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Intrauterine Devices (IUDs): Contraception or Controversy?

Feb 19-22, 2008
http://my.ibpinitiative.org/intrauterinedevices

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.

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:

  1. How active is the IUD service delivery effort in your country? What is your role?
  2. What aspects are going well? Why?
  3. What aspects are not going well? Why?
  4. What are some of the barriers?
  5. 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:

  1. What seems to be the image of IUDs among clients and service providers in your country?
  2. 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:

  1. Who is allowed to provide IUD services in your country?
  2. 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.
  3. What strategies to train providers in the delivery of IUD services have worked in your country?
  4. 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