We supply high-quality, low-cost intra-uterine devices (IUDs) and train providers to safely insert and remove them, including for postpartum women who wish to receive the method immediately after childbirth. Postpartum IUD (PPIUD) availability increases the range of methods available to women in the postpartum period.
Reaching postpartum women with family planning is a critical component of meeting the needs of women who want to limit or space their births. Over 90% of women do not want to have another child within their first year postpartum. Furthermore, to achieve optimal maternal and child health outcomes, the World Health Organization recommends that women wait at least 24 months after a birth before becoming pregnant again. In developing countries, many pregnancies occur during the first year postpartum, as nearly two-thirds of postpartum women have an unmet need for family planning.
The postpartum IUD (PPIUD) — a copper IUD inserted within 48 hours of delivery — is a safe and highly convenient choice for women who desire long-acting, reversible, non-hormonal protection from pregnancy starting during the critical postpartum period.
Integrating PPIUD in Antenatal and Postpartum Service Delivery
For many women in resource-poor communities, it is difficult to find the time and transportation funds to return to a health facility for family planning after childbirth. PPIUD insertion can be quickly performed after delivery while the woman is already at the health facility with the provider. Despite the benefits of the IUD, it is not frequently included in postpartum family planning counseling or service delivery. Barriers facing providers have included: a lack of training and supervision for PPIUD insertion; misunderstandings among clients, providers, and policymakers about the safety of the method; and a lack of coordination across the antenatal care, labor and delivery and family planning units of a health facility.
PSI integrates PPIUD programs into maternal, newborn and child health programs, addressing the barriers that have prevented the method from being available in the past.
Dedicated PPIUD Inserter: A Solution for Postpartum Women
Although PPIUD insertion has several benefits to clients and providers, it also comes with certain challenges due to the shape and size of the uterus postpartum. Conventional IUD inserters are neither long nor firm enough to reach the postpartum uterine fundus. As a workaround, providers have used forceps, which requires them to remove the IUD from the inserter sleeve, place it at the tip of the forceps, and then insert it into the uterus. Additionally, the string in conventional copper IUDs is too short to be visible after PPIUD insertion. Visibility of the string reassures the provider that an IUD is properly placed.
PSI partnered with the Stanford Program for International Reproductive Education and Services (SPIRES) and Pregna International Ltd., to create a low-cost inserter designed specifically for PPIUD insertion. The dedicated PPIUD inserter addresses the particular insertion challenges facing providers during the immediate postpartum period. The new inserter eliminates the need to use forceps for insertion, making the PPIUD insertion technique easier and more similar to interval insertion (i.e., IUDs inserted after four weeks postpartum). Its firm consistency still allows it to bend to accommodate the shape of the postpartum uterus, and its longer string is visible after PPIUD insertion. The PPIUD inserter has the potential to improve providers’ willingness to provide PPIUD services.
- Helping Postpartum Women in Mali Achieve their Fertility Intentions: Perspectives from the Dedicated PPIUD Inserter Pilot Program
Mali has one of the world’s highest fertility rates and one of the lowest rates of modern contraceptive prevalence (mCPR). In Mali, more than 1 in 4 women have an unmet need for family planning (FP). This gap between method demand and access is particularly acute for postpartum women, with nearly 70% reporting an unmet need. In 2016, PSI-Mali piloted a new healthcare device to help address this gap- the dedicated postpartum (PP) intrauterine device (IUD) inserter.
- Streamlining Service Delivery to Expand Access: Innovations in IUD Insertion Technology
This report highlights key messages delivered by speakers at a meeting of the LARC and permanent methods community of practice. The objective of the meeting was to share information about two new IUD insertion technologies..
- Dedicated Post-Partum IUD Inserter
This presentation describes the advantages of intrauterine device (IUD) inserter specifically designed for use in the immediate post-partum period.
- Assessment of the Effectiveness of Dedicated Postpartum IUD Inserter in Achieving Fundal IUD Placement
Immediate Postpartum IUD (PPIUD) insertion offers a novel and convenient method to address unmet need for contraception. However, for this purpose a dedicated PPIUD inserter is not available and instead, forceps are used. Furthermore the string used in traditional IUD inserters is too short to be visible after PPIUD insertion.
We aimed to assess the safety, effective fundal IUD placement, acceptability (provider satisfaction, consumer comfort) and feasibility of a prototype dedicated PPIUD inserter and to determine client satisfaction and IUD retention at follow-up.
- La Classe Des Mere, Strategie Efficace Pour La Promotion Du DIU Post Partum Au Mali
The rate of modern contraceptive prevalence in Mali (10%) is among the lowest in the world and unmet need is 29% in the Sikasso region. In 2012, only 3.4% of women 15-49 used the long-term methods. The postpartum IUD is considered as a method used. The low usage is due to rumors about the IUD, socio-cultural barriers and the lack of target information, especially during pregnancy.
- Enabling the Healthy Spacing and Limiting of Pregnancies: Programmatic Approaches to Expand Postpartum IUD Access
Under the Support for International Family Planning Organizations (SIFPO) project funded by USAID, PSI published a technical brief on 'Enabling the Healthy Spacing and Limiting of Pregnancies: Programmatic Approaches to Expand Postpartum IUD Access'. The brief introduces the need for expanded postpartum family planning options, reviews the advantages and disadvantages of the PPIUD, describes the components of successful initiatives to add PPIUD to the range of options for postpartum women, and illustrates three different models for PPIUD service delivery through case studies from the Democratic Republic of the Congo, Guinea, Zambia and Pakistan.
- PPIUD Services: Start-Up to Scale-Up Regional Meeting Burkina Faso
The Maternal and Child Health Integrated Program (MCHIP) and Population Services International’s (PSI) Support for International Family Planning Organization (SIFPO) program, with funding from the U.S. Agency for International Development (USAID), convened a regional meeting in West Africa to bring together international and regional experts to advance integration of postpartum intrauterine device (PPIUD) services into maternal health services.
- Dedicated Inserter Facilitates Immediate Postpartum IUD Insertion
Population Services International (PSI), in collaboration with the Stanford Program for International Reproductive Education and Services (SPIRES) and Pregna International Ltd., has created a simple, inexpensive inserter designed specifically for PPIUDs.
- Feasibility of Training Zambian Nurse–Midwives to Perform Postplacental and Postpartum Insertions of Intrauterine Devices
This study explores the feasibility of competency-based training of Zambian nurse-midwives in postplacental and postpartum intrauterine device (PPIUD) insertion and estimates learning curves for this procedure.