Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #110981

Ricardo Vernon, PhD¹, Philomena Nyarko, PhD², Harriet Birungi, PhD¹, M.E. Khan, PhD³, and John W. Townsend, PhD⁴. (1) Population Council, Panzacola 62 - 102, Mexico City, 04000, Mexico, (52)(55) 5999-8630, rvernon@popcouncil.org.mx, (2) Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana, (3) Population Council, Population Council, India, One Dag Hammarskjold Plaza, New York, NY 10017, (4) Frontiers in Reproductive Health, Population Council, 4301 Connecticut Ave., N.W, Suite 280, Washington, DC 20008

For reproductive health programs, the IUD offers effective protection against pregnancy, long-term continuation, and low commodity costs. However, 40 years of experience with the provision of IUDs has demonstrated that simply training physicians and supplying IUDs does not translate into client demand or effective service delivery. The failure of programs to sustain demand for the IUD is due to contraceptive market dynamics, poor use of evidenced-based training and supervision models, and the lack of skilled providers at multiple levels in the health system. For example, in Guatemala, low IUD use is still an issue of access. In Ghana, low use has more to do with lack of promotion, as few clients are aware of its availability. In India, the availability of sterilization in clinics and spacing methods through commercial networks has made the IUD an underutilized method.

Several models have demonstrated effectiveness in both urban facilities and rural districts. They include postpartum and postabortion IUD services, and services for women switching to the IUD from another method. Most models have depended on physicians as providers and use large referral networks such as CBD programs and private physicians. Increasingly, nurses and midwives also provide comprehensive IUD services with referral. This paper reviews the evidence from country case studies on the coverage, quality and cost of effective IUD service models, as well as the characteristics of IUD users and providers.

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