Professional associations are vital partners.
Evelyn Mutio, a nurse-midwife and honorary national secretary of the National Nurses Association of Kenya, says the initiative has her group's backing. "Because doctors are too busy in general to provide IUDs and may be completely unavailable in rural settings, nurse-midwives often are the people inserting and removing IUDs in Kenya," she says." I see no problem with this IUD revival as long as nurse-midwives have the proper preservice and in-service training to insert and remove IUDs safely and have reliable supplies to do so. Some nurse-midwives worry about a long queue of women waiting for family planning services if IUD insertion becomes more common. But they just need to be educated that over time IUD provision will take less of their time than provision of other methods requiring multiple visits. In Kenya, the IUD is checked by a provider one month after insertion. After that, if there are no problems, an IUD needs to be checked only once a year." These annual IUD checkups, Mutio notes, provide an excellent opportunity to perform a Pap smear to screen for cervical cancer.
Besides nurse-midwives, most providers of family planning services in rural settings throughout Kenya are clinical officers. Gregory W. Miyanga, secretary-general of the Kenya Clinical Officers' Association (KCOA), says,"Our people are very much interested in the rehabilitation of the IUD. It is dynamic and new, and we do not consider insertions and removals to be time-consuming. If you have the proper training and equipment, IUD insertion barely takes more than 10 minutes."
Gladys Okakah Koyengo, head of the department of clinical medicine at the Kenya Medical Training College in Nairobi--which graduates about 1,000 nurses and 300 clinical officers a year--says,"I see lack of provider motivation to insert IUDs. So changing provider attitudes is important. Once those attitudes change, so too will clients' attitudes. Patients have confidence in health care providers."
"Although reintroduction of the IUD in Kenya will require the strengthening of clinics and raise issues of supplies and expendables, we too are ready with a wide network of skilled professionals to support and contribute to the reintroduction of the IUD," says Dr. Joseph Karanja, chairman of the Kenya Obstetrical and Gynaecological Society (KOGS)." The IUD's decline really is a pity."
Among the IUD's greatest supporters are those health care providers who have personal experience with the method. Nurse-midwife Mutio used the IUD to space the births of her two children. Clinical officer Miyanga's wife used an IUD for eight years before having two children. Koyengo of the Kenya Medical Training College has also used an IUD." I had a wonderful experience," she says." No problems, no complications, for 10 years. Taking pills was too cumbersome. I had four children,two before the IUD, and two after. The same month I removed the IUD, I got pregnant."
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|Date:||Sep 22, 2003|
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