Good training gives providers confidence to insert IUDs.

That good training builds provider confidence to offer clients IUDs is underscored by the experience of the Family Planning Association of Kenya (FPAK), a private nongovernmental organization that is an affiliate of the International Planned Parenthood Federation.

"IUD use has declined throughout Kenya, but at FPAK's 12 clinics--which serve some 27,000 family planning clients each year--one of every five women seeking a contraceptive method chooses the IUD," says Dr. Josiah Onyango, senior program officer of service delivery at FPAK. "And that acceptance rate has remained steady for the last five years.

"I believe there are several reasons for this. First, FPAK providers are confident that they can safely and correctly insert and remove IUDs because they are initially well trained both in IUD insertion and removal and in infection prevention, and they later benefit from training updates and supportive supervision. FPAK providers are also well trained to describe the characteristics of the IUD." Some contraceptive methods may be easier than the IUD to provide, Dr. Onyango admits, but at FPAK "we emphasize the importance of informed choice based on a full explanation of all available contraceptive options. Method choice is not what the provider wants, but what is best for the client, respecting the client's preference."