Safety of intrauterine device insertion by trained nurse-midwives in the Sudan

Insertion of intrauterine devices (IUDs) by trained health workers other th an physicians is increasing, particularly in developing countries. Twenty n urse-midwives in government service in the Sudan, called health visitors (H Vs), were trained to provide intrauterine contraceptives in a research proj ect designed to evaluate the safety of insertion of IUDs by medical personn el who are not physicians. After training, they inserted 763 IUDs. Independ ent evaluation of 520 clients was conducted by gynecologists who found that only six devices (1.2%) had been incorrectly inserted. Outcomes for client s of the health visitors, with respect to perforations, infections, expulsi ons, and pregnancies, compared well with those of eight physicians who part icipated in the study. The research strongly supports the concept of nurse- midwife training for IUD insertion. This would greatly expand the availabil ity of family planning services and would conserve physician time and skill s for problem cases.