JHPIEGO in partnership with Save the Children, Constella Futures, The Academy for Educational Development, The American College of Nurse-Midwives and IMA World Health Reinvigorating the PPIUCD in India Dr. Rinku Srivastava SIFPSA, India

2 Session Objectives  Understand the need for postpartum family planning in India  Describe the confluence of factors for which a strategy of postpartum IUCD is suggested  Understand the strategic approach to national expansion of PPIUCD

33 India: Birth-to-birth Intervals for past five years Source: NFHS 2006 N =39,215 births

44 India: Unmet Need across Postpartum Period and FP use among Sexually Active Women N=1305N=2374N=2661N=2168 Source: NFHS 2006

55 Family Planning Method Mix across Postpartum Periods N=243N=687N=921N=845

6 Opportunities for Strengthening PPFP & PPIUCD services:  10 fold increase in women delivering in hospitals due to Maternity benefit scheme (JSY)  CuT 380 A is effective long term reversible method- an alternative for sterilization for many women  Current national strategy for increasing IUCD uptake  New advances and new understanding about IUCD with low expulsion rate and cost effective

7 PPIUCD initiative in Uttar Pradesh  PPIUCD training initiated on pilot basis in 2008 by SIFPSA  Service Sites assessed and strengthened  ObGyn Department, CSMMU, Lucknow identified as training site for PPIUCD  Providers from District Women Hospital Jhansi & Allahabad trained and service being provided  TA provided by Jhpiego

8 Status of PPIUCD Services in U.P.  7 Faculty members at CSMMU, Lucknow trained as Master trainers by Jhpiego  5 Doctors trained & 4 Staff Nurses oriented from Jhansi and Allahabad SNSiteTotal PPIUCD inserted 1CSMMU. Lucknow245(Jan 09 –Jan 10) 2District Women Hospital, Allahabad 124 (Aug 09-Jan 10) 3District Women Hospital, Jhansi 12 (Aug 09-Jan 10) Total381

9 Service Delivery Statistics

10 Lessons Learnt…  Concentrated efforts are needed to generate demand for PPFF including PPIUCD services  Counseling services to be strengthened  Follow up and tracking of PPIUCD clients to be institutionalized  Capacity building of trainers & service providers including supportive supervision at the service delivery site critical  Strong Monitoring and Evaluation of services needed

11 Plan for Expansion in other states:  Beside Lucknow training sites created and trainers trained at Delhi, Mumbai and Jabalpur  Trainings of providers to role out in additional 12 states from March 2010  Use of standard training material  Course notebook for Trainers  Course Notebook for Learners  Reference Manual  Post Partum IUCD Standards for training and service site  Job aids  ANC Counseling Guide- PPFP  PPIUCD Pre insertion Screening

12 Postpartum IUCD- Summary  Safe, convenient & cost effective, reversible, long term birth spacing method  Should be part of a maternal/newborn/ reproductive health package  JSY is an opportunity to add PPIUCD into FP program and could address the high unmet need for FP in India