Institutionalization of postpartum intrauterine devices

Makins, Anita; Arulkumaran, Sabaratnam

doi:10.1002/ijgo.12597

Cited by 23 publications

(33 citation statements)

References 15 publications

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“…During the first year postpartum, 40% of 3 women are estimated to have an unmet need for contraception (7). Closely spaced pregnancies give rise to adverse maternal, perinatal and infant outcomes (8). The PPIUD enables women to leave the birth facility with a safe and extremely effective LARC ready in place (15).…”

Section: Postpartum Family Planningmentioning

confidence: 99%

Single Center Experience on Implementation of the Postpartum Intrauterine Device (PPIUD) in Sri Lanka: A Retrospective Study.

Dasanayake

Patabendige

Amarasinghe

2020

Preprint

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Objectives to study the institutionalization of PPIUD services at Teaching Hospital, Mahamodara, Galle (THMG) and to study the feasibility, challenges and barriers for implementation.Results Total of 46,815 deliveries had occurred in the facility during the study period. Out of that 23,117 (49.4%) women had been counseled and 5775 (25.0%) of them were primigravida and 892 (3.9%) were teenage mothers. Total of 14,051 (60.8%) women were interviewed, but only 772 (5.5%) women consented for PPIUD. Consent withdrawal was seen in 29 (3.8 %) cases. A total of 409 community health staff were trained for counseling and follow up. PPIUD uptake was 470 (3.4%) which is comparable to national figures. Follow up data at one year was available from 199 women and spontaneous expulsion had occurred in eight (6.7%) cases with no cases of perforation or failure in terms of pregnancy. This short report gives the impression that PPIUD can be successfully implemented in resource limited settings and this also provides a feedback for the policy makers to take the necessary actions to improve the uptake of this cost effective, safe PPFP method. A routine PPIUD service has been successfully established within a tertiary care maternity setting in Sri Lanka.

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Section: Postpartum Family Planningmentioning

confidence: 99%

Single Center Experience on Implementation of the Postpartum Intrauterine Device (PPIUD) in Sri Lanka: A Retrospective Study.

Dasanayake

Patabendige

Amarasinghe

2020

Preprint

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“…In Nepal, PPIUD is currently the only reversible PPFP method available in the immediate post-partum period. Despite the advantages of PPFP, the use of immediate PPFP methods such as PPIUD remains low in Nepal as compared to other countries [10]. A qualitative study from the earlier phase of implementation of this initiative identified societal norms, as well as peer and health provider influences as factors that affected women's behavior on choosing a PPFP method [11].…”

Section: Introductionmentioning

confidence: 99%

Improving post-partum family planning services provided by female community health volunteers in Nepal: a mixed methods study

Thapa

Dhital

Rajbhandari

et al. 2020

BMC Health Serv Res

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Background: Family planning services in the post-partum period, termed post-partum family planning (PPFP) is critical to cover the unmet need for contraception, especially when institutional delivery rates have increased. However, the intention to choose PPFP methods such as post-partum intrauterine devices (PPIUD) remains low in countries such as Nepal. Community health workers such as Female Community Health Volunteers (FCHVs) could play an important role in improving the service coverage of PPFP in Nepal. However, their knowledge of PPFP and community-based services related to PPFP remain unclear. This study aims to assess the effect on communitybased PPFP services by improving FCHV's knowledge through orientation on PPFP. Methods: We conducted this mixed-methods study in Morang District in Nepal. The intervention involved orientation of FCHVs on PPFP methods. We collected quantitative data from three sources; via a survey of FCHVs that assessed their knowledge before and after the intervention, from their monthly reporting forms on counseling coverage of women at different stages of pregnancy from the communities, and by interviewing mothers in their immediate post-partum period in two selected hospitals. We also conducted six focus group discussions with the FCHVs to understand their perception of PPFP and the intervention. We performed descriptive and multivariable analyses for quantitative results and thematic analysis for qualitative data. Results: In total, 230 FCHVs participated in the intervention and their knowledge of PPFP improved significantly after it. The intervention was the only factor significantly associated with their improved knowledge (adjusted odds ratio = 24, P < 0.001) in the multivariable analysis. FCHVs were able to counsel 83.3% of 1872 mothers at different stages of pregnancy in the communities. In the two hospitals, the proportion of mothers in their immediate postpartum period whom reported they were counseled by FCHVs during their pregnancy increased. It improved from 7% before the intervention to 18.1% (P < 0.001) after the intervention. The qualitative findings suggested that the intervention improved their knowledge in providing PPFP counseling. Conclusion: The orientation improved the FCHV's knowledge of PPFP and their community-based counseling. Follow-up studies are needed to assess the longer term effect of the FCHV's role in improving community-based PPFP services.

