

explanation of the study. Post interviewsinterview will be done under observation of the

principal researcher, gaps will be identified and corrected there and the results will be

summarized in the tables for the demographic information and the rest will be analyzed by SPSS

version 20.

3.11 Data analysis and interpretation

Data will be analyzed using Microsoft Excel 2016. Descriptive statistics will be used and will

include frequencies, percentages, mean and median will be summarized using tables and graphs.

3.12 Ethical consideration

The research proposal will be approved by the Principal of Mildmay Institute of Health Sciences,

an introductoryintroductory letter will be obtained from the principal to be presented to the LC1

Busooko-Bubale in wandago who will allow the researcher to conduct the study.

An informed consent will be obtained from the respondents who will be assured of

confidentiality as the study will have no legal implication.

3.12 Study Limitation

The study limitation may include;

Limited period given: This will be solved by scheming a timescheming time table to follow and

which will be adhered totoo.

Financial constraints: Timely saving basedbasing on the project budget will be done.

Participants requesting for money: Proper explanation will be given to respondents.

Failure of participants to respond to questions or give inappropriate and inadequate information

during interviewing time. This will be solved by making a favorable physical and psychosocial

interviewing atmosphere.

3.13 Dissemination of results

The complete copies will be disseminated to;

Uganda Allied Health Examination Board (UAHEB)

Mildmay Institute of Health Sciences

Researcher`s supervisor`s copy

Researcher`s copy
 REFENCESS

Alkema, L., Kantorova, V., Menozzi, C., & Biddlecom, A. (2013). National, regional, and

global rates and trends in contraceptive prevalence and unmet need for family planning

between 1990 and 2015: a systematic and comprehensive analysis. The Lancet, 381(9878),

16421652. doi:10.1016/S0140-6736(12)62204-1

-7- Anguzu, R., Tweheyo, R., Sekandi, J. N., Zalwango, V., Muhumuza, C., Tusiime, S., &

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APPENDICES

Appendix 1: consent form

My name is Kirabo Stella, a student of Mildmay Institute of Health Sciences and I am carrying

out a study on factors affecting the utilization of IUD among women aged 15-45 years in

wandago Buyende district.

You agree that you have willingly consented to participate in the study and all the information

you give will be kept confidential. You still have a right to discontinue participation in this study

at any time.

I have explained the purpose and objectives of the study to participant, and they seem to have

understood and voluntarily consented to participate in the study.

Kirabo Stella (Researcher)

Signature………………………….Date………………………

The study purpose has been fully explained to me and I have understood and voluntarily agreed

and consented to participate in the study.

Respondents’ Signature……………………………Date……………………………..
Appendix 11: Questionnaire for clients

Questionnaire`s No. ……………….

Dear respondents, this study is mainly for academic purposes and is looking forward to establish

the factors affecting utilization of IUD among women aged 15-45 years in wandago, Buyende

district. Be certain that confidentiality will remain utmost.

Section A: Demographic data

Instruction: mark in the box against an appropriate response (s)

1) Age

a) 15-25 1

b) 25-35

c) 35-45

2) Religion

a) Catholic

b) Anglican

c) Muslim

d) Others specify…………….
 3) Residence

a) Rural

b) Urban

4) Occupation

a) Employed

b) Unemployed

c) Others specify

5) Education

a) Primary

b) Secondary

c) Tertiary/ University

6) Are you married?

a) Yes

b) No

7) If yes, what is the education level of your partner?

a) Primary

b) Secondary

c) Tertiary/ university

Section B: The socio-demographic factors affecting utilization of IUD among women aged

15-45 years in wandago Buyende Districts

1) Are you married?

a) Yes

b) No
 c) Single

2) If yes, how many children do you have?

…………………………………………………………………

3) Does your religion allow use of IUD?

a) Yes

b) No

c) I don’t know

4) what does the community think of IUD?

………………………………………………………………………

5) Have you ever used any other family planning method except IUD?

a) Yes

b) No

6) Do you know any misconception associated with the use of IUD?

a) Yes

b) No

c) I don’t know

7) If yes, can you mention some of the misconceptions?

……………………………………………………………………….

Section C: The barriers affecting the utilization of IUD among women aged 15-45 years in

wandago Buyende district.

1) Do you understand the term IUD?

 a) Yes

b) No

2) If yes, would define it?

……………………………………………………………………………..

3) What do your friends and health providers think about IUD in this

community?

…………………………………………………………………………………

4) What do you think are factors preventing women aged 15-45 years from using

IUD?

………………………………………………………………………………………..

5) Are there more things you would like to share with me on IUD?

a) Yes

b) No

Section D: The client related factors affecting utilization of IUD among women aged 15-45

years in wandago Buyende district.

1) Have ever used IUD?

a) Yes

b) No

2) If yes what was your experience?

………………………………………………………………………………..

3) IUD affects periods.

a) Yes

b) No
 c) I don’t know

4) Can a lady have sex while having IUD?

a) Yes

b) No

c) I don’t know

5) Can IUD protect a woman from STI?

a) Yes

b) No

c) Not sure

6) What do you say on IUD use and weight gain?

……………………………………………………………………………..

THANK YOU