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Intrauterine Contraceptive Device (IUD)

The IUD is a long-term, completely reversible method of birth control that is relatively inexpensive, and its efficacy rivals that of female sterilization. PSI provides access to IUDs with effective life spans of 10 years, such as Copper T 380, and 5 years, such as CU-375, by distributing IUDs to local service providers, inserting IUDs at our own service locations, and referring clients to out-of-network service providers.

Unit of interventionOne IUD

TypeLong-Acting Reversible Contraceptive (LARC)

Effective life span5 or 10 years (brand dependent)

Target populationWomen of reproductive age (15-49)

Increased access to family planning helps women prevent unintended and high-risk pregnancies, contributes to the overall health of women and their children, and reduces the need for abortion. For more information about how PSI is empowering women and couples to lead healthier lives, visit our website at:
http://www.psi.org/health-area/contraception/

Model Overview

PSI’s estimates for the health impact of family planning use a methodology developed by Marie Stopes International (MSI) in the Impact 2 model (version 4). Please see http://mariestopes.org/impact-2 for detailed methodology. PSI’s current approach for estimating the impact on child mortality is based on assumptions about changes in mortality risk for children under-five years of age with lengthening birth intervals. PSI is working with modelers from partner organizations to integrate new evidence and adopt a set of common assumptions across impact models for family planning.

PSI uses USAID’s couple years of protection (CYP) conversion factors to represent the estimated protection against unintended pregnancy provided by contraceptive methods during one year. PSI does not modify these conversion factors when estimating CYPs provided.

Service provision:

When a client directly receives a family planning method from a PSI or PSI-affiliated provider during a consultation, PSI claims 100% of the impact of that service.

Distribution:

When PSI distributes a family planning method but does not provide it directly to a client, PSI claims 90% of the impact of that product, to take into account supply chain wastage.

Preventing double counting:

In some cases, PSI will distribute IUDs to our own service providers who insert the IUDs. In these cases, both the distribution and the insertion of the IUD are tracked and reported. To prevent double counting, PSI removes the impact resulting from the distribution of the IUD from our impact estimates, counting only the impact resulting from the insertion of the IUD.

Referrals:

When a client is referred by PSI to a non-PSI service provider, such as the public sector, instead of providing the service itself, PSI claims 50% of the impact of that service. This impact is only attributed to PSI when the referral is confirmed with appropriate documentation.

Model Outputs (impact metrics)

Estimates of DALYs averted, deaths averted, CYPs provided, and unintended pregnancies averted represent the projected health impact of the intervention. It is projected because it has not been directly measured.

Examples based on 10-year IUD intervention in Myanmar in 2015

* We are able to produce deaths averted coefficients for maternal deaths and child deaths individually. Within PSI’s Impact Calculator, these estimates are aggregated into a single deaths averted estimate. Estimates of maternal deaths averted are available via the export function within the calculator in most cases. Please contact analytics@psi.org for more information.

Examples of Statement of modeled results:

If 10,000 10-year IUDs were inserted in Myanmar in 2015, they would provide an estimated 46,000 CYPs and avert an estimated 78 deaths, 6,338 DALYs, and 16,032 unintended pregnancies over the course of their effective life span.**
If 10,000 10-year IUDs were distributed wholesale in Myanmar in 2015, they would provide an estimated 46,000 CYPs and avert an estimated 70 deaths, 5,704 DALYs, and 14,428 unintended pregnancies over the course of their effective life span.**

It is important to use caution when stating modeled results. As noted earlier, an IUD may be distributed to a service provider who will also insert the IUD. If both interventions (the distribution and the insertion) are attributed to the same service organization, such as PSI, the distribution activity should be removed from the estimated impact of the IUD, counting only the impact associated with the insertion.