The provision of immediate postpartum IUD is critical in meeting women’s need for long-term but reversible contraceptive protection. The IUD is safe, effective, long-acting, reversible, and convenient to use, especially when inserted at immediate postpartum.
Women's Health at Risk
During the year following the birth of a child, two in three women are estimated to have an unmet need for contraception. Among the 12 countries in sub-Saharan Africa, the postpartum unmet need was estimated at 73.8 percent compared to 62.3 percent in six countries in Asia and 54.4 percent in seven countries in Latin America. Fewer than 50 percent of women in 30 of the 43 countries with recent Demographic and Health Surveys (DHS) use any method of contraception during 9-11 month postpartum and in 12 of these countries the use was below 20 percent.
The copper-bearing Intrauterine Device (IUD) is a safe and effective method that can be used immediately after delivery, yet, only in three of the 43 counties (Egypt, Kyrgyz Republic and Tajikistan), 20 percent or more of postpartum users of contraception were relying on this method. The immediate postpartum IUD does not interfere with breastfeeding, is safe for use by HIV-positive women, is associated with less discomfort and fewer side effects than interval insertion and allows women to obtain safe, long-acting (up to 12 years), highly effective yet reversible contraceptive protection that can be made readily available to women delivering in health facilities. In countries where women do not return for follow-up visits because of cost or distance, immediate postpartum IUD offers a convenient and cost-effective contraceptive option.
Safety and Efficacy of PPIUD
A number of studies and systematic reviews have evaluated the safety, efficacy and acceptability of immediate postpartum insertion of IUDs compared to late postpartum or interval insertion (after four weeks following delivery). For example, a randomized controlled trial among women delivering in a hospital in Pittsburg (USA) showed that immediate post-placenta (within 10 minutes of the expulsion of the placenta) insertion of levonorgestrel-releasing IUD was linked to higher continuation of use at six months than delayed insertion (84.3 percent vs. 76.5 percent). However, expulsions within six months were higher in the immediate post-placenta group than in the delayed insertion group (24 percent vs. 4.4 percent).
Importance of Training
Several studies reported acceptability of postpartum IUD in diverse settings when information and counselling on postpartum contraceptive methods was provided to women. To expand the use of post-placental and immediate postpartum IUD insertion, high-quality counselling during the antenatal period and training of physicians and midwives is critical. Expulsions will be lower if: (a) the IUD is inserted within 10 minutes after delivery of the placenta; (b) placement is sufficiently high in the uterine fundus; and (c) insertion is done by a specially trained provider.