Context

In some settings, clinicians routinely schedule IUD users for follow-up care, but little effort has been made to compare the health benefit of repeat visits with the costs to programs.

Methods

In a prospective study at eight clinics of the Mexican Social Security Institute, 1,713 new IUD users were instructed to return for either two or four visits in the first 12 months after insertion of the device. To estimate the health benefits and costs of each regimen, data were collected on the frequency of various medical interventions and the labor and material costs.

Results

Of the nearly 2,000 visits made overall, 235 in the four-visit regimen and 159 in the two-visit regimen involved medical interventions to treat serious conditions; 53 and 29, respectively, were scheduled visits by women who had no symptoms but were found to require medical care. Assuming that the program provides about 250,000 IUDs annually, costs would total $1.7 million for the four-visit and $900,000 for the two-visit regimen; the four-visit approach would generate 8,387 more visits involving medical interventions than the two-visit regimen, at a cost of $48 per visit.

Conclusions

Additional follow-up visits create an opportunity to diagnose and treat problems, and therefore provide increased safety for IUD users. However, a four-visit regimen costs much more than a two-visit approach.

International Family Planning Perspectives, 1999, 25(1):21-26