The ins and outs of IUCDs | |
Intrauterine devices. Technical and managerial guidelines for services. Geneva: World Health Organisation 1997 (xiv + 175pp.). ISBN: 92 4 154497 X. |
This practical guide
is primarily directed at organisers of family planning programs in developing countries, but its contents are equally relevant to Australian general practitioners, gynaecologists and family planning physicians and nurses, both in practice and in training. Prepared by several authors for the World Health Organization, it first analyses all recent literature, concluding that the currently available intrauterine contraceptive devices (IUCDs), especially copper-bearing and progestogen devices, provide an effective and cheap method of reversible contraception. Contrary to popular belief, it advises that the risk of complication is low - provided that simple client screening mechanisms are used to eliminate women at high risk of sexually transmitted diseases and aseptic insertion techniques are used. Active campaigns to counteract the poor image of IUCDs following the Dalkon Shield episode are recommended. There are detailed, but easy to read, accounts of patient counselling and selection procedures, insertion and removal techniques, and potential complications and methods of dealing with these, all directly relevant to Australian practice. One whole chapter is devoted to infection prevention measures that are applicable and feasible in any country. The sections dealing with establishing and running an IUCD service are comprehensive yet clearly written, providing checklists and sources of additional information as well as methods of evaluating a service. Such diverse problems as the ordering of supplies and countering misinformation are dealt with competently. There is also a comprehensive guide to the training of health workers and counsellors. Several appendices provide additional practical information for program directors. Overall, this is a really useful and easy-to-read little book. Caroline M de Costa
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