Increasing the use of long acting reversible contraception in El Salvador: Focus on IUD revitalization

Description: In El Salvador, 40% of pregnancies are unintended; sterilization is the most common contraceptive method (32%) followed by injectables (22%). The 2008 DHS reports IUD use at less than 1%. The local Population Services International (PSI) affiliate, PASMO, implemented the Womenxs Health Project, a program aimed at revitalizing IUD use among those seeking highly effective, reversible contraception. Methods: PSI-PASMO trainers/providers in public and private sector facilities provided on the job training, counseling and IUD insertion services. PSI-PASMO community health workers created informed demand for the IUD through interpersonal communication and educational activities. PSI/PASMO Master Trainers monitored quality assurance through routine supervisory visits and PSI-PASMO supervisors collected client data from providers on a monthly basis. Results: From January to December 2009 the project achieved a 300% increase in the use of the IUD in El Salvador. The Ministry of Health records show a total of 2,146 IUDs inserted in 2008; PSI data indicates 6,308 IUDs inserted by the project in 2009. IUDs share of method mix increased from <1% to 3.6%. Discussion: PSI-PASMO is increasing the perception among women and providers that the IUD is a safe, effective family planning method and is improving the quality of IUD insertion services within the private and public sector (where 75% of FP services are offered.) Recommendations: Focus program efforts on generating informed demand for IUD services and matching it with high quality supply of IUD services. Provide on the job-training and supervision to increase providers' competency and confidence in IUD insertion services.