Abstract: In India, despite the provision of free intrauterine contraceptive devices (IUCDs), their uptake remains low. This retrospective cohort study conducted at Sree Avittom Thirunal Hospital, South India, evaluates the clinical outcomes and continuation rates of postpartum intrauterine contraceptive devices (PPIUCDs) over a four-year period (2011-2015). The study included women aged 18-45 who had PPIUCDs inserted immediately postpartum or during caesarean sections. Outcomes measured were complications such as pain, bleeding, infection, contraceptive failure, and expulsion, alongside client satisfaction and continuation rates. Findings indicate a significant unmet need for effective contraception during the postpartum period, despite high awareness levels. The common complications observed were pain and menorrhagia, with a notable rate of device expulsion and removal driven primarily by these complications. Client satisfaction was moderate, with approximately two-thirds of participants opting to continue using the PPIUCD. The study underscores the critical need for improved provider training and client education to enhance the acceptance and sustained use of PPIUCDs, potentially impacting maternal health outcomes positively by ensuring effective and timely contraceptive use.