‘ I am now confident in the counseling and in inserting the loop’: assessing the feasibility of providing hormonal intrauterine devices at the primary health care level in Tanzania

Abstract

BACKGROUND: Unmet need for contraception among women is high in Tanzania. Hormonal intrauterine device was not among the contraceptives offered in public health facilities in Tanzania until a Ministry of Health pilot in 2023-2024. OBJECTIVE: Explore the feasibility of providing hormonal intrauterine devices in public health facilities in Tanzania. METHODS: An observational exploratory mixed-methods study design was conducted, using cross-sectional and longitudinal components, in 20 peri-urban facilities in two districts in Tanzania between January 2023 and February 2024. Facility assessments were collected to understand equipment/infrastructure gaps, while clinical assessments, surveys and in-depth interviews were conducted with trained providers to explore the feasibility of introducing hormonal intrauterine devices. Quantitative data was analyzed descriptively for trends. Qualitative data was analyzed thematically, then triangulated with quantitative data in line with a convergent mixed-methods approach. RESULTS: 1,198 women chose to take up hormonal intrauterine devices during the eight-month pilot. There was an average of 1.8 hormonal intrauterine device clients per facility per week, and overall ratios of 2.5 removals per 100 insertions and 0.3 expulsions per 100 insertions. Clinical average assessment scores in contraceptive counselling and intrauterine device insertion improved over the pilot, from 62% and 79% to 99% and 90% for counselling and insertions, respectively. This tallied with providers' expressions of increased confidence in provision of hormonal intrauterine device through interviews. CONCLUSIONS: It is feasible to introduce hormonal intrauterine device into the public sector in Tanzania, with sufficient training and mentorship to providers on contraceptive counselling, insertion skills, and side effects management.