Improved utilization of spacing methods--intrauterine devices (IUDs) and low-dose combined oral contraceptives (OCs)--through re-orientation training for improving quality of services. Indian Council of Medical Research Task Force on IUD and Hormonal Contraceptives.

A multicentre study was conducted by the Indian Council of Medical Research (ICMR) for improving the utilization of intrauterine devices (IUDs) and oral contraceptives (OCs) at the Post Partum Centres (PPCs) run by District/State Health Authorities. The ICMR's network of Human Reproduction Research Centres (HRRCs) had the technical responsibility for providing re-orientation training to health functionaries (medical and paramedical) of the PPCs for better quality of services and follow-up care for IUD and OC users. The uniform training module was utilized by all HRRCs which specifically assured for improving the counselling/motivational skills as well as screening procedures and management of side-effects and follow-up care by the health functionaries. A total of 4,808 IUD acceptors (2,446 of CuT 200 and 2,362 of CuT 380A) were observed for 84,070 women-months of use (42,433 and 41,637 months for CuT 200 and CuT 380A, respectively). The cumulative method failure rate at the end of two years was 0.7 per 100 users with CuT 200 and 0.3 per 100 users with CuT 380A. No perforations were reported with either types of the CuT devices. The reasons for discontinuations, like pain/bleeding and pelvic infections, were similar with both types of devices. The continuation rates with either CuT 200 or CuT 380A were around 89 and 76 per 100 users at the end of first year and second year of use, respectively, and were comparable. These observations at the post partum centres were similar to those observed earlier by the ICMR in phase III controlled clinical study. A total of 1,961 women were enrolled in the low-dose combined oral contraceptive (OC) group and were followed for 26,462 women-months of use. Two subjects reported pregnancy during regular use of pill, giving the method failure rate of 0.2 per 100 users at 2 years. The continuation rates of OC users were 58 and 37 per 100 users at the end of first year and second year, respectively. The major reasons for discontinuations were lost to follow-up, desire for pregnancy and other personal reasons. In spite of all efforts made by PPC staff as well as HRRCs to do follow-up, the lost to follow-up at two years was around 20 percent for IUD and 31 percent for oral pill users. These data suggest that while the re-orientation training package improved the quality of care resulting in higher continuation rates of IUDs and OCs at PPCs, the issue of follow-up care still requires further improvement in the National Programme.