PPIUD project

FIGO Project for Institutionalising Postpartum IUD Services          

Donor: anonymous

Project Contacts: 
Anita Makins, Project Director
Emily Tunnacliffe, Project Manager

The unmet contraceptive need

885 million women of reproductive age in developing regions want to avoid a pregnancy.
214 million of them have an unmet need for modern contraception.

In countries with an increasing rate of institutional deliveries, the postpartum period
provides an excellent opportunity to deliver family planning services to women who
may otherwise have limited contact with the healthcare system, thereby helping to
address a community’s unmet need for contraception. However, the vast majority of
post-natal women leave facilities without receiving any contraception.

 

Copper IUDs can be used effectively for more than 10 years and, if desired, can be removed easily any time after insertion with immediate return of fertility. They have the lowest rates of discontinuation; are cost-effective; and can be provided by mid-level providers in the long term after suitable training.

This form of long-acting, reversible contraception can be an attractive option for postpartum women as it can be inserted immediately after delivery of the baby – offering a one-stop approach.

What we do

From 2013, FIGO has worked through our national societies in six countries to institutionalise the provision of postpartum IUD (PPIUD) services into routine maternity care. Countries were chosen based on a range of factors including high fertility rates, unmet need for contraception and maternal mortality ratios.

We are now in the final phase of the project, focusing on sustainability.  The project ended in India and Sri Lanka in December 2018 and is still currently running in Tanzania, Kenya, Nepal and Bangladesh.

Across 48 hospitals, the project has trained community midwives, health workers, doctors and delivery unit staff in the effort to institutionalise the practice of counselling on postpartum family planning preferably in the antenatal period, followed by skills in order that insertion of PPIUD can be inserted immediately postpartum.

What we have achieved so far

  • The Kenyan team have trained government community health volunteers
    on postpartum family planning. They are also working to include PPIUD in
    the nursing scope of practice.
  • The team in Bangladesh is working with the government, UNFPA and
    midwifery association to train the newly created cadre of midwives in
    PPIUD counselling and insertion.
  • In Tanzania, through project advocacy, PPIUD is now included in pre-service
    training for healthcare providers.
  • The team in Nepal has developed and implemented two new training techniques –
    On the Job Training (OJT) and mentoring through facility twinning, ensuring quality
    training for the providers without leaving their workplace.
  • The project ended in India and Sri Lanka in December 2018 - click on the links
    to read about their achievements.
 

 

The technique

PPIUD can be inserted immediately postpartum, after either vaginal or caesarean delivery.

Insertion after vaginal delivery can be post placental (within 10 mins of delivery of the placenta) or within 48 hours. Our insertions are carried out using the 33cm long curved Kelly’s forceps for a high fundal placement to ensure a low chance of expulsion.

Intra caesarean insertion is done by hand and under direct vision. We recommend straightening the strings so they lie towards the cervical Os, as this minimises the chances of difficulty visualising the threads at the 6 week follow up.

We do not recommend insertion of PPIUD between 48 hours and 6 weeks postpartum.

Latest news

  
Politics and Family Planning: Nepal Helping Make an Informed Choice Counselling in Bangladesh

 

Project Publications

New supplement available online in the International Journal of Gynecology & Obstetrics, 'Institutionalization of postpartum intrauterine devices'.

Read the latest PPIUD Initiative newsletter (January - March 2019) or access the archive here

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