The PPIUD Project in the Department of Global Health and Population is studying the impact and performance of institutionalizing immediate post-partum IUD (PPIUD) services as a routine part of antenatal counseling and delivery room services in Sri Lanka, Tanzania, and Nepal.
The International Federation of Gynaecology and Obstetrics (FIGO) is implementing an intervention program on the post-partum intrauterine contraceptive device (PPIUD) services through its nationally-affiliated Associations of Gynaecologists and Obstetricians in six countries—Sri Lanka, Kenya, India, Tanzania, Nepal and Bangladesh. The PPIUD Project in the Department of Global Health and Population at the Harvard T. H. Chan School of Public Health is studying the impact and performance of the FIGO PPIUD intervention in three of the six countries, Sri Lanka, Nepal, and Tanzania.
The study will encompass both the impact of the intervention on the uptake and subsequent continued use of PPIUD, the extent to which the intervention leads to the institutionalization of postpartum IUD services in the hospitals, and to what extent the service diffuses to other hospitals or providers. The institutionalization and diffusion of the intervention will be measured by interviewing and following up trained providers, review of hospital records and baseline, during intervention and post-intervention facility surveys.
The impact of the FIGO intervention will be measured in the intervention hospitals by the coverage and quality of antenatal counselling, uptake of postpartum IUD services, and postnatal side effects and expulsions. We will also examine the effect of the intervention on overall contraceptive use, prevention of unintended pregnancy and fertility. We will do this by qualitative in-depth interviews and longitudinal follow up with quantitative surveys of women exposed to the intervention compared to a concurrent control group of women.
Institutionalization in the study hospitals will be measured by the extent to which PPIUD service provision becomes a routine service providing antenatal care, delivery room services, and post natal follow-up in the intervention hospitals. We will measure the extent to which doctors, midwives, and other personnel who go through training on PPIUD service delivery actually deliver this service during the intervention. We will also investigate institutionalization after the project ends to see if PPIUD service delivery continues. We will examine if the personnel trained during the intervention continue delivering services after it ends and if new personnel are trained in PPIUD by existing staff when they enter the hospital. Our aim is to see if there is a fundamental spread and long lasting culture change regarding PPIUD services in antenatal care, in the delivery room, and in postnatal care as a result of this short-term intervention by FIGO. We will assess this through reviewing hospital records and by qualitative in-depth interviews and quantitative surveys of personnel in the intervention hospitals during and after the intervention.
We will also examine the extent to which health care providers who are trained during the intervention, and who subsequently leave the intervention hospitals, continue to undertake PPIUD in their new locations. We will do this by a survey after the intervention has been completed of all providers who were trained during the intervention and who subsequently moved to new work places.