PPIUD project

FIGO Project for ‘Institutionalising Post-Partum IUD Services in six countries’              

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.

If a woman is able to choose to space her pregnancies, she experiences better
health and social outcomes, for herself and her children. Birth spacing allows
for substantial reductions in maternal and neonatal morbidity and mortality. It
gives the woman time to take better care of herself and her children, and
potentially to contribute further to society and her own family’s income.

 

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. 

The project is being implemented in countries with relatively high fertility rates, unmet need for contraception and maternal mortality ratios. These include Tanzania, Kenya, India, Sri Lanka, 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

  • Counselling and insertion of PPIUD has become part of routine 
    practice in maternity care in the six institutions in India. Insertion is practiced by
    nurses as well as doctors, resulting in greater access to the method.
  • Women now receive counselling about postpartum family planning even if they
    live in remote areas of Tanzania, as the project has expanded into satellite facilities,
  • The Kenyan team have trained government community health volunteers on
    postpartum family planning. They are now sensitising couples on postpartum
    family planning in their communities.
  • 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. 
  • Further training of the designated counsellors in Bangladesh has resulted in
    gains in counselling numbers, the number of women consenting to the procedure
    and lower removal rates.
  • The Sri Lankan Minister of Health ratified PPIUD as a method to be offered in
    all facilities nationwide, based on evidence provided by this project.
 

 

The technique

PPIUDs 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 done 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 and so 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 post partums.

Latest news

  
Mumbai workshop for PPIUD teams. Dissemination workshop with WHO. Contraception Working Group meeting.

 

Project newsletters

Read our latest PPIUD Initiative newsletter (April - June 2018) and access the archive below. 

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New PPIUD supplement online

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