**6. Intrauterine devices (IUDs)**

The story of a small pebble placed in the uterus of a camel to prevent pregnancy during long caravan journeys by Arabs in Middle East is regarded as the beginning of intrauterine contraceptive devices [67]. The IUDs is one of the most effective reversible contraceptive methods with an average pregnancy rate after 1 year of use of 3–5 per 100 typical users. Because IUDs have longer continuation rates than the OCs or injectable contraceptives, the overall effectiveness of IUDs and oral contraceptives are about the same in family planning programmes [68]. A major concern of IUDs is expulsion and pregnancy rates as shown in **Table 3**.

As the use of contraceptives increase in Africa, IUDs are becoming more acceptable. However, its popularity varies widely throughout the continent and even within the countries as evidenced by recent DHS reports. For instance, its use in Nigeria between 1990 and 2013 was 0.8–1.1%, [70], while in Mali and Uganda, very few women use IUD [71].

The training of doctors and paramedical staff to deliver family planning services is the cornerstone to the success of family planning programmes. In Africa, the primary goal is to train doctors, nurses, midwives and other field workers to manage family planning clinics as a team. The family planning nurse is essential to the success of the family planning programme.


**Table 3.** Rates of pregnancy and expulsion per 100 women after 12 months of use [69].
