A facility birth can be the time to start family planning: Postpartum intrauterine device experiences from six countries

TLDR

Initiation of family planning at birth is opportune because few women in low‑resource settings who give birth in a facility return for further care. PPFP and PPIUD services were integrated into routine maternal care in six low‑ and middle‑income countries using a Paraguayan insertion technique, with high‑volume facilities selected, provider training and mentoring, and ongoing monitoring for advocacy. Across the six countries, PPIUD acceptance ranged from 2.3 % in Pakistan to 5.8 % in the Philippines, with low complication, expulsion (≤3.7 %), and infection rates (≤1.3 %), demonstrating that offering PPFP/PPIUD at birth improves contraceptive access.

Abstract

Initiation of family planning at the time of birth is opportune, since few women in low-resource settings who give birth in a facility return for further care. Postpartum family planning (PPFP) and postpartum intrauterine device (PPIUD) services were integrated into maternal care in six low- and middle-income countries, applying an insertion technique developed in Paraguay. Facilities with high delivery volume were selected to integrate PPFP/PPIUD services into routine care. Effective PPFP/PPIUD integration requires training and mentoring those providers assisting women at the time of birth. Ongoing monitoring generated data for advocacy. The percentages of PPIUD acceptors ranged from 2.3% of women counseled in Pakistan to 5.8% in the Philippines. Rates of complications among women returning for follow-up were low. Expulsion rates were 3.7% in Pakistan, 3.6% in Ethiopia, and 1.7% in Guinea and the Philippines. Infection rates did not exceed 1.3%, and three countries recorded no cases. Offering PPFP/PPIUD at birth improves access to contraception.