Location and content of counselling and acceptance of postpartum IUD in Sri Lanka (original) (raw)
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Reproductive Health
Background: In Nepal, 54% of women have an unmet need for family planning within the 2 years following a birth. Provision of a long-acting and reversible contraceptive method at the time of birth in health facilities could improve access to postpartum family planning for women who want to space or limit their births. This paper examines the impact of an intervention that introduced postpartum contraceptive counseling in antenatal care and immediate postpartum intra-uterine device (PPIUD) insertion services following institutional delivery, with the intent to eventually integrate PPIUD counseling and insertion services as part of routine maternity care in Nepal.
Our aim was to study acceptability of PPIUCD in our target population, based on their demographic variables including parity and mode of delivery. Method : The study was conducted at V.S.General Hospital, Ahmedabad from 1stJune,2016 to 31December,2016.CuT 380A was inserted in accepters who fulfilled the Medical Eligibility Criteria and had no contraindications for PPIUCD. They were followed up for a period of one year, and studied the various complaints and complications associated with PPIUCD insertion. Conclusion: Both the acceptance and actual insertion of IUCD were low probably because the use of IUCD is a new concept in the community. Inserting CuT 380 A at 10 minutes after placental delivery is safe leading to the expanding of the usage of IUCD meeting the unmet needs. The expulsion rates would be minimal if it was inserted by a trained provider and placed at the fundus. Even though expulsion rate high with IUCD, acceptance was high when it is inserted in postpartum period. Results: 2% of the women who delivered vaginally at VSGH, Ahmedabad chose PPIUCD and 7% of those who undergone C-Section chose PPIUCD.100 of those who received a PPIUCD (256) returned for a follow up visit which is 39%.48.04% of those who inserted IUCD were 2nd para and 37.5% primi para , 11% 3rd para and only 3.47% of 4th para opted for IUCD.6% of all patients demand removal and 3 % demand re-insertion.PPIUCD continuation rate in my study is 83.9%.Only 1 patient had misplaced IUCD in follow up, apart that no patient encountered any serious complication.
Public Health and Preventive Medicine Archive, 2018
Background and purpose: The post-placental intra uterine device (IUD) program is one intervention to increase IUD uptake however the acceptance remains low. Contraceptive counseling during pregnancy is expected to increase IUD uptake. The primary objective of this study is to determine the efficacy of counseling by involving the husband in order to improve post-placental IUD uptake. The secondary objective is to compare knowledge and perceptions of IUD before and after intervention.Methods: A randomized controlled trial was conducted with 58 pregnant women at 37-40 weeks' gestation in three private midwifery clinics in Denpasar, Bali. Subjects were divided into two groups: 29 intervention groups that were given couples counseling and 29 control groups that were given counseling without involving husbands. Base line interview was conducted during enrollment and follow up interview was carried out immediately after delivery.Results: Acceptance of post-placental IUD was found in 2...
Journal of Evolution of Medical and Dental Sciences
BACKGROUND In order to increase the usage of birth-spacing contraceptive methods, GOI has introduced the task-sharing strategy whereby in addition to doctors, staff nurses and ANMs are also trained and entrusted with the responsibility of postpartum intrauterine contraceptive device insertion after vaginal delivery. Aims and Objectives-This study aims to compare the outcome of this strategy at a sub-divisional hospital and medical college in Bihar and to frame recommendations to increase the success of task-sharing for PPIUCD insertions by all cadres of skilled birthattendants in health-care facilities. Setting and Design-The study is conducted in two time-spans when the author was working in a sub-divisional hospital at Sherghaty and later at Sri Krishna Medical College, Muzaffarpur. It is a retrospective comparative observational analysis of data collected from the two levels of healthcare facilities. MATERIALS AND METHODS Data was collected from the PPIUCD insertion and follow-up registers maintained in both hospitals. The percentage of PPIUCD insertions after vaginal delivery and caesarean delivery, the service-provider for PPIUCD insertion, user satisfaction with the method, complications and removals were analysed. RESULTS Percentage of PPIUCD insertions was significantly higher at the SDH compared to the medical college. 50% of insertions were done by nurses and ANMs in the immediate post-placental period. User satisfaction rate was high with very low complication and low removal rates. There were no PPIUCD insertions at the medical college following vaginal delivery. No systematic follow-up records were being maintained there. CONCLUSION In order to increase the effectiveness of the PPIUCD, the task-sharing strategy of GOI can be very effective as shown by the enthusiasm and efficiency of nurses and ANMs at the SDH. Key factors to increase the usage of this PPFP method is motivation, sensitive counseling skills and adequate training and confidence in its insertion technique.
