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Context: The contribution of copper-bearing intrauterine devices (IUDs) to overall contraceptive protection has declined in many countries, despite their well-known advantages. In response, initiatives to promote this method have been undertaken.Objective: To review and interpret the experience of interventions to promote use of IUDs in low- and middle-income countries in order to provide strategic guidance for policies and programs.Methods: We conducted a systematic search of Medline, Popline, Embase and Global Health electronic databases for relevant journal papers, reports and gray literature since 2010. Telephone interviews were held with two donors and six international family planning organizations.Results: We identified a total of 31 publications. Four reported the results of randomized control trials and three were derived from quasi-experiments. The majority were based on service statistics. Eight publications concerned interventions for HIV-positive women or couples, nine for postpartum or postabortion cases and 14 for general populations. Intervention approaches included vouchers, franchising of private practitioners, mobile outreach services, placement of dedicated staff in high-volume facilities and demand creation. Most publications adduced evidence of a positive impact and some reported impressively large numbers of IUD insertions. Results to date on the uptake of IUDs in postpartum interventions are modest. There is also almost no evidence of effects on IUD use at national levels. Implant uptake generally exceeded IUD uptake when both were offered.Conclusion: The evidence base is weak and offers few lessons on what strategies are most effective. The overall impression is that IUD use can be increased in a variety of ways but that progress is hampered by persistent adverse perceptions by both providers and potential clients. Provider enthusiasm is a key to success. The lack of a population impact stems in part from the fact that nearly all interventions are initiated by international organizations, with limited national reach except in small countries, rather than by government agencies. [ABSTRACT FROM AUTHOR]

The most common method of reversible contraception used worldwide is the intrauterine device. However, in the Asia-Pacific the combined oral contraceptive pill and condoms, methods of contraception that require a high degree of day-to-day user compliance, are more popular. The combined vaginal ring and transdermal patch have been developed to overcome the need for daily compliance associated with combined pill use. They have the added advantages of non-oral delivery, thus avoiding gastro-intestinal interference with absorption, and in addition there is no hepatic first-pass effect. Both have been available internationally for some years and offer an alternative to the combined pill. This article reviews and summarises published data on these new methods.

After years of hesitancy, due to financial and manufacturing problems, the Chinese Government has finally moved to replace the steel ring IUD with the Copper T. The steel ring, used by some 60 million women, has been pronounced unreliable by the WHO and is blamed for some 30% of the country's 10 million annual abortions. It will no longer be manufactured. China has received financial and technical assistance from the UNFPA to establish 2 factories to produce the Copper T 220 and next year it will expand this capacity, as well as starting production of the Copper T 380-A. The introduction of the newer IUD is likely to prevent the following events during the next 10 years: 55,600 pregnancies, 18,400 live births, 35,600 induced abortions, 16.300 maternal deaths. 365,000 infant deaths, and 28,800 child deaths. The cheaper IUD was used by more than 40% of Chinese women using modern contraception, making it the country's most common contraceptive method., (full text)

Recent surveys by the Vietnamese Ministry of Health suggest that 60% of married women desire no more children. Yet only 2% of currently married women and less than 1/2 of 1% of their partners use sterilization. Underscoring the high unmet need for effective family planning, over 1 million abortions (legal in Vietnam for the past 20 years) are performed annually. This rate corresponds to 1 abortion for every live birth. The Ministry of Health has recently welcomed a variety of organizations, including AVSC, whose assistance can help expand the country's family planning programs. Sorely lacking in supplies, equipment, and trained personnel, Vietnam has merited priority status--2nd only to China and India--from the UNFPA, which has committed $36 million over the next 4 years. Other organizations currently working in Vietnam include the Population Council, the Population Crisis Committee, and the International Planned Parenthood Federation. Despite enormous casualties during the war years, and a decrease since the 1970s in average family size from 6 to 4 children, the population of Vietnam has continued to grow rapidly, far outpacing economic growth. Currently 67 million, the population is expected to reach 80 million by the year 2000. The average Vietnamese annual income is only $195, among the lowest in the world. Doi moi, the process of economic reform begun in 1986, coupled with new government incentives for families who have no more than 2 children, is changing the face of family planning in Vietnam. Newly opened pharmacies sell imported birth control pills and condoms (to those who can afford them), while government hospitals and health clinics provide mainly IUDs, in addition to limited supplies of pills and condoms. Throughout the country, some 8000 community-level health centers are staffed by nurse-midwives trained in family planning. Voluntary sterilization is available at the district, provincial, and national hospitals. All married women may obtain family planning services free on request. Vietnam's system of free and universal primary health care, combined with high female literacy rates, has kept the country's infant mortality rate low in comparison to other very poor countries. 39% of currently married Vietnamese women ages 15-49 use contraception. Of those, 85% use the IUD, making it far and away the most widely used modern method. In fact, some women think family planning is synonymous with the IUD., (full text)

Preliminary results from the 1990 Jordan Population and Family Health Survey show a 20% decline in fertility since the early 1970s. The total fertility rate (TFR, or average lifetime births/woman) declined from 7.7 births in the 1971-1975 period, to 6.6 in 1980-1983, to 5.6 in 1987-1990. A national sample of 6462 evermarried women of childbearing ages were interviewed. More than 1/2 (58%) of respondents had ever used a method of contraception. 35% of married women reported currently using some method of contraception, up from 26% in 1983. The IUD was the most popular modern method--used by 15% of women. Female sterilization (6% of respondents) edged out the pill (5%). These findings show a shift in contraceptive use from the pill to the IUD and female sterilization compared with 1983. In general, older women, those living in big cities, women with a formal education, and those who have children are more likely to use contraception. Compared with other countries, the level of fertility in Jordan is high for the level of contraceptive use. Reliance on traditional methods may account for this difference: 27% were currently using modern methods and 8% traditional. Knowledge of contraceptive methods is high. Almost all women knew of at least 1 method of family planning, either modern or traditional. The pill and IUD were the best-known methods; 98% of the women knew at least 1 of these. The next best-known were traditional methods: periodic abstinence (77%) and withdrawal (69%). Most women who knew a family planning method also knew where to obtain it. For example, more than 94% of those surveyed knew about female sterilization, of whom 85% knew where to go to have it done. The survey showed infant mortality in Jordan had declined to 27/1000 livebirths. Almost all children under 2 had received some vaccinations, and almost all are breastfed for at least some time. There seems to be a strong program prompting diphtheria/pertussis/typhoid, polio, and measles vaccination in Jordan, according to the report. Of all children 12-23 months, 88% had received these vaccinations, although coverage declined with successive doses., (full text)