PPIUD project

FIGO Project for ‘Institutionalising Post-Partum IUD Services and Increasing Access to Information and Education on Contraception and Safe Abortion Services’

The FIGO Post-Partum IUD Initiative Newsletter is available below.

The Newsletter will be produced four times a year, to keep you informed about the activities and progress of the Initiative.

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Duration: 2013-2018

Donor: anonymous

Project contacts: Laura Banks

Collaborating countries: Sri Lanka, India, Kenya, Tanzania, Nepal and Bangladesh

Background:  Many health facilities in Sri Lanka, India, Kenya, Tanzania, Nepal and Bangladesh have achieved increasing rates of institutional deliveries. However, the proportion of postnatal women leaving the facilities without receiving a contraceptive method remains high. In Sri Lanka, for example, the proportion of women leaving facilities without receiving a contraceptive method of their choice is around 97 per cent.  As women delivering in health facilities rarely return for contraceptive services, the immediate post-partum period presents an ideal opportunity to serve these women with a much needed service. Long-acting reversible contraceptive methods such as the IUD enable a woman to plan her family and space her pregnancies, allowing more time to look after her child. A pregnancy-free interval also provides time for a woman to be more productive, increasing the family and community income. Furthermore, birth spacing helps to improve the health of the mother and her baby.  Copper IUDs can be used effectively for over 10 years by women who want to limit or space their pregnancies; they have the lowest rates of discontinuation; are cost effective; and can be provided by mid-level providers after suitable training. The woman does not need to come back to the clinic for new supplies as she would with other types of contraceptives and the device can be removed at any time with an almost immediate return of fertility. As such this form of long acting reversible contraception can be an attractive option for post-partum women. There is growing evidence that training on the appropriate technique for healthcare providers can reduce the expulsion rate to a low and acceptable level.

Project aims: The initiative, first piloted in Sri Lanka from 2013, aims to address the post-partum contraceptive needs of women by institutionalising the practice of offering immediate post-partum Intra-Uterine Device services (IUD) in hospitals.

Progress:  The learning from the initial pilot stage in Sri Lanka has enabled the project to be extended within Sri Lanka.  The other five countries are at various stages of implementation, some well advanced and others collecting baseline data and training staff. 

Evaluation:  As well as routine monitoring of numbers of women being counselled, numbers having PPIUD inserted and information at follow-up, there is a more in-depth evaluation being conducted by the Harvard School of Public Health.  This will take place in Sri Lanka, Tanzania and Nepal and will include groups of control facilities who start implementation at later dates.  The evaluation will include longer follow-up of women and will have a qualitative component to understand the views of women and of health professionals. 



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