Successful programmatic approaches to facilitating IUD uptake: CARE’s experience in DRC

Abstract

Background Achieving the unfinished agenda towards sexual and reproductive health and rights requires overcoming remaining barriers to contraceptive uptake, which can be method-specific. Women’s uptake of the IUD is poor across sub-Saharan Africa. The objective of this paper is to identify the reasons for comparatively high IUD use observed in a CARE project in DRC, together with the programmatic characteristics which facilitated uptake. Methods Qualitative data were collected in 2015 as part of a reproductive health project in the DRC. Using purposive sampling, 15 focus group discussions took place with IUD users, users of other methods and non-users of modern contraception as well as their male partners. Eighteen in-depth interviews were conducted with health providers, project staff, community health workers and local stakeholders to capture a range of experiences. Data were analyzed using content theory approach and contextualized through a review of routine monitoring data. Results In an area with practically no previous IUD use, 38,662 new FP clients were served during the first 5 years of the project and 82% (31,569) chose long-acting or permanent methods. Over 10,000 clients chose an IUD, representing 30% of the total FP clients. Key informants expressed mainly positive views about the IUD and quality of service. Concerns related to method insertion, which some perceived as too intimate or shameful. Findings indicate that this uptake reflects effective supply chains, good provider training and supervision and multiple communication strategies including those which target men. Community engagement was enhanced by local stakeholders’ participation in sensitization and quality assurance as well in analysis of data for decision-making. Conclusions The findings of the paper showed that by involving local stakeholders in addressing structural and socio-cultural barriers to women’s free access to FP, programs can positively influence quality of service and method mix as well as knowledge and attitudes surrounding FP use and thus improve the uptake of FP in general and IUDs in particular, even in conflict-affected settings. A Theory of Change for enhancing IUD provision within family planning programs is suggested.

Contraceptive use among adolescent and young women in North and South Kivu, Democratic Republic of the Congo: A cross-sectional population-based survey

“…LARC use by the young women in our sample (6.9%), while still low, is higher than that found in many stable populations (2.5% across 46 countries) [23]. While we cannot draw a causal link with our program, it is important to note that program partners provided strong support to the MOH to improve contraceptive service delivery in these areas so that young women likely had better access to LARCs than youth in many other settings do [15][16][17][18][19]; for example, most received their method from a health facility supported by the program partners. It is interesting that 15-19-year-olds had higher LARC use than 20-24-year-olds: implants and IUDs were two of the three most used methods in both age groups.…”

“…Since 2011, the partners focused on provision of good quality contraceptive and postabortion care services in public health facilities. As described elsewhere, support to the MOH included competency-based clinical training and supportive supervision, assurance of supplies and infrastructure, community collaboration and mobilization, and consistent data management for ongoing monitoring, evaluation, and data use, with a strong emphasis on improving quality of care [15][16][17][18][19]. When quality of care challenges were identified, the partners addressed them by, for example, improving training on counseling, improved coaching of providers to improve competence and values clarification, and attitudes transformation activities [20].…”

Towards achieving the family planning targets in the African region: a rapid review of task sharing policies

“…For instance, the Democratic Republic of Congo (DRC) is one of the countries that have suffered the most from human resource shortages in the whole world. A new task sharing programme that sought to promote LARC in remote areas was able to achieve 38,662 new users within a period of 5 years [ 43 ].…”

Contraceptive Method Preference among Conditional Cash Transfer Beneficiaries in Indonesia

“…This program successfully increased IUD uptake around the region. (12) A program that had been proven to succeed in increasing LARC uptake was shown from a study in Rwanda. Community health worker delivered information about fertility goalbased and couple-focused family planning counselling.…”

“…(12) In Democratic Republic of Congo (DRC), government and Disease Prevention and Public Health Journal ISSN: 2720-9997  Contraceptive Method Preference Among Conditional Cash.....(Ratna Frenty Nurkhalim)…”