Training for and Institutionalization of Post-Placental and Immediate Postpartum Insertion of Intrauterine Contraceptive Device (PPIUCD):
A successful intervention being implemented by National Committee for Maternal & Neonatal Health (NCMNH) in two tertiary Hospitals of Karachi.
Pakistan with its population of 185 million is the sixth most populous country of the world. It is estimated that Pakistan will become the 4th most populous country with the population rising to 335 million by 2050. Such soaring population growth, coupled with youthful demographics, high unemployment, and a troubled economy pose great challenges for Pakistan.
Contraceptive Prevalence Rate (CPR) is stagnant at 30%, the unmet need of family Planning (FP) being 25%. In the first year postpartum, 64% of the women have an unmet need for family planning.
35 % of women in Pakistan deliver in health facilities and leave without receiving counseling or FP services. Majority of these women do not return for postpartum check and often come back with an unintended pregnancy.
These facts underscore the need for provision of Post Partum Family Planning (PPFP) services immediately after child birth. To meet this demand, Post-Placental and Immediate Postpartum insertion of Intrauterine Contraceptive Device (IUCD) can be advocated as an ideal choice. PPIUCD insertion has been found to be safe and expulsion rates are comparable to insertion of IUCD in the extended postpartum period.
NCMNH is implementing an important intervention, the objective of which is to train Skilled Birth Attendants (SBAs) to provide Post-Placental and Immediate Postpartum Insertion of IUCD in two tertiary hospitals of Karachi namely, Jinnah Postgraduate Medical Center (JPMC) and Sobhraj Maternity Hospital (SMH). The ultimate goal is to institutionalize this intervention in a sustainable manner.
Six months into this intervention 122 SBAs have been trained and 1676 PPIUCDs have been inserted in 18.1% of childbirths in the two hospitals. One third of the women have been followed up and to date no significant complication has been reported. Expulsion has been noted in 2% of cases.
NCMNH envisages expansion of institutionalization of PPIUCD services after pilot phase. It is expected that wider implementation of PPIUCD service will have a positive impact on averting maternal and neonatal mortality and morbidity.
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