PPIUD Project

Since 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.

What we do

We are now in the final phase of the project, focusing on sustainability. The project ended in India and Sri Lanka in December 2018, Nepal in June 2019, Kenya in September 2019 and Tanzania in March 2020. The project is currently still running in Bangladesh.

Across 48 Referral Hospitals, the project has trained community midwives, health care workers, doctors and delivery unit staff in an effort to institutionalise the practice of balanced counselling on post partum family planning preferably in the antenatal period, followed by training in insertion of PPIUD.

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.

What we have achieved so far

Across six project countries, 9,638 providers have been trained, enabling 701,715 women to receive balanced postpartum family planning (PPFP) counselling. Of these women 74,230 have opted for and successfully received a PPIUD as their chosen method. Please click on the project countries below to find out more.

  • The Kenyan team have trained government community health volunteers on postpartum family planning. They also successfully advocated for the inclusion of PPIUD in the Kenyan Nursing Scope of Practice.
  • In Sri Lanka PPIUD has been formally adopted into government policy, with the government pledging to provide post-partum contraception across all hospitals in the country.
  • In India task sharing between doctors and nurses saw PPIUD insertion rates soar in hospitals.
  • 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 modalities – ‘on the job training (OJT)’ and ‘mentoring through facility twinning', ensuring high quality training for providers without the need for them to leave their workplace.