Campaign for promotion of Post-placental Intrauterine Contraceptive Device (PPIUCD) among rural Indian women

In spite of enormous efforts by the government, the contraceptive prevalence among Indian Rural community continues to remain very low. In rural areas, women start their childbearing soon after early marriage, at times much before the legal age of marriage ie 18 years. The low literacy, poverty and lack of safety for girl children during late adolescence are main reasons for early marriage and resultant childbearing.

Women refuse to use contraceptives for various misbelieves surrounding them. Male counterpart, being equally ignorant about the importance of spacing between two pregnancies, does not use available male contraceptives. Government has put in lot of efforts and money to provide newer, longer acting and reversible methods of contraception in recent times. In India, the government has adopted cafeteria approach for promotion of contraceptives.

Short inter-conceptional periods, especially following operative delivery, ie caesarean section, pose risk to life of the pregnant women, due to risk of scar dehiscence and rupture uterus. Women with short inter-conceptional period are not given trial of vaginal delivery for the fear of scar dehiscence. This itself contributes to rising rate of caesarean section.

Government has implemented various schemes in last decade for promotion of institutional deliveries. Government is providing monitory incentives, food supplements and transport facilities to pregnant women for reaching to the hospital. Rising number of institutional deliveries has provided more opportunities for counselling women regarding contraception and improving utilization of available contraceptive methods.

One of the newer methods of postpartum contraception is a reversible long term contraception ,that is post placental intra uterine contraceptive device, popularly named as PPIUCD. Campaign for promotion of PPIUCD has been undertaken at Pravara Rural Hospital ,where in women are initially counselled during pregnancy regarding benefits of PPIUCD .Brief educational sessions are being conducted in antenatal OPD ,where in short video clips are projected and educational pamphlets are distributed to pregnant women ,giving them information about various contraceptive options and benefits of PPIUCD in particular. The choice of their contraception is obtained and recorded in the antenatal case sheet. Women, who have expressed their willingness for PPIUCD during antenatal period, are re counselled during early labour and written informed consent is obtained for PPIUCD insertion.

The team of doctors has been trained in counselling techniques and PPIUCD insertion. Government has provided two types of intrauterine devices for insertion namely, Copper 375 and Copper 380 A. There has been overwhelming response for acceptance of PPIUCD insertion, especially during caesarean section. More than 300 women have been followed up

during six months period .There has not been any major complication during insertion or post insertion. Women are being regularly followed up for any complications like expulsion, displacement, perforation of uterus or failure of contraception. The method has been found to be very effective, convenient and safe as reversible long term contraceptive for rural women. It will help in improving the spacing between pregnancies. It will result in reducing maternal morbidity and mortality related to frequent childbirth and will also help in improving the child health, as women with PPIUCD will have enough time to look after their small baby, without having physical and psychological stress of new pregnancy and unborn baby.