Introduction of postpartum IUCD (PPIUCD) services in public sector: Experience from India

Methods: To leverage the dramatic increase in institutional deliveries after the introduction of conditional cash- transfer scheme in India and for addressing huge unmet need for contraception in the postpartum period, Government of India (GoI) introduced IUCD services in immediate postpartum period in select facilities in 19 states of India in 2010. A multi-centric follow-up study is being undertaken in 9 states to assess the post-insertion outcomes of clients. Results: Within two years of initiation of the program, PPIUCD services have been established in > 50 facilities across 19 states of India, with the GoI now deciding to scale-up the services across India. >22,000 PPIUCD insertions have been conducted, with > 5% of women delivering in these institutions opting for PPIUCD as their choice of contraception. 30% of PPIUCD acceptors could be followed up after 6 weeks of insertion and follow-up study data demonstrates that almost 90% of women were found continuing with the IUCD at the time of follow-up. Expulsion rate among the clients is 3.2%, which is comparable to the expulsion rates of interval IUCD insertions. 4.5% of women reported infection post-insertion and 7% of women got the IUCD removed within first six weeks of insertion, the major reasons for removal being bleeding and abdominal pain. This calls for strengthening infection prevention measures and counselling services. Conclusion: Introduction of PPIUCD services in public-sector is an effective and scalable public health intervention for increasing the access to wider basket of contraceptive choices to the women in their postpartum period.