Family planning for large families in the Kyrgyz Republic

A woman receives counseling from a medical practitioner about her postpartum contraception options, including the IUD.

Imagine a woman with eight pregnancies and six children to care for by the time she is 30 years old. She wants no more children. Yet no medical staff are trained and qualified to provide her with long-term contraception, such as an IUD, in the village where she lives.

After the Europe and Eurasia Regional Family Planning Activity trained medical providers in the Kyrgyz Republic, use of IUDs rose 3.5 times in the areas where the newly trained doctors practice medicine.
This was indeed the case for one woman from the Kyrgyz Republic who was able—at long last—to obtain an IUD during a postpartum/postabortion IUD insertion training given by the USAID-funded Europe and Eurasia Regional Family Planning Activity.

This was the woman's second trip—and second abortion—to the clinic in Jalalabat in seven months. When she received counseling her about her family planning options after the abortion, the woman was thrilled at the long-term nature of the IUD, saying "You mean I don't have to worry about becoming pregnant for twelve years?"

Clearly, this woman had an unmet need for a long-term, or permanent, method of contraception. She was fortunate to come to Jalalabat when JSI was conducting the IUD training and the contraceptive supplies that she wanted—and so plainly needed—were available to her free of charge.

Unfortunately, this woman's story is common throughout the Kyrgyz Republic and much of rural Central Asia. When the trainees discussed her situation, they were, sadly, all too familiar with her story. They see many such women in their practices. Because long-term and permanent contraceptive methods are not widely available in rural areas, women either resort to abortion, or have more children than they intend.

In Central Asia, the linkages between complementary women's health services and family planning are not strong, resulting in lost opportunities for women who want and need contraception. Outdated clinical practice guidelines mean that many women are denied IUDs immediately postabortion. National guidelines call for extensive (and unnecessary) medical tests and examinations prior to IUD insertion, which means that women face a waiting period and unnecessary costs prior to finally obtaining their IUD.

The Europe and Eurasia Regional Family Planning Activity is an initiative funded by the US Agency for International Development and implemented by John Snow, Inc. which leverages best practices in family planning to accelerate FP program implementation across the region.

There are also missed opportunities for providing women contraception postpartum due to lack of proper training and instruments. Furthermore, current postpartum IUD insertion practices are unsafe: They are usually done at three-to-five days after delivery. Research indicates that the safest time to insert and IUD postpartum is either within 48 hours after delivery of the placenta or four weeks or more after giving birth.

To address these weaknesses in reproductive health services and family planning, JSI's Regional Activity offered a postpartum/postabortion IUD training of trainers activity in Jalalabat, Kyrgyz Republic for health practitioners from the Kyrgyz Republic and Tajikistan. The objectives of the training were to increase participants' knowledge about safe, evidence-based postpartum and postabortion IUD insertion, develop clinical skills to perform IUD insertions, and train them to teach other practitioners to perform this procedure safely and effectively.

After the training, participants agreed how important it is to make family planning methods available to women when they are seeking related reproductive health services. The 30-year old Kyrgyz mother's experience simply underscored the importance of their work, the need to extend this kind of training throughout the region, and their sense of urgency and commitment to help expand complementary family planning services to their home facilities.
This need was quickly proven when, in the maternity hospital where the training was held, postpartum IUD insertions were nearly 3.5 times higher three months after the training compared to three months before the training. With proper training, supplies, and equipment, providers are working to make complementary family planning services widely available to their clients who need them.