Post-Partum IUD Program in Kenya: Best Practice

Joygrace Muthoni

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Presentation Outline

Background Program Intervention/Objectives Methodology Findings Lessons learnt

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

1. Women’s experience with PPIUD insertion

2. 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 July–December 2009 and February-March 2010.

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Findings: Service Providers n=49

“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 ( n=117)

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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(n=63)

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

husband’s 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

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