Many health facilities in Sri Lanka, India, Kenya, Tanzania, Nepal and Bangladesh have achieved increasing rates of institutional birthing deliveries. However, the proportion of postnatal women leaving the facilities without receiving a contraceptive method remains high. In Sri Lanka the proportion of women leaving facilities without receiving a contraceptive method is around 97%. As women delivering in health facilities rarely return for contraceptive services, the immediate post-partum period presents an ideal opportunity to provide a much needed service.
Long-acting reversible contraceptive methods such as the IUD enable a woman to plan her family and space her pregnancies. 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 by allowing more time for her to look after her child.
Copper IUDs can be used effectively for over 10 years by women who want to limit or space their pregnancies. These IUDs have the lowest rates of discontinuation, are cost effective, and can be offered by mid-level providers after adequate training. The woman does not need to come back to the clinic 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 level.
Project Aims
The initiative, first piloted in Sri Lanka from 2013, aims to address the post-partum contraceptive needs of women by institutionalizing the practice of offering immediate post-partum Intra-Uterine Device services (IUD) in hospitals. 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
FIGO is monitoring the numbers of women being counseled and who chooses to have a PPIUD. They are also collecting information for follow-up. the PPIUD Project in the Department of Global Health and Population at the Harvard T. H. Chan School of Public Health is conducting a more in-depth evaluation in Sri Lanka, Tanzania, and Nepal. This study involves a longer follow-up period and contains a qualitative component to explore the views of women choosing PPIUD and health professionals providing the services.
