Peer Review Report For: Service delivery barriers influencing intrauterine contraceptive device uptake in family planning services in the King Sabata Dalindyebo Sub-district, South Africa: A qualitative study approach [version 1; peer review: 1 not approved]

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Background/Objectives Intrauterine contraceptive devices (IUCDs) are highly effective long-acting reversible contraceptives ; however, their utilization remains low in South Africa, particularly in rural settings of the KSD sub-district. This study aimed to explore professional nurses’ perspectives on health system and service delivery barriers influencing IUCD uptake in primary healthcare family planning services in the Eastern Cape Province. Methods This study used a qualitative, exploratory, descriptive design and included 14 purposively selected professional nurses from 4 community health centers in the King Sabata Dalindyebo subdistrict. Data were collected through semi-structured, face-to-face interviews conducted between September and 30 November 2025. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis following Braun and Clarke’s six-step approach. Results Three key themes emerged from the interviews as barriers to IUCD utilization in family planning services: limited knowledge and clinical competence, positive but conditional attitudes, and constrained clinical practices. Most participants (n = 9) reported receiving only informal IUCD training, while three had no training and only two had formal training. Knowledge gaps included uncertainty regarding insertion procedures and management of complications. Although nurses generally expressed positive attitudes towards IUCDs and recognized their effectiveness, a lack of training reduced confidence in recommending and providing the method. Conclusions Despite favorable attitudes, significant gaps in training, competence, and health system support limit IUCD service provision. Strengthening structured training, improving resource availability, and addressing organizational barriers are essential to enhancing nurses’ capacity and improving access to IUCD services in primary healthcare settings. Recommendation Enhancing structured pre-service and in-service training for Professional nurses on IUCDs is crucial to improving clinical competence and confidence in delivering health care services. Health systems should focus on ensuring adequate staffing, necessary equipment, and effective supervision to enhance the availability and quality of IUCD services in community health settings.

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