Poor practitioner training hinders IUD use

Poor training on inserting intrauterine devices (IUD) is hindering the government’s birth-control program under the Jampersal insurance scheme that provides free maternity care to low-income women, an official says.

National Family Planning Board (BKKBN)’s acceptors management director Wicaksono said that the rate of IUD use by Jampersal participants remained low.

“The latest data shows that only 30 percent of the total number of women who have Jampersal insurance coverage agreed to use a long-term method of birth control, such as an IUD,” he told The Jakarta Post on the sidelines of a national coordination meeting at the board’s office in Jakarta.

Starting this year, long-term contraception use will be mandatory for women with three children seeking free maternity care from the Jampersal program.

The 35,000 midwives and 10,000 non-specialist physicians trained by the government on post-placental IUD insertion are apparently too few in number to ensure wide IUD use.

“We are facing challenges in performing post-placental IUD insertions. Only a few doctors and midwives have enough skill to perform such a procedure, although it is actually quite simple,” Wicaksono said.

Most of the experienced midwives who had the skills to perform the procedure have retired, he added.

Without appropriate training, even doctors might fail to perform the procedure, which entails inserting an IUD within 10 minutes after the placenta is expelled.

“It is very important to make sure that we put the IUD into the [woman’s] uterus fundus properly. If the IUD is not in the right place, it can be expelled when the uterus shrinks after childbirth,” Wicaksono said.

An adequate number of trained healthcare professionals could reduce the rate of expulsion for post-placental IUD insertions from between 6 and 12.5 percent at present to 1 percent, according to doctors.

Polora Napitupulu, a 50-year-old nurse from Humbang Hasundutan North Sumatra, said post-placental IUD insertion was a difficult procedure, as a copper IUD had to be inserted into a woman’s uterus when it was still open and bleeding.

“If we improperly insert the IUD in the uterus when blood still gushes from the wound, it may be expelled. Therefore, it would be better to insert the IUD only after the uterus is clean,” she told the Post.

According to the Indonesian Demographic and Health Survey (SDKI), 27 percent of all mothers who gave birth in 2007 received IUDs through post-placental insertion procedures.

The 30 percent figure for mothers covered under Jampersal shows that the free program has not significantly increased IUD use.

Siti Fathonah, head of the West Java family planning office, said that many doctors and midwives lacked the skills to perform post-placental insertions even they had been trained.

Healthcare practitioners were hesitant to perform the procedure since their training involved practice on dummies and not patients.

Officials said it was difficult to coordinate healthcare training dates with the childbirths of expectant women who agreed to use IUDs.

Practitioners who trained with live patients had a greater success rate than those who only used models.

“This means many doctors and midwives are still not confident to perform post-placental insertions,” Siti said.

According to the BKKBN, 29.7 million women in their sexually-productive age were using IUDs in 2011.

BKKBN chief Sugiri Syarief estimated that an additional 2 million women would use IUDs in 2012, 60 percent of whom would come from the Jampersal program.

“Frankly speaking, it’s not difficult to motivate mothers to use long-term contraception soon after the childbirth,” Sugiri said.

However, he said, few local authorities were aware of the importance of family planning.