The promotion of intra-uterine contraception in low- and middle-income countries: a narrative review.


Cleland, J; Ali, M; Benova, L; Daniele, M; (2017) The promotion of intra-uterine contraception in low- and middle-income countries: a narrative review. Contraception. ISSN 0010-7824 DOI: https://doi.org/10.1016/j.contraception.2017.03.009

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Abstract

The contribution of copper-bearing intrauterine devices (IUDs) to overall contraceptive protection has declined in many countries, despite their well-known advantages. In response, initiatives to promote this method have been undertaken. To review and interpret the experience of interventions to promote use of IUDs in low- and middle-income countries in order to provide strategic guidance for policies and programs. We conducted a systematic search of Medline, Popline, Embase and Global Health electronic databases for relevant journal papers, reports and grey literature since 2010. Telephone interviews were held with two donors and six international family planning organisations. We identified a total of 31 publications. Four reported the results of randomized control trials and three were derived from quasi-experiments. The majority were based on service statistics. Eight publications concerned interventions for HIV-positive women or couples, nine for postpartum or post-abortion cases and 14 for general populations. Intervention approaches included vouchers, franchising of private practitioners, mobile outreach services, placement of dedicated staff in high-volume facilities, and demand creation. Most publications adduced evidence of a positive impact and some reported impressively large numbers of IUD insertions. Results to date on the uptake of IUDs in postpartum interventions are modest. There is also almost no evidence of effects on IUD use at national levels. Implant uptake generally exceeded IUD uptake when both were offered. The evidence base is weak and offers few lessons on what strategies are most effective. The overall impression is that IUD use can be increased in a variety of ways but that progress is hampered by persistent adverse perceptions by both providers and potential clients. Provider enthusiasm is a key to success. The lack of a population impact stems in part from the fact that nearly all interventions are initiated by international organisations, with limited national reach except in small countries, rather than by government agencies.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Population Health (2012- ) > Dept of Population Studies (1974-2012)
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: Maternal Health Group
PubMed ID: 28365165
Web of Science ID: 404947000001
URI: http://researchonline.lshtm.ac.uk/id/eprint/3716520

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