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

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Maternal and Child Health Integrated Program (MCHIP)

• USAID Bureau for Global Health’s 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

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CPR and unmet need for FP in Ethiopia

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Current use of Family Planning in Ethiopia

Source: EDHS 2011

Pills; 0.3% IUCD; 2.1%

Injectable; 20.8%

Condom; 0.2%

Implants; 3.4%

PM; 0.5%

Tradi-tional

methods, 1.3%

non-users; 71.4%

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Family Planning Use Among Postpartum Women Across Postpartum Periods

91%82%

72%81%

9%17%

27%19%

<1%1%<1%<1%

0%

20%

40%

60%

80%

100%

0-5.9 MosN=1,332

6-11.9 MosN=1,177

12-23.9 MosN=1,944

Total 0-23.9Mos

N=4,453

Trad

Modern

No method

Source: MCHIP 2013 Family planning needs during the 1st two years Postpartum in Ethiopia

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42%

22%

63%

47%53%

29%33%

76%

86%

0%

20%

40%

60%

80%

100%

0-5.9 MosN=1,332

6-11.9 MosN=1,177

12-23.9 MosN=1,944

Unmet need - spaceUnmet need - limitTotal unmet need

Unmet Need for FP Across Postpartum Periods

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

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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

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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

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

Post pla-cental, 345,

43.8%

Immediate PP, 424, 53.8%

Intra C/S, 19, 2.4%

PPIUCD insertions by timing, March 2012-September 2013

N=788

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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

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Thank you!

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