Background: IUD uptake remains low in Pakistan, in spite of three major efforts to introduce the IUD since the\r\n1960s, the most recent of these being through the private sector. This study examines barriers to IUD\r\nrecommendation and provision among private providers in Pakistan.\r\nMethods: A facility-based survey was conducted among randomly selected private providers who were members\r\nof the Greenstar network and among similar providers located within 2 Kilometers. In total, 566 providers were\r\ninterviewed in 54 districts of Pakistan.\r\nLogistic regression analysis was conducted to determine whether correct knowledge regarding the IUD, selfconfidence\r\nin being able to insert the IUD, attitudes towards suitability of candidates for the IUD and medical\r\nsafety concerns were influenced by provider type (physician vs. Lady Health Visitor), whether the provider had\r\nreceived clinical training in IUD insertion in the last three years, membership of the Greenstar network and\r\nexperience in IUD insertion. OLS regression was used to identify predictors of provider productivity (measured by\r\nIUD insertions conducted in the month before the survey).\r\nResults: Private providers consider women with children and in their peak reproductive years to be ideal\r\ncandidates for the IUD. Women below age 19, above age 40 and nulliparous women are not considered suitable\r\nIUD candidates. Provider concerns about medical safety, side-effects and client satisfaction associated with the IUD\r\nare substantial. Providersââ?¬â?¢ experience in terms of the number of IUDs inserted in their careers, appears to improve\r\nknowledge, self-confidence in the ability provide the IUD and to lower age-related attitudinal barriers towards IUD\r\nrecommendation. Physicians have greater medical safety concerns about the IUD than Lady Health Visitors. Clinical\r\ntraining does not have a consistent positive effect on lowering barriers to IUD recommendation. Membership of\r\nthe Greenstar network also has little effect on lowering these barriers. Providersââ?¬â?¢ barriers to IUD recommendation\r\nsignificantly lower their monthly IUD insertions.\r\nConclusions: Technical training interventions do not reduce providersââ?¬â?¢ attitudinal barriers towards IUD provision.\r\nFormative research is needed to better understand reasons for the high levels of provider barriers to IUD provision.\r\nââ?¬Å?Non-trainingââ?¬Â interventions should be designed to lower these barriers.
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