Reinvigorating the PPIUCD in India

1. Reinvigorating the PPIUCD in India Dr. Rinku Srivastava SIFPSA, India

2. Session Objectives • Understand the need for postpartum family planning in India • Describe the confluence of factors for which a strategy of postpartum IUCD is suggested • Understand the strategic approach to national expansion of PPIUCD

3. India: Birth-to-birth Intervals for past five years 3 Source: NFHS 2006 N =39,215 births

4. India: Unmet Need across Postpartum Period and FP use among Sexually Active Women N=1305 N=2374 N=2661 N=2168 4 Source: NFHS 2006

5. Family Planning Method Mix across Postpartum Periods N=243 N=687 N=921 N=845 5

6. 10 fold increase in women delivering in hospitals due to Maternity benefit scheme (JSY) CuT 380 A is effective long term reversible method- an alternative for sterilization for many women Current national strategy for increasing IUCD uptake New advances and new understanding about IUCD with low expulsion rate and cost effective Opportunities for Strengthening PPFP & PPIUCD services:

7. PPIUCD initiative in Uttar Pradesh • PPIUCD training initiated on pilot basis in 2008 by SIFPSA • Service Sites assessed and strengthened • ObGyn Department, CSMMU, Lucknow identified as training site for PPIUCD • Providers from District Women Hospital Jhansi & Allahabad trained and service being provided • TA provided by Jhpiego

8. Status of PPIUCD Services in U.P. • 7 Faculty members at CSMMU, Lucknow trained as Master trainers by Jhpiego • 5 Doctors trained & 4 Staff Nurses oriented from Jhansi and Allahabad

9. Service Delivery Statistics

10. Lessons Learnt… • Concentrated efforts are needed to generate demand for PPFF including PPIUCD services • Counseling services to be strengthened • Follow up and tracking of PPIUCD clients to be institutionalized • Capacity building of trainers & service providers including supportive supervision at the service delivery site critical • Strong Monitoring and Evaluation of services needed

11. Plan for Expansion in other states: • Beside Lucknow training sites created and trainers trained at Delhi, Mumbai and Jabalpur • Trainings of providers to role out in additional 12 states from March 2010 • Use of standard training material • Course notebook for Trainers • Course Notebook for Learners • Reference Manual • Post Partum IUCD Standards for training and service site • Job aids • ANC Counseling Guide- PPFP • PPIUCD Pre insertion Screening

12. Postpartum IUCD- Summary • Safe, convenient & cost effective, reversible, long term birth spacing method • Should be part of a maternal/newborn/ reproductive health package • JSY is an opportunity to add PPIUCD into FP program and could address the high unmet need for FP in India