Abstract of Dissertation

Agency : PPIUCD, Postpartum Intrauterine Contraceptive Devices, Unmet Need, Family Planning, Postpartum Family Planning, IUCD, Intrauterine Contraceptive Devices, ANC

Objective : The objectives of this study were: 1. To understand the provider perspective with respect to PPIUCD trainings, service delivery, and counselling provided by them. 2. To learn about women’s experience with PPIUCD insertion, counselling provided, follow up and satisfaction from service provider. 3. To identify the gaps in performance of providers by comparing their knowledge and insertion procedure with standard guidelines in PPIUCD services.

Background : The postpartum insertion of an IUCD provides a convenient opportunity for women to receive contraceptive services. The postpartum period is potentially an ideal time to begin contraception as women are more strongly motivated to do so at this time, which also has the advantage of being convenient for both patients and health-care providers. The GoI has developed training strategies, materials and systems for PPIUCD, development of standards and guidelines for service delivery. Despite all the efforts, in Haryana proportion of PPIUCD acceptors are just 9% and follow up rates also low 33%. In addition to this, a large sum of money is being spent on trainings. In 2012-13, approximately 18 lacs were spent per district on PPIUCD still the unmet need has not been met. In PPIUCD service delivery skills of providers play very important role. Not only insertion part but also counselling part is very crucial. Proper insertion technique by following GoI guidelines along with effective counselling can increase the acceptance of PPIUCD in society. This study attempted to assess the PPIUCD trainings in Panchkula and Ambala.

Methodology : This was a descriptive cross-sectional study .Systematic sampling was being used for providers and beneficiaries. Assessment of PPIUCD service of trained and untrained MO, SN, Gynaecologist was done. This assessment was done by assessing knowledge and skills of providers in two districts Panchkula and Ambala. Perspective of providers and beneficiaries was known by semi structured questionnaire. From each district 30 providers+ 2 counsellors were taken ( total 60 ). Women who were currently using or have used PPIUCD in past 12 months were taken to know beneficiary perspective about PPIUCD.

Findings : Fourty seven percent provider reported that practical trainings provided to them were incomplete, 58 % providers shared that pain, bleeding, expulsion were the negative experiences about PPIUCD. While almost all the providers in Panchkula and Ambala reported of counselling women on FP about 3-5 times starting from ANC, around 82% beneficiaries reported that provider never talked to them about FP. Only 3 % provider said PPIUCD insertion is very painful whereas 13 % females shared that it was very painful and 34 % said it was painful. This could be seen as an indication of quality of the services being provided to the women. According to provider 73% females were satisfied with their decision of PPIUCD insertion but when women were asked about their satisfaction, only 43% said they were satisfied with decision of PPIUCD insertion. Eighty five percent of the interviewed women experienced problems with PPIUCD insertion. Majority complained of watery discharge, burning sensation, heavy or irregular bleeding due to which got anaemic. Among both trained and untrained staff knowledge level of providers at Panchkula was better than in Ambala. In both Post placental & immediate IUCD insertion providers of Ambala performed better than Panchkula.Trained counsellors were able to perform very less 35% correct steps especially in Panchkula.

Recommendations :

The trainings being given under PPIUCD lacks focus on practical orientation and practice. Those who were trained were not able to perform all the steps correctly and with confidence. Lot of contradictory responses were found on counselling and satisfaction about PPIUCD among providers and beneficiaries. Counselling part was lacking as per beneficiaries experience. Females reported to be facing problems related to 34 PPIUCD like pain, bleeding etc. While providers have knowledge about these problems, they relate it with psychological pain. This needs to be corrected so that PPIUCD could be accepted as desirable FP method.