IMPROVED UTILIZATION OF SPACING METHODS - INTRAUTERINE-DEVICES (IUDS)AND LOW-DOSE COMBINED ORAL-CONTRACEPTIVES (OCS) - THROUGH REORIENTATION TRAINING FOR IMPROVING QUALITY OF SERVICES

A multicentre study was conducted by the Indian Council of Medical Res earch (ICMR) for improving the utilization of intrauterine devices (IU Ds) and oral contraceptives (OCs) at the Post Partum Centres (PPCs) ru n by District/State Health Authorities. The ICMR's network of Human re production Research Centres (HRRCs) had the technical responsibility f or 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 utilize d by all HRRCs which specifically assured for improving the counsellin g/motivational skills as well as screening procedures and management o f 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 rat e at the end of two years was 0.7 per 100 users with CuT 200 and 0.3 p er 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 device s. 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 us e, respectively, and were comparable. These observations at the post p artum centres were similar to those observed earlier by the ICMR in ph ase III controlled clinical study. A total of 1,961 women were enrolle d in the low-dose combined oral contraceptive (OC) group and were foll owed for 26,462 women-months of use. Two subjects reported pregnancy d uring regular use of pill, giving the method failure rate of 0.2 per 1 00 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 mad e py PPC staff as well as HRRCs to do follow-up, the lost to follow-up at two years was around 20 percent fo IUD and 31 percent for oral pil l users. These data suggest that while the re-orientation training pac kage improved the quality of care resulting in higher continuation rat es of IUDs and OCs at PPCs, the issue of follow-up care still requires further improvement in the National Programme.