An Epidemiological Study On IUD's Downward Dislocation In Chinese Rural Users

Objective: To explore the issue of IUD's downward dislocation in China's users andits influential factors, thus promoting the effectiveness of IUD.Method: The study is part of a national tenth five-year IUD project. Theories andmethods of descriptive and analytical epidemiology are used in research design. Baseon stratified cluster random sampling, 18922 IUD users in rural areas are selected asthe study subjects. Statistical softwares such as SPSS11.5 and WHO-developed LTA,are employed in data analysis, especially survival analysis.Results: (1) IUD users are 27.71 years old on average with a majority below 30, atthe range of reproductive ages. Nearly 70% of them have had junior school educationor above. The major pregnancy outcomes on the latest occasion include vaginal birth(62.48%) and Caesarean birth (17.58%). Most have experienced the initial delivery(85.57%). Subjects who have used IUDs only once account for 61.76% of the total,those who used IUD twice constituting 29.64%, and three times and above 8.71%. (2)The primary number of IUDs are inserted in township-level family planning facilities.The types of IUDs used fall into the category nationally prescribed. Active roundIUDs left outside of national IUD procurement category, however, are widely used.Inertia IUDs are still being used in individual areas, though forbidden by nationalpolicy. IUD-inserting practitioners have operations in certain physiological periodswhich comply with the national protocols. (3) Among reasons contributing to IUD usefailure, downward dislocation is a major one. The total failure rate rises from less than1/6 to approximately 1/4. The cumulative downward dislocation rate goes up overtime. The rates in 1, 3, 6, 12, 18, and 24 months come to respectively 0.10(0.05～0.14),0.37(0.29～0.46), 0.80(0.67～0.92), 2.34(2.12～2.56), 3.62(3.30～3.94), and4.12(3.50～4.73). The possible reasons responsible for IUD downward dislocation include local geography and economy, age, uterus position, menses period, degree ofdysmenorrhea, pregnancy outcome on the latest occasion, number of inserting IUD,type of IUD, and IUD-inserting facilities.Recommendations: In order to put national family planning policy into effect,promote women with reproductive age, and ensure the effectiveness of IUD, furtherresearch is needed to examin IUD downward dislocation. In terms of current situation,the following suggestions are developed: to help women choose appropriate IUDsaccording to their features, and to take advantages of township-level family planningfacilities.