Using a new cheaper, simpler inserter for IUDs after labor and delivery can save lives in the developing world.
Washington, DC, (March 22, 2016) Following a proof-of-concept study to be published March 23 in the journal Global Health Science and Practice, Population Services International (PSI) Global Medical Director Paul Blumenthal, MD, reports benefits from a ground-breaking device for simply inserting intrauterine devices (IUDs) shortly after birth, particularly in low-resource countries.
PSI, in collaboration with the Stanford Program for International Education and Services (SPIRES) created a simple, intuitive inserter designed specifically for post-partum IUDs (PPIUDs). It eliminates the need for specialized instruments like forceps and allows for a standardized, easy- to-learn technique. The PPIUD inserter originally earned a coveted Saving Lives at Birth Grand Challenge for Development grant in 2013 based on its ambitious aim to help meet the immense challenge of protecting mothers and newborns in the poorest places on earth.
Dr. Blumenthal, also a Stanford University School of Medicine professor of obstetrics and gynecology, and his PSI colleagues know well the high maternal mortality rates in the developing world for women whose pregnancies occurred less than 24 months apart. Infants are two times more likely to die if they’re conceived within 9 months of a sibling’s birth and children are also at risk of adverse health outcomes even when they survive.
![Birth spacing](https://www.psi.org/wp-content/uploads/psi-impact/uploads/2016/03/PSI-Lucknow-3rd-Sepptember-19.jpg)
Birth spacing has long been advocated as a way to save the lives of both mother and child, but access to contraception for women who may only seek out a medical provider during the onset of labor is extremely low. Giving a woman the chance to choose a long-lasting family planning method, such as an IUD or contraceptive implant, immediately following labor and delivery presents the opportunity to space her pregnancies in a healthy and easy way. Not only does it save a woman travel time, cost and other factors that may discourage a return visit to a family planning clinic, inserting the IUD immediately after delivery may offer fewer side effects than a procedure done weeks later.
“The postpartum period is underutilized by women as a time to start their next method of contraception,” Blumenthal said. “It’s important for women to space births, but many give birth and never come back for family planning. Then the next time we see them, they are pregnant again, very often with a pregnancy that was unplanned.” Having an IUD provided just after delivery, he said, is “an opportunity for ‘one-stop shopping’ that is very convenient.”
The ability to provide women with an IUD following delivery has existed, but the procedure and lack of dedicated tools formerly acted as an obstacle. It was Dr. Blumenthal’s innovative tool designed for simply inserting a PPIUD that won him the innovation grant to test his proof of concept. The inserter consists of a long tube of silicone and plastic, preloaded with an IUD, that can be inserted into the top portion of the uterus, where it may provide contraceptive protection for as long as 10 years. The inserter is very inexpensive, a small fraction of the cost of forceps — and forceps require sterilization after each use, which can be a barrier in the low- resource settings.
“It’s simple, it works and it’s cheap,” Blumenthal said. “This is something that could really enhance the providers’ willingness and the patients’ acceptability of this approach.”
Dr. Blumenthal and his colleagues at PSI’s network member in India used the inserter device to provide services to 80 women who opted to have PPIUDs in Delhi and Lucknow, India, from March to July 2015. The women, who all consented to the procedure and received counseling about the various options for postpartum contraception and the health benefits of spacing pregnancies, said placement of the IUD caused them little or no additional pain compared with the birth of their child.
![PPIUD inserter](https://www.psi.org/wp-content/uploads/psi-impact/uploads/2016/03/PPIUD.png)
According to the study, about half the IUDs were provided within an hour after delivery, and 26 percent were placed within six hours. IUDs can be inserted up to 48 hours after delivery. After 48 hours, women must wait at least 4 weeks to receive an IUD and many will not have access to a facility that can provide them.
After placement of PPIUD, using the new inserter, the researchers used abdominal ultrasound to confirm they had reached the proper position in the uterus. When the women were asked about their pain levels during the procedure, 74% reported same level of pain before and after insertion. In a follow-up clinic visit, all of them said the experience was a positive one, with 100 percent reporting that their providers met or exceeded their expectations.
The procedures were done by 11 trained health-care providers, 93 percent of whom reported it to be an easy process. Providers are more apt to educate a woman about the PPIUD when they feel comfortable providing it.
Pregna International, which refined and manufactured the device for the pilot study, is keen to bring it to market. In the meantime, the use and benefits of the PPIUD inserter continue to be studied, with more findings to be published in the coming year.
ABOUT PSI
PSI is a leading global health organization working in HIV, reproductive health, child survival, non-communicable diseases and sanitation. Partnering with the public sector and harnessing the power of markets, PSI provides life-saving products, services and communications that empower vulnerable populations to lead healthier lives. Learn more about PSI.
ABOUT Saving Lives at Birth
The Saving Lives at Birth partnership, launched in 2011, currently includes the U.S. Agency for International Development (USAID), the Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada (funded by the Government of Canada), the U.K’s Department for International Development (DFID) and the Korea International Cooperation Agency (KOICA). It is a global call for groundbreaking, scalable solutions to infant and maternal mortality around the time of birth. It aims to address the 303,000 maternal deaths, 2.7 million neonatal deaths, and 2.6 million stillbirths that occur each year around the world. To date, Saving Lives at Birth innovations have benefited over 1.5 million women and newborns, saving at least 7,000 lives.
ABOUT SPIRES
The Stanford Program for International Reproductive Education and Services (SPIRES) aims to advance women’s health in developing countries. The program focuses on building medical capacity by providing technical expertise and training for international non-governmental organizations (NGOs).
Photo Credit (banner): Courtesy of PSI