**3. Status of copper IUCDS as a contraceptive option**

The copper-containing intrauterine contraceptive device (Cu T IUCD) in its various designs has been available globally both in the government sector and in private health facilities for several decades. In government facilities, the IUCD is provided free of cost. In private facilities, social marketing strategies often make it available at very subsidized rate so that it becomes affordable for the user. However, the timing of its insertion was restricted to the interval period (i.e. between pregnancies and interval insertion) or immediately following pregnancy termination (post MTP

#### *Barriers and Challenges in the Acceptance and Continuation of Postpartum Intrauterine… DOI: http://dx.doi.org/10.5772/intechopen.112366*

insertion). Apart from registered medical practitioners and specialist obstetricians and gynecologists, nurses and auxiliary nurse midwives trained in insertion procedures were delegated the task of interval IUCD insertions as part of task shifting / sharing approach in the health service delivery system. However, this timing and strategy of contraceptive provision failed to cater to the unmet contraceptive needs of the vulnerable postpartum women. An unintended pregnancy for such women poses risks for their own health as well as that of their children [7–9].

Technical experts on reproductive health and contraception reached the consensus that health care providers (HCP) had the opportunity for IUCD insertion in the immediate postpartum period when the parturient/puerpera was still within a healthcare facility. The delivery site could function both as an institutional delivery setup and contraceptive provision center. Since the commencement of this millennium, this strategy has been rolled out in several low- and middle-income countries (LMIC) first as pilot projects in a few targeted centers with high delivery rates and then introduced into health facilities at various tiers of health care delivery system [10].

The FIGO initiative is the largest intervention study to date which examined the feasibility and efficacy of PPIUCD as a contraceptive option provided in the basket of choices offered in government hospitals in six LMICs in Asia—India, Nepal, Bangladesh, Sri Lanka, Tanzania, and Kenya [11–15]. The study highlighted certain important observations related not only to the satisfactory rating of the PPIUCD as an effective contraceptive option for women having institutional delivery but also how task-sharing by specialist obstetricians, general duty medical officers trained in vaginal delivery, and staff nurses, and midwives could dramatically increase the number of women who could avail the benefits of the IUCD and leave the health care facility with a highly effective and safe contraceptive option in place in order to protect them from unintended pregnancies. Community health workers like dedicated family planning counselors and ASHAs (accredited social health activists) in India who are oriented and trained in contraceptive counseling can effectively contribute to demand generation in the community for PPIUCD acceptance and continuation.
