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July – September 2015
 
Dear Friends and Colleagues,
 
Welcome to our first FIGO Post-Partum IUD initiative newsletter.  We plan to send these out four times a year. Each newsletter will feature a country specific update.  To kick us off, Kenya provides a summary of their Master training.  We want this newsletter to be useful to you so please do give us feedback and also make suggestions for future articles.  This current edition includes:
What is the PPIUD Initiative?

The PPIUD initiative aims to address the postpartum contraceptive needs of women by training community midwives, health workers, doctors and delivery unit staff in postpartum IUD counselling and insertion.

The initiative was initially piloted in 2013 in Sri Lanka in 6 teaching hospitals before scaling up in January 2015 to include 12 more hospitals in Sri Lanka, and 6 teaching hospitals in each of Tanzania, India, Kenya, Nepal and Bangladesh. The initiative will strengthen the capacity of community midwives to counsel women on the benefits of postpartum contraception, in particular IUDS. It will also support health care providers and managers to regularly review and improve the performance on postpartum IUD services.

An evaluation of three of the participating countries is being led by the Harvard School of Public Health.
The Latest Stats
Bangladesh
Training conducted in 6 facilities
12 Master trainers trained
270 Doctors trained in PPIUD insertion and Family Planning counselling
6 Counsellors trained in Family Planning counselling
119 PPIUD insertions achieved

India
Training conducted in 6 facilities
74 Master trainers trained
340 Doctors trained in PPIUD insertion and Family Planning counselling
12 RMCH Counsellors trained in Family Planning counselling
1214 PPIUD insertions achieved

Kenya
12 Master trainers trained
Nepal
Master training to commence in last week of November for 3 facilities, as per the Harvard Research timeline.

Sri Lanka
Training conducted in 11 facilities
32 Master trainers trained
424 Doctors trained in PPIUD insertion and Family Planning counselling
2460 Community Midwives trained in Family Planning counselling
2910 PPIUD insertions achieved

Tanzania
Master training to commence in late February for 3 facilities, as per the Harvard Research timeline.
GLOWM

The GLOWM web-site includes free materials for training and for promotion of PPIUD.  An exciting recent development is an animated video on Family Planning in general and PPIUD which is currently being translated to different languages for countries to use in antenatal clinics involved with the initiative.
Country Focus - Kenya

The PPIUD initiative is being implemented in Kenya in 6 hospitals in Thika, Mombasa, Eldoret, Meru, Kisumu and Nakuru to facilitate birth spacing. In September, the PPIUD Data Collection Officers from each of these facilities in Kenya gathered together to learn about data collection and be trained in the use of the CommCare data collection application that will be used in all 6 participating countries.  The  health records officers were quick learners and provided many solutions to work-flow and response rate challenges.  

Later in the week, Professor Hemantha and Dr Ratnisiri joined the team from the Sri Lanka programme to lead the master training in PPIUD and share their experiences and expertise. The coordinators and deputies used Mama-U models to learn how to insert IUD post partum as well as the importance of contraceptive counselling.  The Master training emphasised the different techniques used for PPIUD compared to interval IUD, the former requiring the longer, curved Kelly's forceps.  With the correct technique and equipment, the spontaneous expulsion rates can be significantly reduced.  The facility coordinators and deputies were very motivated to raise awareness in their areas and to deliver training to medical and nursing staff at their hospitals and the training was a great success.
Equipment being prepared for the Kenya Master Training
CommCare

Both the PPIUD initiative and the Harvard research evaluation of the initiative will utilise CommCare - an open source mobile platform that supports frontline workers in low-resource communities - developed and customized for the project by Damagi. The Data Collection Officers and Research Assistants in the initiative will utilise CommCare via tablets to register all women delivering at participating facilities, collect data on the timing and quality of general family planning and PPIUD counselling, women consenting to PPIUD, insertions and follow-up to track expulsion rates.  The Harvard research will follow up women for longer to find out her views of the method and family spacing. An important component of CommCare is the ability to monitor activity easily so that supervisors and hospital coordinators can understand how health providers are utilising their training in PPIUD and provide support if required.  
Upcoming Training

9th-12th November: International Conference on Family Planning, Indonesia

Upcoming Events

2nd-12th December: Data collection and Commcare, Tanzania
Useful Resources

LOPEZ, L. et al (2015) Update of Cochrane review of Immediate postpartum insertion of intrauterine device for contraception. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003036.pub3/full [Accessed: 2nd November 2015]  
Women who want to start intrauterine contraception (IUC) during the postpartum period might benefit from IUC insertion immediately after delivery. Postplacental insertion greatly reduces the risk of subsequent pregnancy and eliminates the need for a return visit to start contraception. Without the option of immediate insertion, many women may never return for services or may adopt less effective contraception.

STRAFFORD, M., Nahar, D. & Chappelle, J. (2015) The effects of a standardized counselling video on the knowledge and planned utilization of contraceptives in the postpartum periodContraception. [Online] 92 (4). p. 405. Available from: http://www.contraceptionjournal.org/article/S0010-7824(15)00450-3/abstract. [Accessed: 2nd November 2015]
 An evaluation of the effect of standardized audiovisual materials on women's knowledge and planned contraceptive use in the postpartum period. Results found that no women in the experimental group were undecided about their contraception choices and there was an increase in the number of women who had a contraceptive plan at the time of discharge. 

UNFPA (2014) Adding it up: Investing in Sexual and Reproductive Health: Global Fact Sheet. Available from: http://www.unfpa.org/resources/adding-it-2014-global-fact-sheet [Accessed: 2nd November 2015]
An estimated 290,000 women die each year in developing countries from pregnancy-related causes, and 2.9 million newborns die in the first month.
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