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PPIUD Newsletter Issue No. 7
January-March 2017

 

Dear Friends and Colleagues,
 
The PPIUD initiative had a busy start to 2017 with project planning, data training and conferences. We showcase a few of the best bits in this quarter's newsletter which includes:  

Updates
Country Focus

Resources
Updates

RCOG Congress - Anita Makins, PPIUD Deputy Director

 
Over 2400 delegates from over 70 countries came together from the 20th to the 22nd March in the beautiful city of Cape Town. Global health took centre stage, with human rights and women’s health at the forefront.

In the contraception 
sessions, we heard from a variety of speakers. Highlights included learning how a pilot PPIUD project in Pakistan led to successful government roll out, with over 40 000 insertions.

Dr Blumenthal presented studies looking at the dedicated PPIUD Pregna inserter, noting that results are comparable to those of Kelly’s insertion. Prof Arulkumaran presented results on the PPIUD initiative in the plenary session ‘Changing Hearts and Minds’, which was very well received.

The meeting was also a great opportunity to meet with some of the global PPIUD team including Sri Lankan, Nepali and Kenyan colleagues, as well as our donors.
Prof. Arulkumaran presenting the PPIUD initiative at the RCOG World Congress

Data Transition Training - Sri Lanka & Nepal
The start of 2017 saw the conclusion of Form 1 data collection for the Harvard research countries and the transition to a FIGO-National Society led data collection. As such, Maya and Jennifer conducted two 'data transition' trainings in Sri Lanka (January) and Nepal (March). 
 
These trainings enabled the data collectors to become acquainted with the style and content in the new applications so they could start using them upon returning to their facilities.

It was also an opportunity to provide some refresher training, focusing on key areas of the data collection where there have been difficulties in the past, such as recording reasons for withdrawal of consent for PPIUD.

 
Right: Maya leads a post-lunch energiser entitled 'Find the Kelly's' during the DCO training in Sri Lanka

Country Focus
Nepal

In March, the Nepal PPIUD team warmly welcomed Anita, Maya and Jennifer from FIGO HQ for a productive week of facility visits, data training and meetings with the team and government officials, followed by two days of intensive planning and re-budgeting.

One of the objectives of the visit was to work with the Nepal team to identify ways in which counselling rates can be improved in Nepal, and increase demand for PPIUD. The FIGO team visited 3 facilities – Western Regional Hospital, Koshi Zonal Hospital, and B.P. Koirala Institute of Health Sciences. It was clear from these visits that despite great commitment from the providers, the doctors and nurses remain stretched due to very high delivery rates (over 51,000 across the 6 facilities in 2016) and large ANC clinics (one facility saw 550 women attending ANC a day). This limits the number of women the staff can counsel in postpartum family planning (PPFP) and thus affects the demand for PPIUD. The recruitment of dedicated counsellors in September 2016 has had a positive impact on the numbers of women counselled on PPFP and consenting to a PPIUD and the facility teams continue to work incredibly hard to overcome these challenges.
Woman receiving PPFP counselling during an M&E visit in Nepal.
Following the visits, the FIGO and NESOG teams spent valuable time together discussing ways to further improve counselling rates, in light of all that was learnt during the facility visits. The Nepal team came up with some excellent strategies which included conducting regular CME sessions in each facility to raise awareness of PPIUD, the importance of birth spacing, and the range of PPFP methods available. This would equip more providers along the patient journey with the necessary information to counsel women and answer key questions. 

The visit proved very fruitful for both FIGO and NESOG, and the FIGO team look forward to conducting equally productive visits to the other five countries over the next few months.

Thread Retrieval Training Video

In response to M&E data and feedback from the country teams, the PPIUD team has developed a thread retrieval training video to train providers how to retrieve the IUD threads at the 4-6 week check-up appointments. The video explains the procedure for both cytobrushes and thread retrievers - either of which can be used in the procedure. 

The PPIUD team has found in all intervention countries that the absence of noticeable threads is a key reason for women requesting PPIUD removal at their check-up appointments. We have found that when providers take the time to pull the threads down from the cervix, the woman is assured that the IUD is in place and, thus, that she has a reliable form of contraception.

 
The thread retrieval training video has been distributed to all six countries in the initiative to incorporate into their ongoing provider training. It is also available to view online here:
The Latest Stats
These statistics are cumulative from the start of the initiative and based on the most recent report for the semester ending December 2016.
Bangladesh
32% of women counselled on PPIUD
3867 PPIUD insertions achieved
870 doctors trained in PPIUD insertion and family planning counselling
6 counsellors trained in family planning counselling

India
90% of women counselled on PPIUD
11753 PPIUD insertions achieved
762 doctors trained in PPIUD insertion and family planning counselling
12 RMCH counsellors trained in family planning counselling

Kenya
27% of women counselled on PPIUD
1319 PPIUD insertions achieved
1122 providers trained in PPIUD insertion and family planning counselling
Nepal
15% of women counselled on PPIUD
1097 PPIUD insertions achieved
128 doctors trained in PPIUD insertion and family planning counselling
797 counsellors trained in family planning counselling​

Sri Lanka
43% of women counselled on PPIUD
7439 PPIUD insertions achieved
805 doctors trained in PPIUD insertion and family planning counselling
4193 community midwives trained in family planning counselling

Tanzania
9% of women counselled on PPIUD
1297 PPIUD insertions achieved
353 doctors trained in PPIUD insertion and family planning counselling
476 counsellors trained in family planning counselling

Events

13th International Conference of Nepal Society of Obstetricians and Gynaecologists (NESOG)
7th-8th April, Kathmandu, Nepal

Population Council (2017) The Need for Improved Information Exchange Between Family Planning Providers and Clients. Available from: http://www.popcouncil.org/uploads/pdfs/2017RH_ImprovedInfoFP.pdf [Accessed: 3rd April 2017]  
Policy brief outlining the need for improved family planning counselling in order to achieve the FP2020 goals. 

HOFLER, G. et al (2017) Implementing Immediate Postpartum Long-Acting Reversible Contraception ProgramsClinical Practice and Quality. [Online] 129 (1). p. 3. Available from: http://journals.lww.com/greenjournal/Abstract/2017/01000/Implementing_Immediate_Postpartum_Long_Acting.2.aspx. [Accessed: 3rd April 2017]
 Objective: To understand the most important steps required to implement immediate postpartum long-acting reversible contraception (LARC) programs in different Georgia hospitals and the barriers to implementing such a program. 

STOVER, J. and Sonneveldt, E. (2017) Progress Towards the Goals of FP 2020. Studies in Family Planning. [Online] 48 (1). p. 83 Available from: http://onlinelibrary.wiley.com/doi/10.1111/sifp.12014/abstrac[Accessed: 3rd April 2017]
FP2020, seeks to revitalize the field of family planning by scaling up efforts to expand knowledge, access, use, and quality of family planning services. The commitment includes increased resources and new approaches for increasing the use of modern contraception in order to address unmet need among couples in developing countries.We are now at the half-way point in the initiative, and it is appropriate to consider what progress has been made and whether we are on track to achieve the goals.

Do you have something you would like to share with the PPIUD team? Just email ppiud@figo.org with additions to the 'updates', 'peer-learning', 'research', 'events' or 'resources' sections.
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