Dr. Bulbul Sood Country Director Jhpiego/ India XX FIGO Conference of Gynecology and Obstetrics Rome, October 712, 2012
Courtesy: HIP
Objectives
Unmet need for PPFP and opportunities Starting and scaling up PPFP/ PPIUCD services Post-insertion outcome from PPIUCD services
Year 2030
India (1484.6) China (1462.5)
In the next 18 years, India will be the most populous nation in the world
Source: World Population Prospects: 2008 Revision Population Database UN Popula tion Division
21%
11% 16%
19% 34%
40% 20%
7-17
18-23
24-35
36-47
48+
0% 0-3
N= 1305
4-6
N= 2374
7-9
N= 2661
10-12
N= 2168
Beneficiaries (lakhs)
Percentage
Post-placental:
10 minutes after delivery of placenta
Immediate postpartum
Within 48 hours after delivery
Intra-cesarean
During cesarean section
Insertion techniques:
Support from national as well as state governments during the expansion, with a paradigm shift in Govt. of India focusing on spacing methods
N= 56,590
20,000
19,174
Intracesarean 21%
15,000
10,000
7,188
5,000
746
696
548
75
38
2% 2% 2%
State Name
Follow-Up Study
Study period: November 2011June 2012 2,733 clients who had PPIUCD insertion and consented to participate were interviewed before discharge from hospital, and 1,811 clients were interviewed at around 6 weeks after insertion in 16 facilities Study was approved by Institutional Review Board (IRB) of Johns Hopkins University
Educational Status of Client No schooling Primary (until 5th) Secondary school (until 8th) Intermediate (until 12 th) 22.6% 19.1% 20.5% 10.4% 11.7%
24% 71%
To reduce expulsion
Use correct technique:
Straighten cervico-uterine angle Position the IUCD at the fundus before release Release the IUCD by sweeping to the side Withdraw the instrument in open position
Conclusion
Introduction of PPIUCD services in the public sector is feasible and effective. Government of India is scaling up PPIUCD services in all 150 districts in high-focus states of Bihar, U.P., Jharkhand, Rajasthan, M.P. and Chattisgarh. Trained doctors and nurses can safely and effectively provide PPIUCD services. Key program component for success is supportive supervision.
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Thank Y ou
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