Open Access, Self-Assessed IUD Insertion Simulation Training

An estimated 218 million women in low­ and middle ­income countries want to prevent pregnancy but lack access to effective birth control and/or comprehensive family planning and sexuality education. 

The copper T380A and levonorgestrel-releasing (LNG) intrauterine devices (IUDs) are safe, low-cost, and highly effective, long-term, reversible contraceptive methods that are appropriate for use by most female adolescents and women. 

IUDs are under-used in many parts of the world, partially due to a lack of trained providers who are knowledgeable, skilled, and confident in delivering quality IUD services. To address this shortage, the World Health Organization recommends training medical personnel who are not physicians to insert IUDs to improve access to long-term and emergency contraception.

The traditional in-person teaching approach to IUD insertion requires access to training centers, course workshops, teachers, and expensive mannequins.

We have created an open-access, self-assessed, easily reproducible, high quality, and frugal simulation training module to allow clinical practitioners to learn copper and hormonal IUD insertion skills without the need for mentors anywhere in the world at any stage of their career.

The STARS (Sexual and Reproductive Health and Rights) - IUD Insertion training module uses open-source 3D printing and frugal technologies to empower nurses, midwives and clinical officers to become confident and competent in maintaining aseptic technique in sounding the uterus, loading the IUD in the sterile package, setting the gauge to the sounded depth, and gently inserting and deploying the IUD as part of copper and hormonal IUD insertion procedures for long-acting reversible contraception services performed in low to middle income countries.

The 3D Printed Uterus Simulators offer different uterine depths so the learner can practice sounding the uterus and placing hormonal and copper IUDs at the uterine fundus.

The frugal, low-tech Cervix and Vaginal Canal (with Augmented Feedback) Simulator is made of locally available, inexpensive materials and trains the learner to maintain aseptic technique in sounding the uterus. 

The unfolding of the arms of the IUD is a critical step of the procedure. For copper IUDs, the practitioner inserts the IUD to the fundus and then pulls back on the inserter tube to permit the arms to spread upwards to the "T" position. For hormonal IUDs, the arms spread downwards to the "T" position so the practitioner must insert the IUD slightly past the os, and release the arms before advancing it to the fundus.

This module trains learners on how to insert copper and hormonal IUDs because using both types of IUDs does not happen frequently enough for practitioners or trainees to experience them in their practice, which can result in increased risk of patient morbidity, including but not limited to embedment of the IUD in the myometrium and perforation into the abdominal cavity.

The user's learnings will directly translate into clinical performance of aseptic technique for uterine sounding and proper insertion of hormonal and copper IUDs.

An estimated 218 million women in low­ and middle ­income countries want to prevent pregnancy but lack access to effective birth control and/or comprehensive family planning and sexuality education. 

The copper T380A and levonorgestrel-releasing (LNG) IUDs are safe, low-cost, and highly effective, long-term, reversible contraceptive methods that are appropriate for use by most women. Copper IUDs can be inserted up to 14 days after unprotected intercourse and can prevent unwanted pregnancies in female survivors of sexual violence and sexual trafficking. Women should be provided the option of hormonal IUDs for long-term, reversible contraception because their better side effects profile may help increase rates of IUD use globally.

In 2017, approximately 295,000 women died during and following pregnancy and childbirth. 94% of all maternal deaths occur in low to middle income countries with sub Saharan Africa accounting for two-thirds (196,000), Southern Asia accounting for nearly one-fifth (58,000), and South-Eastern Asia accounting for over 5% of global maternal deaths (16,000). To avoid maternal deaths, it is essential to prevent unwanted pregnancies. Thus, all women, including adolescents, require access to safe, effective, and low-cost contraception.

IUDs are under-used in many parts of the world, partially due to a lack of trained providers who are knowledgeable, skilled, and confident in delivering quality IUD services. To address this shortage, the World Health Organization recommends training medical personnel who are not physicians to insert IUDs to improve access to long-term and emergency contraception.

The STARS (Sexual and Reproductive Health and Rights) - Intrauterine Device (IUD) Insertion open-access, simulation-based and self-assessed training module uses open-source 3D printing technology and locally, low-cost materials to empower nurses, midwives and clinical officers in low to middle income countries to become confident and competent in performing copper and hormonal IUD insertion procedures without the need for clinical mentors anywhere in the world at any stage of their career.

Our international, and multidisciplinary team consists of:

Team Co-Lead: Nkeiruka Ameh, MBBS, MBA, FWACS, is a Professor in the Department of Obstetrics & Gynecology at Ahmadu Bello University in Zaria, Nigeria and serves as an examiner for the West African College of Surgeons. She has authored over 50 publications in peer-reviewed national and international journals, contributed chapters to Nigerian and foreign textbooks, and serves as a reviewer for local and international high-impact journals. She has taught over 3,300 medical students, supervised over 15 dissertations for postgraduate medical training candidates, and has over 25 years of clinical experience in deliveries, IUD insertion training and other reproductive health procedures.

Team Co-Lead: Julielynn Wong, MD, MPH, FACPM is a physician-scientist, innovator, and educator whose life’s mission is to take technology to the extreme to benefit the world. She is internationally recognized as a 3D printing pioneer who uses low-cost technologies to deliver healthcare solutions across diverse environments, from outer space to remote communities with limited access to healthcare resources. She is board certified in public health and general preventive medicine, aerospace medicine, occupational medicine, and clinical informatics, has authored over 35 scientific and technical publications and has 14 patents issued for medical devices. She founded Medical Makers, a global community of innovators, patients, and healthcare providers who use human-centered design and low-cost technologies to develop life-saving solutions to serve vulnerable populations in need. 50% of Medical Makers are girls and women.