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“…Nepal Society of Obstetricians and Gynecologists (NESOG) jointly with the Nepalese government and with the support from International Federation of Obstetrics and Gynecology (FIGO) had implemented the initiative of institutionalizing immediate postpartum family planning (PPFP) services in selected major referral facilities of Nepal between 2015 and 2019. [1][2][3] The initiative had focused on PPFP services that could be incorporated as a routine part of maternity care in the selected hospitals. The outcome of institutionalization was to improve the coverage of PPFP counseling and uptake of immediate PPFP methods.…”

Section: Introductionmentioning

confidence: 99%

“…The outcome of institutionalization was to improve the coverage of PPFP counseling and uptake of immediate PPFP methods. [1][2][3] The increasing institutional deliveries in Nepal provides a one-stop approach to provide maternity and PPFP service at the same time. 4 However, the data on postpartum family planning service coverage from the health facilities in Nepal remains limited.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Postpartum Family Planning Service Coverage in Selected Referral Facilities of Nepal

et al. 2020

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Introduction: Nepal Society of Obstetricians and Gynecologists jointly with the Nepalese governmentand with the support from the International Federation of Obstetrics and Gynecology hasimplemented an initiative to institutionalize postpartum family planning services in selected majorreferral facilities of Nepal to address the gap of low uptake of postpartum family planning in Nepal.The aim of the study is to find the prevalence of the service coverage of postpartum contraception inthe selected facilities. Methods: A descriptive cross-sectional study was conducted in seven major referral facilities acrossNepal. Data were collected from the hospital records of all women who delivered in these facilitiesbetween October 2018 and March 2019. Ethical approval for this study was obtained from NepalHealth Research Council. Data analysis was done with SPSS version 23. Results: Among the 29,072 deliveries from all the facilities, postpartum family planning counselingcoverage was 27,301 (93.9%). The prevalence of uptake of Postpartum Intrauterine Device is 1581(5.4%) and female sterilization is 1830 (6.3%). In total 11387 mothers (52.2%) had the intention tochoose a postpartum family planning method. However, 36% of mothers neither used nor had theintention to choose a postpartum family planning method. Conclusions: The coverage of Postpartum Intrauterine Device counseling service coverage in Nepal ishigher in 2018 as compared to 2016-2017 and in other countries implementing Postpartum IntrauterineDevice initiatives. However, the prevalence of service coverage of immediate Postpartum FamilyPlanning methods, mainly Postpartum Intrauterine Device in 2018 is lower in Nepal as compared to2016-2017, and other countries implementing Postpartum Intrauterine Device initiative. More effortsare needed to encourage mothers delivering in the facilities to use the postpartum family planningmethod.

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Institutionalization of postpartum intrauterine devices

Abstract: Globally, 225 million women need contraception. Birth spacing reduces perinatal and maternal morbidity and mortality. PPIUD is cost‐effective and reversible with minimal expulsions and complications.

Cited by 23 publications

References 15 publications

Single Center Experience on Implementation of the Postpartum Intrauterine Device (PPIUD) in Sri Lanka: A Retrospective Study.

Single Center Experience on Implementation of the Postpartum Intrauterine Device (PPIUD) in Sri Lanka: A Retrospective Study.

Improving post-partum family planning services provided by female community health volunteers in Nepal: a mixed methods study

Prevalence of Postpartum Family Planning Service Coverage in Selected Referral Facilities of Nepal

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