Expanded services for intrauterine contraception in Sudan

Twenty nurse-midwives in government service in the Sudan (health visitors) were trained to provide intrauterine contraceptives in a research project designed to evaluate the safety of insertion of IUDs by medical personnel who are not physicians. After training, they inserted 763 IUDs. Independent evaluation of 520 clients was conducted by obstetrician-gynecologists who found that only six (1.2%) had been incorrectly inserted. Outcomes for clients of the health visitors with respect to perforations, infections, expulsions, and pregnancies compared well with those of eight physicians who participated in the study. The research strongly supports the concept of nurse-midwife training for IUD insertions which would greatly expand the availability of family planning services and would conserve physician time and skills for problem cases.In 1986, 20 nurse-midwives (health visitors) inserted 763 IUDs at health centers belonging to the Ministry of Health in Khartoum, the Sudan. Gynecologists evaluated 520 insertions after 1 month. The health visitors' outcomes were compared with those of 8 gynecologists who inserted 69 IUDs. Evaluating gynecologists found 98.8% of insertions to be correct and 99% of pelvic conditions to be normal. 47 IUDs inserted by health visitors were removed compared to 12 removals for the gynecologists. Only 14.9% of health visitor patients did not return for a post exam compared to 20.3% for those of gynecologists. Indeed the outcome of health visitors' patients remained better than the outcome of the gynecologists' patients. For example, 2.9% of IUDs inserted by the gynecologists were expelled whereas only .8% of those inserted by the health visitors were expelled. In addition, only .6% became pregnant with a health visitor inserted IUD while 1.4% of gynecologist patients became pregnant. Side effects from the IUD occurred significantly more often in gynecologist patients (13%) than health visitor patients (2.2%). A possible reason for this difference may be that the health visitors better prepared clients for temporary discomforts they would experience than did the gynecologists. Moreover only .6% of health visitor inserted IUDs were not in situ compared to 2.9% of gynecologists inserted IUDs. The research demonstrated that the nurse-midwives could indeed safely insert IUDs and improve the availability of IUDs. Other advantages of using them to perform this service are they knew their clientele well and clients are more comfortable with a female.