Provider perspectives in implementing the Postpartum Intrauterine Device Initiative in Sri Lanka: a qualitative study

Background Integration of maternal care and family planning services has the potential to reduce unintended pregnancies and closely spaced births, leading to reductions in maternal mortality and morbidity. However, few models exist detailing how to implement/integrate such services. This study explored the implementation of the Postpartum Intrauterine Device (PPIUD) Initiative in Sri Lanka, which trained healthcare providers on how to counsel women about contraception during routine antenatal care and insert PPIUD immediately following delivery. Methods We applied a qualitative design to ascertain the perspectives of maternal health service providers who participated in the PPIUD Initiative. We conducted 12 in-depth interviews with providers. We used thematic analysis to analyse the data and the results were interpreted within the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Results Findings indicated that providers were willing to adopt the intervention and reiterated the importance of postpartum family planning. However, the intervention was not consistently implemented as intended, including provider bias in counselling and lack of attention to women's preferences. Organisational barriers to implementation included time constraints and inadequate training. Providers suggested that a range of paramedical staff be trained in counselling and PPIUD insertion to mitigate barriers and to facilitate scaling up the intervention. Conclusions To improve and scale up the PPIUD Initiative, training efforts should be expanded to primary and secondary care facilities and implementation strategies better utilised (eg, on-the-job training). The training can be strengthened by improving providers' knowledge of all types of methods and interpersonal communication skills, and emphasising the importance of unbiased, evidence-based contraceptive counselling techniques.

Automated summary

The study explored the implementation of the Postpartum Intrauterine Device (PPIUD) Initiative in Sri Lanka, which aimed to train healthcare providers on counseling women about contraception during routine antenatal care and immediately inserting PPIUD following delivery. Findings indicated that while providers were willing to adopt the intervention and emphasized the importance of postpartum family planning, there were inconsistencies in implementation, including provider bias in counseling and lack of attention to women's preferences. Organizational barriers included time constraints and inadequate training, with suggestions for training more paramedical staff to mitigate barriers and facilitate scaling up the intervention.