Four years of the FIGO postpartum intrauterine device initiative in Sri Lanka: Pilot initiative to national policy.

OBJECTIVE: To analyze the difficulties and challenges arising from introduction of postpartum intrauterine device (PPIUD) services into the Sri Lankan health system. METHODS: Phase I of a FIGO PPIUD initiative was implemented in 2013 in six hospitals; phase II began in 12 hospitals in 2015. During this period, 915 Medical Officers were trained in PPIUD insertion and 5370 personnel were trained in PPIUD counseling. Women were followed up at 4-6 weeks after insertion. RESULTS: A total of 184 433 women (62.4% of hospital deliveries) were interviewed about PPIUD as a method of contraception. Of those interviewed, 116 159 (63.0%) received counseling on PPIUD and 11 339 (6.1%) consented to PPIUD insertion. Of consenting women, 9346 (82.4%) had a PPIUD inserted. There were no significant complications reported at insertion. Expulsion rates were 2.9% and removal rates were 4.1%. CONCLUSION: PPIUD as a method of contraception was successfully introduced into the 18 participating hospitals. Given the success of this pilot intervention and the safety profile demonstrated, PPIUD was added to the national family planning program in 2017.

Susceptibility to rubella among pregnant women and the serological evidence of congenital rubella in newborn babies at Colombo South Teaching Hospital.

OBJECTIVE: To determine the susceptibility to rubella infection in early pregnancy and the incidence of seropositivity of cord blood for rubella specific IgM among the newborn babies at Colombo South Teaching Hospital. METHODS: 1000 cord blood samples and 500 maternal blood samples from pregnant women before the 16th week of gestation were taken from the labour room and the antenatal clinic of the University Unit, Colombo South Teaching Hospital during the period of February 1999 to February 2001. These samples were tested for rubella specific IgM and IgG antibodies by ELISA. A detailed questionnaire was filled during the time of sampling. RESULTS: Of the 500 antenatal blood samples 82% were positive for rubella specific IgG. 373(75%) women gave a history of vaccination against rubella before their present pregnancy. Among the vaccinated 2(0.5%) were negative for IgG antibodies by ELISA. Out of 127 unvaccinated women 12(9%) gave a history of past infection with rubella and of this 3(25%) were seronegative for rubella specific IgG. 18% of pregnant women at 16 weeks of gestation were at risk of giving birth to a baby with congenital rubella syndrome. Among the tested 1000 cord blood samples three were seropositive (0.3%) for rubella specific IgM. CONCLUSIONS: A significant proportion of pregnant women were susceptible to rubella infection in the studied population. The present strategy of selective rubella vaccination should be reconsidered if we are to get closer to eliminating rubella syndrome in Sri Lanka.