Beyond Training: Key Interventions in Scaling Up

Postpartum IUCD Services in India

Dr. Saswati Das

Senior Advisor, Clinical Services and
Training
Jhpiego, India
 Need for PPFP/PPIUCD Services in India

 Huge unmet need: 65% of the women have an

unmet need for family planning in 1st year of
postpartum period, but only 26% are using any
contraceptive method
 Ensuring healthy spacing between births: Average birth-to-
birth interval is less than 36 months in 61% of births
 Resurgence of interest in IUCD: Globally, Government of
India’s initiative to revitalize IUCD
 Increased institutional deliveries: Due to Government’s
JSY scheme
 Immediate postpartum insertion of IUCD is convenient
 Start of PPFP/PPIUCD Program in
2009–2010
 Started PPIUCD training in Queen
Mary Hospital, Lucknow
 Safdarjung Hospital, Delhi,
identified as national training
center
 Regional training sites established
at medical colleges in Mumbai and
Jabalpur

Aim was to establish PPIUCD services in identified medical colleges and

district hospitals in 16 states (total of 31 sites).
Doctor and nurse team from two sites each in 16 states were trained and
were expected to start PPIUCD services at their respective facilities.

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 Status after Training
(Facility Assessment – 2011)
31 Status of PPIUCD services in these
16 facilities?
 1 or 2 providers in each facility
providing PPIUCD services –
18 (58%)
16 (52%) Services were not available for
all women delivering at these
facilities (2011 assessment)
 5% of total deliveries at these
facilities accepted PPIUCD (2010)
PPIUCD training Number of Number of  56% facilities (9 out of 16) inserted
conducted for facilities having facilities with PPIUCD in <2% of deliveries
number of trained provider in trained providers
facilities in year- place providing services (2010)
2010
 Total number of PPIUCD
2011 Assessment
insertions in 2010 was 4,966

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 Scaling Up of PPIUCD Services

(Jabalpur)

(Mumbai)

National Training Site

Service Delivery Site

Regional Training Site

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 Post-Initial Training Interventions Started in 2011
(in 16 States with BMGF Support)
The number of PPIUCD sites increased from 31 [in 2010] to 51 [in 2011]
and 71 [in 2012].

 Established training sites in 12 states

 Dedicated counselors, especially for busy facilities
 Finalization of PPIUCD service delivery standards, in
consultation with key obs/gyn providers from states
 Periodic post-training support visits to the PPIUCD
service sites
 Strengthening follow-up of PPIUCD clients – Contacting
clients on phone + Clinic-based follow-up

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Post-Initial Training Interventions Started in 2011
(in 16 States with BMGF Support)
The number of PPIUCD sites increased from 31 [in 2010] to 51 [in 2011]
and 71 [in 2012].

Support visits included:

 On-site orientation of
hospital staff
 On-the-job support on
insertion technique,
counseling, infection
prevention, assessment
of service standards
 Provision of more
insertion forceps, IEC
materials, registers for
data collection
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What Happened in 16 Facilities: Percentage
of Deliveries Accepting PPIUCD
12% Initiated Post-
Training 10%
% PPIUCD Acceptors

10% Interventions
8%
6%
6%
5%
4%

2%

0%
2010 2011 2012 (until July)
Year
 Progress in PPIUCD Acceptance
(in 16 Facilities)
Year - 2010 Year - 2011 Year- 2012 (until July)
6%
<=2%
19%
25% 2 to 4%
31%
44% 4 to 6%
57% 6 to 8%
8 to 10%
>10%

Summary: % of Reporting > 10% PPIUCD Acceptors

50%
40%
% facilities

30%
20% 44%
31%
10% 19%
0%
2010 2011 2012 (until July)
Year
 Overall PPIUCD Insertions in India
(from 2010 to July 2012)
25,000 Initiated Post-Training
Number of PPIUCD Insertions

Interventions
20,000 21%
44%
15,000
35%
10,000 19,570
17,901

5,000 Post-placental (within 10 min)

4,966
0
Postpartum (within 48 hrs)
2010 (n=31) 2011 (n=51) 2012 until July Intra-cesarean
(n=71)
Reporting Year

Percentage of PPIUCD Clients Progress in Achievement of

Followed Up after 6 Weeks PPIUCD Service Delivery
Standards
2010 10%
From 32% in baseline (2011)
2011 36% to 56% in midline assessment
2012 (until July) 53% (2012)
 Follow-up Findings from Monthly Reports

Year – 2011 (n=6,379) Year – 2012 (n=10,290)

No Complaint
6% 4%
Missing String
3%
1% 90%
Expulsion 2%
9%
81%
Infection 1%
3%
Other
complaint

Data as on 31st Aug 2012, reports till Jul-12

 Conclusion

Scaling up PPIUCD services requires

complementary efforts to translate
effective training into quality services.

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 Acknowledgments

Thanks to my co-authors at Jhpiego, India:

 Bulbul Sood, Country Director
 Rashmi Asif, Director, Clinical Services & Training
 Somesh Kumar, Director Programs
 Vivek Yadav, National Program Manager
 Siddhartha Saha, M & E Advisor
Thanks to Jhpiego experts in Baltimore and the
M&E Team, India, for their help and support.

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THANK YOU

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