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Background: Immediate postpartum CuT380A intrauterine contraceptive device (PPIUCD) insertion provides a novel approach in reducing the unmet contraceptive needs of postpartum women within the first twelve months of delivery. It is a long acting reversible contraceptive method that is cheap, convenient and safe during breast feeding. It also promotes early return to sexual activity. Evidence from literatures has shown that immediate PPIUCD insertion either at caesarean section or following vaginal delivery, is a relatively safe practice, with few complications. There are few studies on immediate PPIUCD insertion in our environment and none has compared the clinical outcomes with respect to route of insertion. Aim: This study seeks to compare the clinical outcomes of immediate PPIUCD insertions at caesarean and within 10 minutes of vaginal delivery, and to address potential complications. Methodology: This study was a comparative cohort study of eighty one pregnant mothers who were recruited into two groups; 27 mothers in the caesarean delivery group and 54 mothers in the vaginal delivery group. They were selected into both groups using a convenient sampling technique during the antenatal clinic and early labour. The mothers were followed up till the six weeks postnatal visit after PPIUCD insertion. Information on their socio-demographic characteristics, obstetrics and gynaecology history were obtained with the aid of a proforma. This proforma was updated with the clinical outcomes of immediate PPIUCD insertions in the two groups, at the six weeks visit. Data obtained were analysed using statistical package of social sciences version 21. Continuous variables were expressed as means and standard deviations. The Chi square test was used for dichotomous or categorical variables. A p-value of less than 0.05 was considered statistically significant.