Impact and Performance of Institutionalizing Immediate Post-partum IUD Services

Conditions

Contraception

Keywords

Post-partum intrauterine device (PPIUD)

Brief summary

Studying the impact and performance of institutionalizing immediate post-partum IUD services as a routine part of antenatal counselling and delivery room services in Sri Lanka, Tanzania, and Nepal.

Detailed description

The International Federation of Gynaecology and Obstetrics (FIGO) has designed and is planning to implement, through its nationally-affiliated Associations of Gynaecologists and Obstetricians, an intervention program on post-partum IUD (PPIUD) services. As part of this Program, FIGO is responsible for information material, training providers, improving facilities, quality of service, and monitoring the program. Independent of the implementation, this study will measure the impact and performance of this intervention in three (Sri Lanka, Nepal and Tanzania) of the six countries participating in the FIGO project entitled: Institutionalization of immediate post-partum IUD (PPIUD) services as a routine part of antenatal counselling and delivery room services in Sri Lanka, Kenya, India, Tanzania, Nepal and Bangladesh. The FIGO intervention will take place over a nine-month period in Tanzania (nine months in the first group of three hospitals and three months in the second group of three hospitals), and over a fifteen-month period in Nepal and Sri Lanka (fifteen months in the first group of three hospitals and nine months in the second group of three hospitals). Investigators will study both the impact of the intervention on the uptake and subsequent continued use of PPIUD and the extent to which the intervention leads to the institutionalization of postpartum IUD services in the hospitals during and after the FIGO intervention and to what extent the service diffuses to other hospitals or providers. The institutionalization and diffusion of the intervention will be measured by interviewing and following up trained providers, review of hospital records and baseline, during intervention and post-intervention facility surveys.

Puri MC, Guo M, Stone L, Shah IH.

2023-03-22

10.1371/journal.pgph.0001665

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2020-05-1223 citations

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10.1186/s12978-019-0738-1

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Elina Pradhan, Erin Pearson, Mahesh Puri, Manju Maharjan, Dev Maharjan et al. (6 authors)

BMJ Open2019-01-0118 citations

10.1136/bmjopen-2018-023021

Institutionalizing postpartum intrauterine device (IUD) services in Sri Lanka, Tanzania, and Nepal: study protocol for a cluster-randomized stepped-wedge trial

David Canning, Iqbal Shah, Erin Pearson, Elina Pradhan, Mahesh Karra et al. (9 authors)

BMC Pregnancy and Childbirth2016-11-2146 citations

10.1186/s12884-016-1160-0

Interventions

DEVICEPost-partum IUD

The PPIUD intervention aims to address the postpartum contraceptive needs of women by training community midwives, health workers, doctors and delivery unit staff in postpartum IUD counselling and insertion.

Study design

Allocation

RANDOMIZED

Intervention model

CROSSOVER

Primary purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Eligibility

Sex/Gender

FEMALE

Healthy volunteers

Yes

Inclusion criteria

* Delivered in intervention hospital during 12-month enrollment period (Tanzania)/18-month enrollment period (Nepal and Sri Lanka)

Exclusion criteria

* Does not live in the country where delivered * Tanzania only: Under age 18

Design outcomes

Primary

Measure	Time frame	Description
Percentage uptake of PPIUD	Within approximately 24 hours postpartum, before discharge from the hospital.	To ascertain what percentage of women delivering in study hospitals take uptake PPIUD, participants will be interviewed after delivery, before they are discharged from the hospital.

Secondary

Measure	Time frame	Description
Percentage of women receiving PPIUD counseling	Within approximately 24 hours postpartum, before discharge from the hospital.	To ascertain what percentage of women delivering in study hospitals receive counseling on PPIUD, participants will be interviewed after delivery, before they are discharged from the hospital.
Percentage of PPIUD acceptors who have expulsions at 4-6 weeks postpartum	6 weeks postpartum	Participants who have not deliberately removed the PPIUD will be examined by providers at 4-6 weeks postpartum, and providers will report whether the PPIUD was expelled.
Percentage of women using modern contraception at 9 months postpartum	9 months postpartum	Participants will be interviewed at 9 months and asked whether they are using a modern method of contraception.
Percentage of women using modern contraception at 18 months postpartum	18 months postpartum	Participants will be interviewed at 18 months and asked whether they are using a modern method of contraception.
Percentage of women pregnant at 18 months postpartum	18 months postpartum	Participants will be interviewed at 18 months and asked whether they are pregnant.

Countries

Nepal, Sri Lanka, Tanzania

Outcome results

None listed