**4. Status of PPIUCD as a viable popular contraceptive option.**

PPIUCD has an established reputation as an efficient, safe, reversible, long-acting nonhormonal contraceptive. It is also cost-effective and readily available, with a short learning curve for service providers to learn its insertion technique [16–19]

Despite the promising results elicited by the FIGO endeavor and government enthusiasm and support in the participating six countries, PPIUCD remains an under-utilized contraceptive option and falls short of expectations in lowering fertility rates in those populations, where it is most needed. A recent systemic review on the utilization of PPIUCD globally comes to the conclusion that despite its safety and efficacy it remains an underused contraceptive option [20]. It concludes with the observation that future research is warranted and vital to explore the reasons behind these discouraging trends and the low acceptance and provision of PPIUCDs currently. The analysis needs to be in various dimensions including the innate characteristics of the device and the logistics of its availability and utilization by the service providers. Without an in-depth analysis, it would not be prudent for governments to withdraw it as a freely available, free-of-cost/subsidized option in the contraceptive basket provided by government and private health care setups.
