# Postpartum Intrauterine Device Removal and Access to Removal in the 18 Months Following an Intervention in Tanzania, Sri Lanka, and Nepal

## TL;DR

This study examines barriers to removing postpartum intrauterine devices in Tanzania, Sri Lanka, and Nepal, finding that many women face obstacles to discontinuing this form of contraception.

## Contribution

The study provides new empirical evidence on structural barriers to LARC removal in three Global South countries.

## Key findings

- About 75% of participants still had their PPIUD in use 18 months post-insertion.
- 22% of participants sought removal, and 25% of those faced barriers, mostly provider-imposed.
- Barriers to LARC removal are linked to public health goals promoting contraceptive uptake.

## Abstract

Family planning programs in the Global South promote long‐acting reversible contraception (LARC), but research suggests that women face barriers to LARC discontinuation, inhibiting their reproductive autonomy. Scholars have called for improved data visibility around LARC removal access. We use data from the Postpartum Intrauterine Device (PPIUD) Study, a randomized trial of a PPIUD intervention conducted in Nepal, Sri Lanka, and Tanzania from 2015 to 2018. Among women who adopted PPIUDs, we describe PPIUD status (in‐use, expelled, deliberately removed) at three follow‐up points. We report the proportion of participants who sought PPIUD removal and, among those, whether they faced barriers to removal. About three‐quarters of 5370 participants had their PPIUD in use 18 months following insertion; one‐fifth had their PPIUD deliberately removed, and 6 percent had their PPIUD expelled. Of the 22 percent of participants who sought PPIUD removal, a quarter faced a barrier to removal; most barriers were provider‐imposed. In conjunction with existing literature, our findings highlight that barriers to LARC removal are structural, rooted in larger public health and demographic goals that aim to promote contraceptive uptake. We call for safeguards to ensure that people who desire LARC removal can discontinue their method.