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Expanding Women's Choices through a Balanced and Sustainable Contraceptive Method Mix The latest research on the copper T intrauterine device (IUD) and the contraceptive method's reintroduction in Kenya, where its use has declined, is provided in several information briefs. Six key topics describe the IUD's many benefits: Increasing access to and provision of the IUD is a way of expanding women's contraceptive choices. The device is safe, effective, and reversible. It is an extremely low-cost option. It is convenient for client and provider, and has minimal associated health risks. Finally, it can be a contraceptive option for HIV-positive clients, as reflected in the World Health Organization's recent update of its Medical Eligibility Criteria for IUD use. Selected resources about IUDs in general and IUD research in Kenya are provided with the briefs, which have been produced by the Kenya Ministry of Health and its partners. The IUD reintroduction strategy, launched in February 2003 by the Ministry of Health (in collaboration with the private sector, professional organizations, national and international reproductive health organizations, and international donors) is coordinated by FHI.Brief 1: Expanding Women's Contraceptive Choices The intrauterine device (IUD) is used by relatively few women in Kenya, suggesting that the IUD's advantages – including its safety, effectiveness, low cost, convenience, and long-term use – are not well understood. This introduction describes reasons for the Kenya Ministry of Health's decision to reintroduce the method (known there as the intrauterine contraceptive device, or IUCD): namely, to help ensure that women have access to a more balanced and sustainable mix of safe and effective family planning methods. Brief 2: Safe, Effective, and Reversible The intrauterine device (IUD) is a safe and extremely effective contraceptive. It has very few contraindications or complications. It can be safely used by sexually active women of any age, regardless of whether they have had a child. The IUD's high effectiveness is comparable to that of female surgical sterilization, yet the device offers the benefit of being completely reversible. And, common side effects of pelvic cramping and menstrual problems often can be managed successfully by counseling clients. Brief 3: An Extremely Low-Cost Option While the IUD has a relatively high initial cost, it is an extremely low-cost option for clients over time. It is also very economical for the health care system since procurement and service-delivery costs for IUDs are quite low compared with those of many other methods. Brief 4: Convenient for Client and Provider IUDs can be inserted any time during the menstrual cycle. Among reversible contraceptive methods, the IUD is unique in that it requires no attention from client or provider for at least 10 years, except for a one-month follow-up examination, annual checkups, and periodic self-checks to confirm the device is still in place. Brief 5: Minimal Associated Health Risks IUDs do not cause infertility. However, if a client has a sexually transmitted infection (STI) at the time of insertion, pelvic inflammatory disease and related complications such as infertility may result. Although rare, these and other risks can be minimized if providers are well trained and perform careful STI screening before IUD insertion. Providers' risks of acquiring HIV when inserting IUDs are minimal, as well. Brief 6: Contraceptive Option for HIV-Positive Clients Evidence suggests that the IUD can be safely used by HIV-positive women, provided they have continuing access to medical services and careful follow-up. No evidence exists that IUD use increases an HIV-positive woman's risk of transmitting the virus to a sexual partner. However, HIV-positive women who use the IUD – like all HIV-positive women – should be counseled to use condoms consistently and correctly to guard against transmitting or acquiring HIV and other sexually transmitted infections. In 2004, the World Health Organization (WHO) revised the guidelines for IUCD use as part of an update of its Medical Eligibility Criteria for Contraceptive Use (MEC). The WHO now recommends that women at high risk of HIV, women infected with HIV, and women at general risk of sexually transmitted infections (STIs) can initiate and continue use of the IUCD, although careful follow-up may be required. Women with AIDS generally should not initiate IUCD use unless they are taking antiretroviral therapy and doing clinically well on these drugs. Additional information on IUDs – in general and in the Kenyan context – is available here. |
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