Role of Quality Control Circle to Improve PPIUCD Insertion Rates: Results from a Novel Quality Improvement Project

India is the world's second most populous country, and according to projections, it is soon going to surpass China and take the first position.Despite being the first country in the world to introduce a dedicated Family Planning program in 1952, India's figures on the progress of outcome indicators have not been very encouraging over the last two decades, as reflected in various National Family Health Surveys conducted over the last 20 years.Unmet need for contraception in South Asian women is much higher than the global average.This unmet need for contraception is even higher in postpartum females, which is up to the tune of 65% as per some reports.Evidences clearly show that inter pregnancy interval of less than 18 months results in increased maternal and perinatal morbidity and mortality.The World Health Organization (WHO) technical committee on birth spacing recommends a minimum inter-pregnancy interval of 2 years to minimize adverse maternal and perinatal outcomes.The postpartum period is an ideal time to initiate use of any of the family planning methods which is suitable for a lactating lady and that can act as a continued method of family planning up to 2-3 years or even more.During the postpartum period, a lady stays with the healthcare facility for at least 24 hours, and it is a golden chance to educate and counsel her at this time before she is discharged.Various studies done over time have documented reasons for low acceptance and high discontinuation rates for Postpartum Intrauterine Copper-T Device (PPIUCD) among postpartum females.In our study, it was observed that generating awareness through proper counseling among the eligible women is very important to increase the PPIUCD coverage, but is not sufficient; the training and sensitization of the providers, along with continued supply of PPIUCDs, are equally important.A dedicated strategy was formulated through a novel quality improvement initiative.The immediate PPIUCD insertion rate was increased by utilizing community health workers for quality counseling services after their training, training of junior-level staff on PPIUCD insertion, ensuring continued supply of PPIUCD through administrative staff involvement, vigorous audit, and continuous feedback on PPIUCD use.The project interventions have proven sustainable over a long period.There was an overall increase in PPIUCD insertion rate from baseline 2.7 to 22% at the end of the project.We firmly believe that replication of interventions adopted in the present project shall be beneficial to overcome existing deficiencies in the field of family planning coverage among postpartum women.