FIGO postpartum intrauterine device initiative: Complication rates across six countries

Int J Gynaecol Obstet. 2018 Sep:143 Suppl 1:20-27. doi: 10.1002/ijgo.12600.


Objective: To record and analyze complication rates following postpartum intrauterine device (PPIUD) insertion in 48 hospitals in six countries: Sri Lanka, India, Nepal, Bangladesh, Tanzania, and Kenya.

Methods: Healthcare providers were trained in counselling and insertion of PPIUD via a training-the-trainer model. Data were collected on methodology, timing, cadre of staff providing care, and number of insertions. Data on complications were collected at 6-week follow-up. Statistical analysis was performed to elucidate factors associated with increased expulsion and absence of threads.

Results: From May 2014 to September 2017, 36 766 PPIUDs were inserted: 53% vaginal and 47% at cesarean delivery; 74% were inserted by doctors. Follow-up was attended by 52%. Expulsion and removal rates were 2.5% and 3.6%, respectively. Threads were not visible in 29%. Expulsion was less likely after cesarean insertion (aOR 0.33; 95% CI, 0.26-0.41), following vaginal insertion at between 10 minutes and 48 hours (aOR 0.59; 95% CI, 0.42-0.83), and when insertion was performed by a nurse (aOR 0.33; 95% CI, 0.22-0.50).

Conclusion: PPIUD has low complication rates and can be safely inserted by a variety of trained health staff. Given the immediate benefit of the one-stop approach, governments should urgently consider adopting this model.

Keywords: PPIUD; Absent thread; Complications; Expulsions; FIGO initiative; Outcomes; Postpartum intrauterine device; Removal.

MeSH terms

  • Adult
  • Bangladesh
  • Contraception / methods*
  • Family Planning Services / organization & administration*
  • Female
  • Health Plan Implementation / methods*
  • Hospitals
  • Humans
  • India
  • Intrauterine Devices / statistics & numerical data*
  • Kenya
  • Nepal
  • Postnatal Care / organization & administration*
  • Postpartum Period*
  • Pregnancy
  • Sri Lanka
  • Tanzania