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

2. 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 3

4. Program Intervention/Activity Tested 1.Women’s experience with PPIUD insertion 2.Service providers perspectives, practice and experience with PPIUD services 4

5. Methodology 5

6.  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. 6

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. 7

8. PPIUCD Insertion ( n=117) 8

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) 9

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) 10

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...” 11

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 12