Helping Postpartum Women in Mali Achieve Their Fertility Intentions: Perspectives From Introduction of the Dedicated Postpartum IUD Inserter

Abstract

In this pilot introduction setting, trained providers reported higher acceptance and preference for the dedicated inserter compared with the conventional postpartum insertion with forceps, suggesting potential for the dedicated inserter to expand access to postpartum IUDs.

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,…”

“…It is important to note that there were several confounding factors present in the interventions of the 27 cohort studies. In 18 studies [17][18][19]22,24,25,[28][29][30][31]33,34,36,40,[42][43][44] a steady supply of contraceptives was ensured simultaneously with the training intervention, which may have influenced the positive changes in uptake. Likewise, 12 studies 17,24,[32][33][34][35][36]38,40,[42][43][44] arranged activities to improve community awareness of the availability of LARCs, as well as to dispel myths and end-user misconceptions surrounding LARCs.…”

Missing strings following immediate postpartum IUD placement

“…There does not appear to be a strong correlation between manual versus ring forceps insertion as postpartum people randomised to insertion technique reported similar 6-month expulsion rates (13.3% vs 12.7%) 9. Similarly, a newly developed dedicated postplacental IUD inserter did not show a difference in expulsion rate between the dedicated IUD inserter and forceps at 6–8 weeks postpartum (7.9% vs 5.4%)10; among very experienced providers using the device there was only a 3% expulsion rate 11. The lack of high-quality data to inform ideal postplacental IUD placement technique remains an area of ongoing clinical inquiry.…”