Contraception, 2016
Objective: As part of a strategy to revitalize postpartum family planning services, Government of India revised its policy in 2013 to permit trained nurses and midwives to insert postpartum intrauterine contraceptive devices (PPIUCDs). This study compares two key outcomes of PPIUCD insertionsexpulsion and infectionfor physicians and nurses/midwives to generate evidence for task sharing. Study design: We analyzed secondary data from the PPIUCD program in seven states using a case-control study design. We included facilities where both doctors and nurses/midwives performed PPIUCD insertions and where five or more cases of expulsion and/or infection were reported during the study period (January-December 2013). For each case of expulsion and infection, we identified a time-matched control who received a PPIUCD at the same facility and had no complaints. We performed a multiple logistic regression analysis focusing on provider cadre while controlling for potential confounding factors. Results: In 137 facilities, 792 expulsion and 382 infection cases were matched with 1041 controls. Provider type was not significantly associated with either expulsion [odds ratio (OR) 1.84; 95% confidence interval (CI): 0.82-4.12] or infection (OR 0.73; 95% CI: 0.39-1.37). Compared with centralized training, odds of expulsion were higher for onsite (OR 2.32, 95% CI: 1.86-2.89) and on-the-job training (OR 1.23, 95% CI: 1.11-1.36), but odds of infection were lower for onsite (OR 0.45, 95% CI: 0.27-0.75) and on-the-job training (OR 0.31, 95% CI: 0.25-0.37). Conclusion: Trained nurses and midwives who conduct deliveries at public health facilities can perform PPIUCD insertions as safely as physicians. Implications: Institutional deliveries are increasing in India, but most normal vaginal deliveries at public health facilities are attended by nurses and midwives due to a shortage of physicians. Task sharing with nurses and midwives can increase women's access to and the acceptability of quality PPIUCD services.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2019
Apart from this, it does not interfere with breastfeeding. 5 In addition, complaints associated by IUCD insertion are masked by postnatal lochia and afterpains. 6 The objective of the present study was to assess the Knowledge, attitude and practice of postpartum Intrauterine contraceptive ABSTRACT Background: PPIUCD has been introduced in the national family welfare program since March 2010 in several states. AN IUCD can be inserted in 48 hours postpartum, referred to here as postpartum intrauterine contraceptive device. This study was done to assess the Knowledge, attitude and practice of postpartum Intrauterine contraceptive device in antenatal patients at a tertiary care centre in Northern India. Methods: This is a questionnaire based cross sectional observational study including 350 antenatal women attending antenatal OPD over a period of 6 months. Results: Out of these 350 women, 126 women (36%) had knowledge of PPIUCD. only 30 % of women had previous knowledge about PPIUCD however only 10 % of women practiced it in the past. After appropriate counselling 18% of women agreed for insertion of PPIUCD after this delivery. Conclusions: The study concludes that the antenatal women had poor knowledge regarding PPIUCD. Practices were even worse. This might be attributed to low education , refusal by family especially male partner, and religious beliefs. But once appropriate knowledge and information is provided, attitude gradually changes.
International Journal Of Community Medicine And Public Health, 2020
Background: Post-partum insertion of intra uterine devices (PPIUCD) increased the accessibility for women following childbirth. In India, the most women in the first year postpartum have an unmet need for family planning due to lack of information and fear of complications. The aim of the study is to assess the knowledge and attitude regarding postpartum insertion of intra uterine devices, among antenatal mothers.Methods: Descriptive cross-sectional survey design. The antenatal mothers, gestational age above 20weeks, registered at AIIMS Jodhpur were selected by purposive sampling technique. A total of 183 subjects were recruited for the data collection. A structured knowledge questionnaire and 5 point Likert scale was used to assess the knowledge and attitude among regarding PPIUCD respectively. Informed consent was taken from each participant prior to data collection and descriptive and inferential statistics were employed to analyze the data.Results: Majority (57.4%) of the subjec...
Reproductive Health, 2020
BackgroundPostpartum intrauterine device (PPIUD) use remains very low in Nepal despite high levels of unmet need for postpartum family planning and the national government’s efforts to promote its use. This study investigates reasons for continuing or discontinuing PPIUD use among Nepali women.MethodsWe conducted in-depth interviews (IDIs) with 13 women who had discontinued PPIUD use and 12 women who were continuing to use the method 9 months or longer following the insertion. All interviews were audio recorded, transcribed, translated into English, and analyzed using a thematic approach.ResultsWomen discontinued PPIUD for several reasons: 1) side effects such as excessive bleeding during menstruation, nausea, back and abdominal pain; 2) poor quality of counselling and, relatedly, mismatched expectations in terms of device use; and 3) lack of family support from husbands and in-laws. In contrast, women who were continuing to use the method at the time of the study stated that they had not experienced side-effects, had received appropriate information during counselling sessions, and had the backing of their family members in terms of using PPIUD.ConclusionExperiencing side-effects or complications following PPIUD insertion and poor quality of family planning counselling were the two main reasons for discontinuation. Family members appeared to play a major role in influencing a woman’s decision to continue or discontinue PPIUD suggesting that counseling may need to be expanded to them as well. Improving quality of counselling by providing complete and balanced information of family planning methods as well as ensuring sufficient time for counselling and extending PPIUD service availability at lower level clinics/health posts will potentially increase the uptake and continued use of postpartum family planning, including PPIUD, in Nepal.