Post-Partum IUD Program in Kenya: Best Practice

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Post-Partum IUD Program in Kenya Best Practice

• Joygrace Muthoni

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Presentation Outline

• Background
• Program Intervention/Objectives
• Methodology
• Findings
• Lessons learnt

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Background

• Conducted a pilot activity 2007-2009
• 3 day orientation package
• Cascade training
• Identification and establishment of champions
• PPIUCD training
• CHW orientation
• Evaluation to generate field-based
  recommendations to improve services

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Program Intervention/Activity Tested

• Womens experience with PPIUD insertion
• Service providers perspectives, practice and
  experience with PPIUD services

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Methodology
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Methodology

• Desk review of facility records
• Interviews (phone, face-to-face) with service
  providers (123), PPIUD clients (117) prior to
  discharge, and at follow-up
• FGD (2 groups) between JulyDecember 2009 and
  February-March 2010.

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Findings Service Providers n49

• Ideal counselling time was during antenatal
  care- 96, (47/49)
• Ideal timing for PPIUD insertion was
  postplacental- 82, (40/49)
• Ten service providers mentioned that
• PPIUD is less painful than interval IUD (19)
• Cervix is open and therefore it is easy to
  perform insertion (17)
• Provides immediate FP protection (11)
• Cost-effective to client and/or provider (11)
• 92, 45/49 providers preferred manual insertion
  over instrumental.

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PPIUCD Insertion ( n117)
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Findings Clients

• Told about PPFP by provider- 44, (51/117)
• Counseled about PPIUD 80 (41/51)
• 56 (66/117) decided to have PPIUD after
  delivery.
• Counseling received was adequate 98 (115/117)

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Findings Client Follow-up Via Phone /
Face-to-face(n63)

• 76, (48/63) were still using the same PPIUD
  after three to six months,
• 17 (11/63) had expelled the IUD
• 6 (4/63) had it removed
• husbands wish (2)
• post caesarean infection (1)
• pregnancy (1)

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Findings Focus Group Discussion

• Women experienced positive changes in life since
  receiving PPIUD. Life is easy.  
• Money was not a barrier to use. Some partners
  were not aware of PPIUCD.  
• Misconceptions and oppositions to IUD still
  existed in the communities They are afraid
  because they do not know.
• All of them were willing to promote/recommend the
  method to the community We want other mothers
  to have it (PPIUD). Because when you have it, you
  will enjoy, husbands are happy...

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Program Implications/Lessons

• Demonstrated the feasibility of introducing PPIUD
  in low resource settings.
• Maintaining systematic counseling during
  antenatal care and early labor was another key to
  increase uptake of PPIUD.
• Service providers demonstrated that with all
  round support they were able to change their
  perceptions on providing PPIUD services
• Manual insertion did not result more pain nor
  higher explosion rate
• Cost was not a hindrance