Background <p>The WHO classification of contraceptive effectiveness placed IUCD in the most effective first tier. The family welfare program, in India, has recently emphasized postpartum IUCD insertion to space childbirth, resulting in reducing childbirth-related complications and a small family norm. However, evidence suggests that the acceptability of PPIUCD is still a challenge in developing countries, though in fully informed woman, PPIUCD is a satisfactory method of contraception. Therefore, the present study will try to find out the factors associated with the acceptance and refusal of PPIUCD which is available free of cost, under the National Family Planning Program in India.</p> Methods <p>This is a cross-sectional study conducted in the Gynecology and Obstetrics Department, over a period of 1 year, from February 2023 to January 2024. Women who delivered, either vaginally or by cesarean section were included in the present study. The categorical variables were expressed as frequencies and percentages. A P value of 0.05 was considered significant.</p> Results <p>Out of 1127 women who delivered and were counseled for PPIUCD as contraception, 32.7% (368) accepted and 67.3% (759) refused it. Of all, 42.5% were from the 20–30 years age group, but acceptance of PPIUCD was seen higher (36.2%) in the 30–40 years age group. The odds of acceptance of PPIUCD were 4.2 times higher in housewives compared to working women [OR = 4.2; 95% CI: 3.2–5.6]. Women with ≥ 4 ANC checkups in recent pregnancy accepted PPIUCD use by 47.2%. 53.2% of women (404/759) cited unawareness of the method as the main cause of refusal.</p> Conclusion <p>More antenatal checkups resulted in higher acceptance of PPIUCD. Preference for another method of contraception and not being aware of PPIUCD are the major contributing factors to its refusal.</p>