Expanded services for intrauterine contraception in Sudan

Area of Science:

• Reproductive Health
• Public Health
• Medical Training

Background:

• Intrauterine devices (IUDs) are a highly effective form of reversible contraception.
• Physician availability for IUD insertion can be a barrier to family planning access in some regions.
• Training non-physician healthcare providers may expand service delivery.

Purpose of the Study:

• To evaluate the safety and efficacy of IUD insertions performed by trained nurse-midwives.
• To compare the outcomes of IUD insertions by nurse-midwives with those performed by physicians.

Main Methods:

• Twenty nurse-midwives in Sudan received specialized training for IUD insertion.
• Nurse-midwives inserted a total of 763 IUDs.
• Obstetrician-gynecologists independently evaluated 520 clients for insertion accuracy and complications.

Main Results:

• Only 1.2% of IUD insertions by nurse-midwives were found to be incorrect.
• Complication rates (perforations, infections, expulsions) and pregnancy rates were comparable to those of physicians.
• Nurse-midwives demonstrated proficiency in IUD insertion procedures.

Conclusions:

• Nurse-midwives can be safely and effectively trained to perform IUD insertions.
• Expanding IUD services through nurse-midwives can significantly increase family planning accessibility.
• This approach conserves physician expertise for complex cases and optimizes healthcare resource allocation.