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IUD Toolkit

Up-to-date evidence and best practices related to the Intrauterine Device

Brought to you by USAID's Maximizing Access & Quality Initiative

Who can provide the IUD?

In order to increase IUD uptake, programs must first enable various types of health care personnel to provide IUD services. Extensive research indicates that the ingredients for improved access and quality are proper training, appropriate job aids, and supportive supervision. Given appropriate training, a wide variety of health care providers can provide IUDs safely and effectively (see Essential Knowledge). These include physicians, midwives, nurses, nurse auxiliaries, and clinical officers.
Following are examples of how encouraging a variety of providers to offer quality IUD services can improve clients’ access to and uptake of the method. However, several important components to keep in mind include 1) conducting a careful selection of trainees, 2) finding providers that are “potential champions”, meaning that they are committed to the provision of IUD services, 3) that programs do not necessarily need to “train everyone” but might get more impact with a more strategic approach to selection and subsequent support of trainees, and 4) to support specific providers in terms of the structure of work, recognition, and other positive reinforcement as it relates to IUD provision.

Studies in Guatemala (2003) showed that training auxiliary nurses led to an increase in the overall number of IUD services provided by participating health centers and posts. The rates of expulsions and complications were not higher than those reported for professional personnel. Such findings confirm the experiences of other countries including Honduras, Peru, and Kenya (see Country Experiences).
Training and certification of non physicians in many countries has been a critical step for improving access to IUD services in underserved areas and therefore in expanding women’s choice of methods. For instance, in 2003, a project in Kyrgyzstan demonstrated to the Ministry of Health (MOH) that training midwives could effectively expand access to contraception and that midwives could do a good job in providing IUDs. The MOH concluded that the project was successful and that it could be expanded throughout rural areas of Kyrgyzstan.
In many parts of the world women prefer female reproductive health service providers. In some cases cultural values prevent women from getting a genital examination by a male physician. This becomes a problem in countries with few female providers. In Jordan, for example, the IUD is the most popular contraceptive method. Although physicians are abundant in Jordan, there is a shortage of female physicians at primary health care centers, especially in remote areas. This constitutes a mayor obstacle to providing the service to many women in need of contraception who want to use the IUD. The MOH approved a pilot study to assess the feasibility of allowing midwives to insert IUDs. Given the success of the pilot project, the MOH will continue midwife training to provide this service to Jordanian women.