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Post-Partum IUD Program in Kenya: Best Practice

Post-Partum IUD Program in Kenya: Best Practice. Joygrace Muthoni. Presentation Outline. Background Program Intervention/Objectives Methodology Findings Lessons learnt. Background. Conducted a pilot activity 2007-2009: 3 day orientation package Cascade training

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Post-Partum IUD Program in Kenya: Best Practice

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  1. Post-Partum IUD Program in Kenya: Best Practice Joygrace Muthoni

  2. Presentation Outline • Background • Program Intervention/Objectives • Methodology • Findings • Lessons learnt

  3. 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

  4. Program Intervention/Activity Tested • Women’s experience with PPIUD insertion • Service providers perspectives, practice and experience with PPIUD services

  5. Methodology

  6. 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.

  7. 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.

  8. PPIUCD Insertion ( n=117)

  9. 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)

  10. 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)

  11. 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...”

  12. 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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