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

Insertion of intrauterine devices (IUDs) by trained health workers other than physicians is increasing, particularly in developing countries. Twenty nurse-midwives in government service in the Sudan, called health visitors (HVs), were trained to provide intrauterine contraceptives in a research project designed to evaluate the safety of insertion of IUDs by medical personnel who are not physicians. After training, they inserted 763 IUDs. Independent evaluation of 520 clients was conducted by gynecologists who found that only six devices (1.2%) had been incorrectly inserted. Outcomes for clients of the health visitors, with respect to perforations, infections, expulsions, and pregnancies, compared well with those of eight physicians who participated in the study. The research strongly supports the concept of nurse-midwife training for IUD insertion. This would greatly expand the availability of family planning services and would conserve physician time and skills for problem cases.