Menu
Menu
Menu
Menu
Background: Mali has one of the highest maternal mortality ratios in the world coupled with one of the lowest modern contraceptive use rates. Nearly a quarter of the country’s 750,000 annual births occur within 24 months of a previous birth, increasing the risks for mothers and babies. Nearly 70% of postpartum women have an unmet need for family planning. In 2016, Population Services International Mali (PSI-Mali) introduced a dedicated postpartum intrauterine device (PPIUD) inserter to replace the technique of using forceps for PPIUD insertion, with the aim of helping to address this substantial family planning gap. Methods: A mixed-methods approach was used to assess program results and the experiences of PSI-trained providers using the dedicated PPIUD inserter in 5 health facilities in Bamako. We conducted 10 key informant interviews with providers and 4 key informant interviews with operational and clinical staff involved in training and supporting providers. Further data were collected from district health surveys and facility registers. Secondary data encompassed documentation from 2011 through 2017, with the service delivery figures of PPIUD using the dedicated inserter focused on the pilot period of March 2016 through December 2017. Primary data were collected in Mali in July 2017. Results: Between March 2016 and December 2017, PSI-Mali trained 134 providers on the dedicated PPIUD inserter and provided more than 3,500 voluntary PPIUDs. Of the 1,840 voluntary PPIUDs provided in 2017 alone, 67% were provided by facilities trained to use the dedicated PPIUD inserter. Providers stated a preference for the inserter (compared with the use of forceps) due to its ease, speed, and perceived lower associated risks of infection. Service data from the 5 facilities visited showed an overall average PPIUD uptake of 7.3% of deliveries in 2017. Although private facilities had considerably fewer deliveries than public facilities (600–900 compared with 20–30, respectively), a much higher proportion of women delivering in the private facilities chose a PPIUD. Conclusion: The acceptance of the dedicated PPIUD inserter by providers may help reduce some of the supply-side barriers that inhibit women’s access to postpartum family planning methods. With continued support to providers, coupled with ongoing efforts to address differences in service trends between sectors and demand-side barriers to the PPIUD and family planning more broadly, the dedicated PPIUD inserter could play an important role in responding to the high unmet need among postpartum women in Mali.
We used a mixed-methods approach to assess program results to date as well as the experiences of PSI-trained providers using the dedicated PPIUD inserter. The data collected included a review of PSI documentation and secondary data from the PSI management information system, District Health Information System 2 (DHIS 2), and facility-level registers in PSI-trained facilities as well as primary data collected through key informant interviews. The secondary data review examined documentation produced between 2011 and 2017, which allowed a review of trends before and after the introduction of the dedicated PPIUD inserter. Key informant interviews were conducted to collect provider perspectives on the dedicated PPIUD inserter and to explore the perceived drivers behind PPIUD uptake. Purposive sampling was used to identify public and private facilities and providers based on a range of criteria, specifically that providers have been trained in PPIUD insertion with forceps and with the dedicated inserter by PSI-Mali; facilities have a relatively high volume of deliveries; and providers work in a facility where PPIUD service provision is high, medium, or low to assess differences and outliers. The total sample was 10 providers—6 midwives, 2 gynecologists, and 2 doctors—trained on the dedicated PPIUD inserter who were based in 5 different health facilities in Bamako: 3 public referral health centers, known as Centres de Santé de Reference, and 2 private sector Protection de la Famille (PROFAM)-branded clinics from PSI-Mali’s social franchise network. The names of facilities and providers have been omitted from this article to respect the confidentiality and anonymity of the interview informants. Instead, the facility names have been replaced with code names: Public A, B, and C for the 3 public health facilities and Private A and B for the 2 PROFAM clinics. To complement provider perspectives of the dedicated PPIUD inserter, 4 PSI-Mali operational and clinical staff who worked directly on the PPIUD program were also interviewed. The primary data that inform this case study were collected in Mali in July 2017, and the secondary data were later updated with the most recent PSI data from DHIS 2. After the interviews were transcribed, manual thematic analysis of the transcripts was conducted and codes entered into a data analysis framework to highlight key themes. District- and facility-level data and provider interviews were analyzed to better understand PPIUD trends and experiences. Because the purpose of this case study was determined to be for internal programmatic improvement, it did not meet the definition of human subjects research needing the review of the Institutional Review Board. However, key steps were taken prior to meeting with the providers PSI-Mali had trained on the dedicated PPIUD inserter to ensure data collection was conducted in an ethical manner. Health authorities in the Ministry of Health (MOH) and the participating facilities were informed of the objectives of the case study and their approval was sought prior to conducting interviews with providers. The research team explained to all potential interview participants the objectives of the interview, any potential risks and benefits, that any information provided would be confidential and anonymous, and that their participation was voluntary. All providers provided written informed consent prior to participating in an interview. The MOH provided written support to publish the study results.
N/A
