Capturing a missed opportunity through postpartum intrauterine contraceptive device (PPIUCD) in Ethiopia: Experience of the Maternal and Child

Health Integrated Program (MCHIP)

Serawit Lisanework, Alemnesh Tekleberhan, Nega Tesfaw, Hannah Gibson, Tsigue Pleah, Nancy Koskei

Presentation Outline
Background Program Intervention Major Accomplishments Lessons Learnt

Maternal and Child Health Integrated Program (MCHIP)

USAID Bureau for Global Healths flagship maternal, newborn and child health program. MCHIP is active in Ethiopia since 2010 and supports

interventions in MNCH, FP, PMTCT and Health Systems

Strengthening

CPR and unmet need for FP in Ethiopia

Current use of Family Planning in Ethiopia

Pills, 0.3%
IUCD, 2.1% Injectable, 20.8% Condom, 0.2% Implants, 3.4% PM, 0.5% Traditional methods, 1.3%

non-users, 71.4%

Source: EDHS 2011

Family Planning Use Among Postpartum Women Across Postpartum Periods

100% 80% 60% 40% 20% 0%
0-5.9 Mos N=1,332 6-11.9 Mos 12-23.9 Mos Total 0-23.9 N=1,177 N=1,944 Mos N=4,453
6 Source: MCHIP 2013 Family planning needs during the 1st two years Postpartum in Ethiopia

<1% 9%

<1% 17%

1% 27%

<1% 19%

Trad
91% 82% 72% 81%

Modern No method

Unmet Need for FP Across Postpartum Periods

100%
86%

80% 60% 40%

33%

76% 63% 53% 47% 42% 29% 22%

Unmet need - space Unmet need - limit Total unmet need

20% 0%
0-5.9 Mos N=1,332 6-11.9 Mos N=1,177

12-23.9 Mos N=1,944

Source: MCHIP 2012 Family planning needs during the 1st two years Postpartum in Ethiopia

PPIUCD program in Ethiopia

In March 2012, MCHIP in collaboration with the FMoH introduced provision of PPIUCD services in 8 health facilities In March 2013, PPIUCD services expanded to additional 10 hospitals Clients are counseled on postpartum family planning (PPFP) during ANC, latent phase of labor and after delivery For clients who decide to use PPIUCD, insertions are done immediately after delivery

Why PPIUCD?
PPIUCD is the only long acting method that does not interfere with breastfeeding, can be provided before the woman leaves the birthing facility.

Requires no transition (from LAM to hormonals)

Side effects & complications are minimal

Meets the needs of women who either wish to limit or space

Major Accomplishments to date

Trained 104 service providers in Contraceptive technology update & PPFP Counseling skills Trained 60 service providers in PPIUCD insertion skills Provided technical support to FMoH in the adaptation of PPIUCD training package for national use Trained 12 Proficient PPIUCD service providers in training skills so that they will be national trainers for PPIUCD expansion efforts

10

Major Accomplishments to date cont.- PPIUCD insertions, March 2012-September 2013

PPIUCD insertions by timing, March 2012-September 2013 Immediate PP, 424, 53.8% Post placental, 345, 43.8%
11

Intra C/S, 19, 2.4%

N=788

Lessons learnt
Demand for PPIUCD is growing Post-training transfer of learning is important to reinforce skills of trained service providers Follow-up meetings facilitate experience sharing & motivation for better performance Whole staff orientation is vital to promote team work Support from facility managers & department heads is vital in improving services

12

13