FIGO calls to integrate PPIUD into maternal healthcare
The FIGO Committee on Contraception have released a global position statement urging the integration of postpartum intrauterine device (PPIUD) services into standard maternity care. The initiative seeks to address the unmet need for contraception, which affects over 218 million women worldwide, especially in low- and middle-income countries.
Short birth intervals are strongly associated with increased maternal and infant mortality, preterm births and poor child health outcomes. Offering contraception immediately after childbirth provides a crucial opportunity to improve maternal and reproductive health. The PPIUD is a non-hormonal, long-acting reversible contraceptive and can be safely inserted within 10 minutes after delivery, offering protection for up to 12 years.
Despite its safety, cost-effectiveness and compatibility with breastfeeding, the PPIUD remains underutilised due to fragmented services, provider bias, limited training, and persistent sociocultural misconceptions. This position statement outlines comprehensive recommendations to overcome these barriers and expand access to postpartum family planning.
“The PPIUD recommendations mark a significant milestone in postpartum care, equipping OBGYNs with evidence-based guidance to offer effective, long-acting contraception. By integrating these insights into practice, healthcare providers can enhance patient care and expand reproductive health options. We urge all practitioners to adopt PPIUD into their method mix, strengthening their services and improving women’s health worldwide.”
Authors Dr Azra Ahsan and Dr Anita Makins
This position statement calls on governments, health systems, and global partners to prioritise and fund scalable, equitable PPIUD programmes that meet the needs of women everywhere.
Key recommendations include:
- Integration into maternity services: Postpartum contraception, including the PPIUD, should be incorporated into routine maternity and Emergency Obstetric and Newborn Care services. Contraceptive counselling should begin during antenatal care and continue through labour and the immediate postpartum period.
- Task sharing: Midwives and nurses should be trained and authorized to insert PPIUDs, particularly in settings where most deliveries are attended by non-physician providers. This strategy expands access and ensures that PPIUD services are available at all levels of care.
- Comprehensive counselling: Women should receive non-coercive, balanced information about contraceptive options throughout their care journey. Counselling should address potential side effects, method efficacy, insertion techniques, and management of common concerns such as expulsion or missing threads.
- Community engagement: Community-level education is vital to dispel myths and promote acceptance of postpartum contraception. Involving partners and family members, where culturally appropriate, can enhance support and informed decision-making.
- Provider training and supervision: Regular, hands-on training using anatomical models and updated guidelines should be integrated into medical and nursing curricula and continued through in-service education. Ongoing supervision and quality assurance are essential to maintain safety and effectiveness.
- Supply chain strengthening: Health facilities must maintain a reliable, 24/7 supply of contraceptive commodities in labour rooms and operating theatres. Clear protocols for procurement and stock management are critical to sustaining service delivery.
- Monitoring and follow-up: Although routine follow-up visits are not mandatory, women should be advised on how to self-check for IUD threads and when to seek care. Facilities may offer optional check-ups to ensure placement and address concerns.