Discussion
Statistics
Number of participants: 179
Number of participants' countries: 48
Number of contributions: 22 contributions
% of contributions from developing countries: 25%
Number of countries contributing: 14 countries
Contributing countries:
Iran, Kenya, China (3), Pakistan, Nigeria, Brazil, Nepal (3), Kenya,
Ethiopia (2), Sierra Leone (2), Nigeria, US, UAE, Swaziland, Congo,
Myanmar(13)
Purpose
and Objectives
Purpose:
The purpose of this one-week forum is
to review and discuss the latest guidance on intrauterine devices
(IUDs) featured in Family Planning: A Global Handbook for
Providers.
Objective:
- Provide an opportunity to review the latest guidance on
IUDs featured in Family Planning: A Global Handbook for Providers
(www.fphandbook.org).
- Provide an opportunity to exchange information and
expertise with colleagues who are working to provide good-quality IUD
services.
- Provide you with an opportunity to collaborate with your
colleagues and exchange your knowledge and experiences related to
providing IUDs and introducing them into diverse service delivery
settings.
Day 1. Examining the IUD
service delivery situation around the world.
Objective:
- How active is the IUD service delivery effort in your
country? What is your role?
- What aspects are going well? Why?
- What aspects are not going well? Why?
- What are some of the barriers?
- What questions would you like to ask your colleagues who
have been experiencing success in increasing IUD service
delivery?
Week
1 Summary:
The guest experts answered
participants’ questions about a range of IUD related issues including
expulsion rates of copper IUDs following postpartum insertion, side
effects of different types of IUDs, and low acceptance rates of IUDs in
many countries.
Day 2. The image of IUDs in different countries.
Objective:
- What seems to be the image of IUDs among clients and
service providers in your country?
- What are the key components being tried in your country to
achieve renewed interest in the IUD in your country (i.e. training,
behavior change communication (BCC) campaigns, increased funding
investment, reduced cost, etc.)?
Day
2 Summary:
Participants discussed the image of
IUDs in Iran, Kenya, China, Nigeria, and Brazil. Many discussed efforts
by government and NGOs to improve the image of IUD and increase
acceptance rates. One participant asked why IUDs are not recommended
after the 48th hour of delivery until the end of 4 to 6
weeks. Experts explain that IUD insertion is not recommended after 48
hours post-delivery until 4-6 weeks because of concern over both higher
expulsion and higher perforation rates. An expert also raises some
additional issues regarding the role of the IUD/IUS for couples
interested in limiting childbearing and the role of the LNG IUS
(Mirena) in peri-menopausal women with menorrhagia or excessive
menstrual bleeding.
Day 3. IUD service delivery.
Questions:
- Who is allowed to provide IUD services in your country?
- What strategies would you recommend to increase service
delivery? For example, training is often one of the three or four
interventions programs used to increase IUD service delivery.
- What strategies to train providers in the delivery of IUD
services have worked in your country?
- Which indicators are you using to track the effects of
training in IUD service delivery? What have you been able to
track?
Day
3 Summary:
Participants described the details of
IUD service delivery in their countries. One expert summarized the
contributions and noted that the most important issues with IUDs are
information to community and training of providers. Both components
should be sustained over time because rumors are always circulating in
the communities and it is important to maintain activities to
counteract the wrong information about the method. In addition, because
of the turnover of providers, training must be also a continuous
action. When concerted efforts are implemented for training and
information dissemination, the results are relatively good, but
changing the image of IUDs in the community and among providers is not
an easy task.
Program Examples
Objective:
Iran. Pregna International has been
actively involved in the IUD program of Iran. Pregna has been supplying
IUDs to Iran since the year 2000 and was invited by the Ministry of
Health (MOH), Iran to conduct training for midwives.
Pregna has been conducting training for midwives for 4 years and has
seen a significant rise in usage of IUDs. The training is a simple
refresher training using the film developed by IPPF (modified by Pregna
as advised by IPPF) and with the help of hand-held uterus models and
samples provided by Pregna.
The feedback has been excellent and usage of IUDs has grown while
reports of side effects have dropped.
The success of program is also due to the support of the MOH, Iran and
their promotional efforts.
Post-forum survey results
N of surveys completed - 22
% who have passed content to
others - 48%
% who have or will use in
their work - 90%
% very satisfied with forum
content - 73%
Suggestions
for improvement:
- More topics and more days, e.g. use the entire week for
discussions with introductions the week before and conclusions the week
after.
- To organize similar online exchange on issues facing the
promotion of the method mix to better respond to clients’ needs.
- I think that the forums should be announced more intensely
to get broader participation.
Additional
quotes/comments
- As the timing is different in our part of our world, it was
difficult to participate online. However, it was good that we were well
informed about the discussion through email.
- The approval process for online posting should be shorter.
References and resources
Click
here to see
community
library/list of references
Organizing groups
Population Council and the INFO Project based at the Center for
Communication Programs at the Johns Hopkins University with support
from partners of the Implementing Best Practices (IBP) Initiative.
Contributing
experts/facilitators
Dr. Ricardo Vernon, Population Council
Dr. John Townsend, Population Council
Dr. Irving Sivin, Population Council
Dr. Juan Diaz, Population Council
Dr. Roy Jacobstein, The ACQUIRE Project/EngenderHealth
Steering committee
Population Council and the INFO Project based at the Center for
Communication Programs at the Johns Hopkins University with support
from partners of the Implementing Best Practices (IBP) Initiative.
Moderators
Lisa Basalla, The INFO Project, JHU/CCP
