Potential for Improving Intrauterine Device (IUD) Service Delivery Quality: Results from a Secondary Data Analysis

Manish Gehani; Manoj Pal; Anupama Arya; Shobhana Singh; Kaushik S; Kathryn A O'Connell; Levent Cagatay; Sumon Sengupta; Sunita Singal

doi:10.12688/gatesopenres.12997.3

Potential for Improving Intrauterine Device (IUD) Service Delivery Quality: Results from a Secondary Data Analysis

Gates Open Res. 2020 Mar 4:3:1473. doi: 10.12688/gatesopenres.12997.3. eCollection 2019.

Authors

Manish Gehani¹, Manoj Pal², Anupama Arya³, Shobhana Singh³, Kaushik S², Kathryn A O'Connell⁴, Levent Cagatay⁵, Sumon Sengupta², Sunita Singal²

Affiliations

¹ EngenderHealth Inc., Ahmedabad, Gujrat, India.
² EngenderHealth Inc., New Delhi, Delhi, India.
³ EngenderHealth Inc., Jaipur, Rajasthan, India.
⁴ EngenderHealth Inc., Washington, DC, USA.
⁵ EngenderHealth Inc., Izmir, Turkey.

Abstract

Background: To accelerate progress toward Family Planning 2020 (FP2020) goals, the government of India focused on improving the quality of intrauterine device (IUD) services. EngenderHealth, an international sexual and reproductive health and rights organization, has been supporting the governments of Gujarat and Rajasthan since 2014 through the Expanding Access to IUD Services in India (EAISI) project by building the capacity of service providers, monitoring compliance with standard practices, and strengthening health systems. This study sought to assess whether EAISI-trained providers offer higher quality IUD services than non-EAISI-trained providers, as indicated by a reduction in confirmed IUD complications. Methods: The study team conducted an analytical cross-sectional study of secondary data collected from follow-up registers at 176 intervention facilities (38 in Gujarat and 138 in Rajasthan) during Phase I of the EAISI project. The analysis included follow-up clients who returned to the same facility between April 2018 and March 2019. We performed a multivariate logistic regression to determine factors associated with IUD complications. Results: During the period of assessment, 56,733 clients received IUD insertions, and 10,747 (18.9%) clients returned for follow-up services. Of the returning clients, 49.4% (N=5,305) had received IUDs from EAISI-trained providers, while 50.6% (N=5,442) had received IUDs from non-EAISI-trained providers. A total of 4.0% (N=432) of all returning clients experienced complications (expulsion: 1.3%, missing strings: 1.7%, infection: 1.1%). Clients who received IUDs from non-EAISI-trained providers were 55.5% more likely (95% CI [26.2%, 91.5%], p<0.0005) to have experienced complications than clients who received insertions from EAISI-trained providers. The type of IUD, the timing of the insertion, and the timing of the follow-up visit also affected complication prevalence. Conclusion: Our findings indicate that intensive, practical clinical skills training for IUD insertion can reduce the prevalence of complications.

Keywords: Quality of IUD services; client follow-ups; complications of IUD insertions; secondary data analysis.

Grants and funding

No funding was needed or availed for conducting this research. Funding for publication of this paper was provided by Bill & Melinda Gates Foundation, under Investment ID OPP1181398.