title: Comparison of outcomes at 6 weeks following postpartum intrauterine contraceptive device insertions by doctors and nurses in India: a case-control study.
abstract: OBJECTIVE
  As part of a strategy to revitalize postpartum family planning services, Government of India revised its policy in 2013 to permit trained nurses and midwives to insert postpartum intrauterine contraceptive devices (PPIUCDs). This study compares two key outcomes of PPIUCD insertions--expulsion and infection--for physicians and nurses/midwives to generate evidence for task sharing.
  
  
  METHODS
  We analyzed secondary data from the PPIUCD program in seven states using a case-control study design. We included facilities where both doctors and nurses/midwives performed PPIUCD insertions and where five or more cases of expulsion and/or infection were reported during the study period (January-December 2013). For each case of expulsion and infection, we identified a time-matched control who received a PPIUCD at the same facility and had no complaints. We performed a multiple logistic regression analysis focusing on provider cadre while controlling for potential confounding factors.
  
  
  RESULTS
  In 137 facilities, 792 expulsion and 382 infection cases were matched with 1041 controls. Provider type was not significantly associated with either expulsion [odds ratio (OR) 1.84; 95% confidence interval (CI): 0.82-4.12] or infection (OR 0.73; 95% CI: 0.39-1.37). Compared with centralized training, odds of expulsion were higher for onsite (OR 2.32, 95% CI: 1.86-2.89) and on-the-job training (OR 1.23, 95% CI: 1.11-1.36), but odds of infection were lower for onsite (OR 0.45, 95% CI: 0.27-0.75) and on-the-job training (OR 0.31, 95% CI: 0.25-0.37).
  
  
  CONCLUSIONS
  Trained nurses and midwives who conduct deliveries at public health facilities can perform PPIUCD insertions as safely as physicians.
  
  
  CONCLUSIONS
  Institutional deliveries are increasing in India, but most normal vaginal deliveries at public health facilities are attended by nurses and midwives due to a shortage of physicians. Task sharing with nurses and midwives can increase women's access to and the acceptability of quality PPIUCD services.
authors.affiliation: Jhpiego - an affiliate of Johns Hopkins University, 221, Okhla Phase III, New Delhi 110020, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Yadav
authors.affiliation: Jhpiego - an affiliate of Johns Hopkins University, 221, Okhla Phase III, New Delhi 110020, India.
authors.forename: Sudharsanam
authors.initials: S
authors.lastname: Balasubramaniam
authors.affiliation: Jhpiego - an affiliate of Johns Hopkins University, 221, Okhla Phase III, New Delhi 110020, India. Electronic address: drssinha@gmail.com.
authors.forename: Saswati
authors.initials: S
authors.lastname: Das
authors.affiliation: Jhpiego - an affiliate of Johns Hopkins University, 270, 1st Floor, Patliputra Colony, Patna, Bihar 800013, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Srivastava
authors.affiliation: Jhpiego - an affiliate of Johns Hopkins University, 221, Okhla Phase III, New Delhi 110020, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Srivastava
authors.affiliation: Jhpiego - an affiliate of Johns Hopkins University, 221, Okhla Phase III, New Delhi 110020, India.
authors.forename: Somesh
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Jhpiego - an affiliate of Johns Hopkins University, 221, Okhla Phase III, New Delhi 110020, India.
authors.forename: Bulbul
authors.initials: B
authors.lastname: Sood
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005193:Family Planning Services; D005260:Female; D006801:Humans; D007194:India; D007239:Infections / Q000453:epidemiology; D007433:Intrauterine Device Expulsion; D007434:Intrauterine Devices / Q000009:adverse effects; D016015:Logistic Models; D008880:Midwifery; D009726:Nurses; D010820:Physicians; D049590:Postpartum Period; D016896:Treatment Outcome; D014481:United States; D014492:United States Public Health Service
keywords: Midwives; Nurses; Postpartum family planning; Postpartum intrauterine contraceptive device; Task sharing