A woman who has gonorrhea or chlamydia now should not have an IUD inserted. Having these sexually transmitted infections (STIs) at insertion may increase the risk of pelvic inflammatory disease. These STIs may be difficult to diagnose clinically, however, and reliable laboratory tests are time-consuming, expensive, and often unavailable. Without clinical signs or symptoms and without laboratory testing, the only indication that a woman might already have an STI is whether her behavior or her situation places her at very high individual risk of infection.

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This wheel contains the medical eligibility criteria for starting use of contraceptive methods. It is based on the Medical Eligibility Criteria for Contraceptive Use, 3rd edition and its 2008 Update. This update of the MEC Wheel contains 25 new recommendations that tell family planning providers whether a woman presenting with a known medical or physical condition is able to use various contraceptive methods safely and effectively.

Family Health International (FHI), with support from the U.S. Agency for International Development, has developed a simple checklist to help providers determine quickly and with confidence whether a client may use an IUD. Based on WHO's Medical Eligibility Criteria for Contraceptive Use (2004; updated 2008), the checklist consists of a series of questions designed to identify any medical conditions or behaviors that would either prevent safe IUD use or require special precautions or further screening.

  The Pregnancy Checklist contains a series of questions to rule out pregnancy. These questions, based on criteria established by the World Health Organization (WHO) for determining with reasonable certainty that a woman is not pregnant, are also included in the COC, DMPA, IUD, and implant checklists, eliminating the need to use two separate checklists.

The World Health Organization (WHO) develops detailed criteria that health care workers can follow to determine which contraceptive methods are medically suitable for their clients. These criteria are based on the most current scientific knowledge about the effectiveness, risks, and benefits of various family planning methods, and they can help providers guide their clients in making safe and informed decisions. The WHO recently revised the criteria in response to recommendations made by an expert working group who met in Geneva, Switzerland, in April 2008.

Gain a sense of client’s knowledge, attitudes, expectations and any concerns about the IUD in order to address as appropriate. Discuss important advantages of the IUD, tailored to client’s situation, for example:

The Balanced Counseling Strategy (BCS) is a practical, interactive, client-friendly counseling strategy that uses three key job aids (visual memory aids) for counseling clients about family planning. The process, tested and refined in several countries, involves a set of steps to determine the method that best suits the client according to her/his preferences and reproductive health intentions. 

The information in this document is compiled from the Contraceptive Myths and Counseling Messages Database. It provides evidence-based information and counseling messages that providers around the world have used to dispel commonly-held contraceptive myths and misperceptions. Health care professionals can use this resource to correct misinformation and support informed decisions by helping clients understand the facts on how contraceptive methods work, on who can use them, their possible side effects, and much more.

Family Planning: A Global Handbook for Providers, offers clinic-based health care professionals in developing countries the latest guidance on providing contraceptive methods. Primary features of the handbook include:

This brief gives providers tips for to counteract rumors and misconceptions about IUDs that clients might have. It also provides common rumors or misconceptions about IUDs and the facts that providers need to dispel those rumors/misconceptions.

This interactive counseling resource is a tool for family planning clients and providers to use together to: help clients choose and use the method of contraception that suits them best; give providers essential information needed to offer high-quality family planning care to clients; and help providers counsel clients more effectively. This tool, which is consistent with the WHO Medical Eligibility Criteria and the Selected Practice Recommendations, contributes to ensure informed free choice and proper use of a method of contraception.

Good client-provider interaction (CPI) helps promote informed choice, method adoption and continuation, and resulting positive health outcomes. This brief discusses the key components of CPI for various types of family planning clients and describes ways in which providers, clients, and programs can support good CPI.  

These PowerPoint slides discuss information related to the IUD including: how it works, advantages, disadvantages, misconceptions, eligibility criteria, and contraindications to use.

This PowerPoint presentation lays out the challenges presented by HIV and the contraceptive needs of HIV-positive women. It briefly highlights the characteristics of the IUD, as the IUD can be an option for HIV-positive women. The presentation also covers changes to the WHO Medical Eligibility Criteria for IUDs in 2004, which stated that IUDs can be used by women at risk of or currently infected with HIV.

Although the primary infection concern during insertion of IUDs is pelvic inflammatory disease (PID), the risk of PID attributable to the IUD is considerably lower than believed.  The risk relates to progression of gonorrhea or Chlamydia infection present in the cervix at the time of insertion and not to the IUD itself.  Infection Prevention (IP) procedures have little or no effect on the course of gonorrhea or Chlamydia infections; nonetheless good IP practice is important in helping protect both clients and providers from infection in general.

This tool provides detailed instructions for processing instruments, gloves, and other items used for IUD insertion and removal to prevent infections. Reprinted, with slight modifications, from JHPIEGO. IUD Guidelines for Family Planning Service Programs: A Problem-Solving Reference Manual, 3rd edition. Adapted from: Tietjen, L. Bossemeyer, D. and McIntosh, N. (2003). Infection Prevention: Guidelines for Healthcare Facilities with Limited Resources. JHPIEGO, Baltimore, Maryland.

This tool provides tips to prevent infections during IUD insertion and removal, including selecting the appropriate setting and attire for clients and staff, as well as specific infection prevention measures to take before, during, and after the insertion and removal procedures. Reprinted, with slight modifications, from JHPIEGO. IUD Guidelines for Family Planning Service Programs: A Problem-Solving Reference Manual, 3rd edition.

This tool provides detailed instructions for inserting a loaded IUD into a woman's uterus. Reprinted, with slight modifications, from JHPIEGO (2006). IUD Guidelines for Family Planning Service Programs: A Problem-Solving Reference Manual, 3rd edition. Baltimore, Maryland. Adapted from: Program for International Training in Health (INTRAH). (1993). Guidelines for Clinical Procedures in Family Planning: A Reference for Trainers. INTRAH, Chapel Hill, North Carolina.

This tool provides detailed instructions for loading the regular Copper T 380A IUD in the sterile package. Reprinted, with slight modifications, from JHPIEGO (2006). IUD Guidelines for Family Planning Service Programs: A Problem-Solving Reference Manual, 3rd edition. Baltimore, Maryland. Adapted from: Program for International Training in Health (INTRAH). (1993). Guidelines for Clinical Procedures in Family Planning: A Reference for Trainers. INTRAH, Chapel Hill, North Carolina.

This tool provides detailed instructions for loading the Safe Load Copper T 380A IUD in the sterile package.  Reprinted, with slight modifications, from JHPIEGO (2006). IUD Guidelines for Family Planning Service Programs: A Problem-Solving Reference Manual, 3rd edition. Baltimore, Maryland. Adapted from: Program for International Training in Health (INTRAH). (1993). Guidelines for Clinical Procedures in Family Planning: A Reference for Trainers. INTRAH, Chapel Hill, North Carolina.

This tool provides detailed instructions for sounding the uterus. Reprinted, with slight modifications, from JHPIEGO (2006). IUD Guidelines for Family Planning Service Programs: A Problem-Solving Reference Manual, 3rd edition. Baltimore, Maryland. Adapted from: Program for International Training in Health (INTRAH). (1993). Guidelines for Clinical Procedures in Family Planning: A Reference for Trainers. INTRAH, Chapel Hill, North Carolina.

Download Word Version Download PDF Version Routine follow-up visit at 3-6 weeks post insertion Normally, clients should return after the first post insertion menses (three to six weeks), but not later than three months, for their first check up. Thereafter, there is no need for a fixed follow-up schedule.

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