The impact of using nurses to perform postpartum intrauterine device insertions in Kalyani Hospital, India

Abstract

In the postpartum period women are vulnerable to unintended pregnancy, which may lead to legal or illegal abortion and impact on maternal and neonatal morbidity and mortality. Although several postpartum family planning options are available, lack of access to and availability of family planning services and trained staff pose serious challenges. Peripheral centers may not have a doctor; however, they will have nursing staff that can be trained to offer family planning counselling and services. The present study demonstrates how task sharing with nurses to provide postpartum intrauterine device (PPIUD) services worked to give women a convenient and safe contraceptive method. PPIUD insertion provides women the additional advantage of leaving hospital with appropriate long-term contraception after institutional delivery, and also decreases the costs borne by patients and the government. This approach also impacts maternal and newborn health by avoiding unwanted pregnancy.

Training of healthcare providers and use of long‐acting reversible contraception in low‐ and middle‐income countries: A systematic review

“…All studies were published between 2006 and 2020. In 20 studies, the number of healthcare providers that received training in LARC ( n = 4942) was reported, 17‐37 whereas eight studies did not report the number of providers that received training 20,38‐44 . A total of 6 112 544 women and 5331 healthcare facilities were included in the different studies.…”

“…20,[38][39][40][41][42][43][44] In 17 studies, the women's sociodemographic characteristics were described, including factors such as age, education, parity, number of living children and marital status. 17,18,[20][21][22][23][24]27,29,32,35,37,[39][40][41][42]44 Our primary outcome of interest, end-use of LARC, was reported in all 28 included studies, and was measured as (1) change in uptake of LARC -including number of women choosing LARC to be their first method of contraception as well as women switching to LARC from a different method [18][19][20]24,25,[27][28][29][30][31][32][35][36][37][38][39][40][41][42][43][44] ; and (2) change in IUD uptake specifically -including postpartum intrauterine devices. …”

“…17,18,[20][21][22][23][24]27,29,32,35,37,[39][40][41][42]44 Our primary outcome of interest, end-use of LARC, was reported in all 28 included studies, and was measured as (1) change in uptake of LARC -including number of women choosing LARC to be their first method of contraception as well as women switching to LARC from a different method [18][19][20]24,25,[27][28][29][30][31][32][35][36][37][38][39][40][41][42][43][44] ; and (2) change in IUD uptake specifically -including postpartum intrauterine devices. 17,[21][22][23]26,33,34 No studies reported the number of unintended pregnancies at 12 months after initiating LARC use, and 15 studies reported the preferred LARC method among healthcare workers and women. 19,…”

“…19,20,25,[27][28][29][30][31][32]36,38,[40][41][42][43] Uptake of other contraceptives was measured in 19 studies, including use of SARC methods, 19,24,27,28,31,32,37,[39][40][41] overall users of family planning methods 18,25,30,[32][33][34][36][37][38]40,41,43,44 and users of oral contraceptives specifically. 27,28,30,31,41 Of the included studies, 89% found an increased uptake of LARC methods (n = 24 cohort + 1 randomized control trial/ 28), 17,19,21,[23][24][25][27]…”

Institutionalization of postpartum intrauterine devices

“…On‐the‐job training was developed in Nepal and was found to be highly successful, with the benefit of not taking health personnel away from the work place for organized training . Task sharing of insertion of IUDs by midwives and nurses in India, Nepal, Kenya, and Tanzania proved to be extremely successful, with escalation of acceptance rates and very little variance in complication rates. Training of lay people as counsellors in Bangladesh had some advantages albeit not the anticipated impact on PPIUD acceptance, which reflected the multifaceted factors that are at play in some cultures where the woman is not the decision maker when it comes to her own sexual and reproductive health.…”