Clinician/Educator: Rogers Kajabwangu, MBchB, M Med is a clinician, educator, and researcher who is an Obstetrician/Gynecologist at Mbarara University Teaching Hospital and the Coordinator of Postgraduate Studies in the Department of Obstetrics and Gynecology at Kampala International University Teaching Hospital. He is a recent awardee of a D43 grant to study metabolic syndrome and cervical cancer in women at Mbarara Regional Referral Hospital under the Multi-Morbidity Research Capacity Initiative at Mbarara University of Science and Technology. He has authored and co-authored 4 publications and been cited 3 times as indicated by Google Scholar. He is currently supervising 5 postgraduate students in the Departments of Obstetrics and Gynecology at Mbarara University and Kampala International University Teaching Hospitals. He serves as a member of the Faculty Ethics Research Committee in the Faculty of Medicine at Kampala International University Teaching Hospital.

Clinician/Educator: Paul Ssempebwa, MBchB, has 4 years of clinical experience in resource-constrained settings, including 1.5 years of experience as a Medical Officer responsible for the maternity ward at the Dr. Ambrosoli Memorial Hospital in Kalongo, Uganda and 2.5 years of experience working at Ishaka Adventist Hospital in Ishaka, Bushenyi District, Western Uganda. He has conducted over 100 cervical cancer screening procedures, provided family planning services, including over 300 IUD insertion procedures, and has performed over 500 C-section deliveries. Since 2019, he has been providing on-the-job training and mentoring of nurses, midwives, and clinical officers. He is currently enrolled in the Masters of General Surgery program at the Mbarara University of Science and Technology in Mbarara, Uganda.

Clinician/Educator: Esther Uchenna Oganiru, RN, RM is a nurse-midwife who provides sexual and reproductive health education and care at primary health care clinics in Calabar Municipality, Cross River State, Nigeria.

3D Printing Design Specialist:
Erin Austen, BSc (Mechanical Engineering), Masters in Applied Science (Aerospace Engineering) has over 9 years of CAD experience with Solidworks, Fusion360, and AutoCAD Inventor and has authored technical documents for an autonomous planetary rover and a CubeSat. She has been involved in Medical Makers social impact projects since 2018 to use her engineering skills for social good.

91% percent of our team are minorities and 82% are women. For a full list of our current team members, please go to: https://www.appropedia.org/User:Medical_Makers#Team_Members_3.

We are seeking partners who can help advance our innovative training solution through monetary and non-monetary support.

We seek mentorship, coaching, and expert strategic advice from experts in overcoming cultural barriers to training non-physicians to insert IUDs and to improve confidence in and use of IUD services by underserved populations, building an impact measurement practice, and accessing affordable software licenses and legal services to support the piloting, growth, and scaling of our open-access, self-assessed training solution to advance sexual and reproductive health and rights at home and internationally.

We face financial challenges in ensuring local 3D printing enterprises and local logistics service organizations in resource-constrained settings are paid at fair market value rates to manufacture and deliver affordable, 3D Printed Uterus Simulators to train local healthcare practitioners serving vulnerable populations in need.

We face market barriers in raising global awareness that our Appropedia-based, open access, and self-assessed IUD Insertion simulation training module is freely available in multiple languages to train nurses, midwives and clinical officers to become confident and competent in performing IUD insertion to serve vulnerable populations in need.

We seek to be inspired and guided by a trusted peer support group, and a powerful network of impact-minded leaders across industries and sectors in our exciting journey to advance sexual and reproductive health and rights for girls and women worldwide.

The STARS - Intrauterine Device (IUD) Insertion module is better and more effective than traditional approaches available in low to middle income countries to nurses, midwives, and clinical officers.

We are not aware of any IUD Insertion Simulator that provides augmented feedback to alert the learner if the sterile metal uterine sound touches the vaginal sidewalls, metal pelvic speculum blades, or tenaculum.

The ZOE® Gynecological Skills Trainer provides one clear uterus for unblinded IUD insertion training. The 3D Printed Uterus Simulators offer a range of uterine depths for blinded IUD insertion training which more accurately reflects the real clinical scenario for this procedure.

Unlike single-use fruit-based simulators, the 3D Printed Uterus Simulators and Cervix and Vaginal Canal (with Augmented Feedback) Simulator are fully reusable with an indefinite lifespan which minimizes their per use cost.

The 3D Printed Uterus Simulators are made from polylactic acid (PLA), a biorenewable, biodegradable, and minimally off-gassing thermoplastic.

The 3D Printed Uterus Simulators are open source and can be locally made on open-source, open filament, user friendly, single extruder desktop 3D printers that print polylactic acid, a low-cost and easy to print plastic.

Unlike most 3D printed medical training models, all of the module's 3D Printed Uterus Simulators are designed to:

• print without support material, rafts or brims
• require no cleaning, sanding, gluing, priming, painting, dipping, coating, smoothing, polishing, or any post-processing
• not require any non-3D printed parts, and
• be ready for use right out of the 3D printer.

Medical Makers is a minority woman-led and woman-founded social enterprise that uses 3D printing to directly benefit marginalized groups by reducing inequities and strengthening their rights. 50% of Medical Makers are girls and women.