In order to meet Indicator 1d-1, a provider must:

  1. Score at least 80% on PSI Quality Standards (against individual country tool),    AND
  2. Score 100% on Critical Clinical Steps 

A provider must perform each and all of the Critical Clinical Steps for IUD Insertion Services correctly, as per the broader quality assurance guidelines at the platform, in order to receive a passing score on the Critical Clinical Steps. Additionally, provider must score 80% overall on all quality guidelines at the platform related to IUD insertion and removal in order to meet the indicator guidelines.  These criteria are to be assessed during one or several supervisory visits where IUD insertion is observed, as per platform quality assurance processes.

The Critical Clinical Steps for IUD Insertion Services below have been selected as a standardized means to measure service quality across platforms.  The Critical Clinical Steps do not represent an exhaustive list of all required steps in the insertion process but are critical and cannot be omitted. Programs are still required to follow other policies and guiding principles in the quality provision of family planning services, including those related to informed choice. The Critical Clinical Steps for IUD Insertion Services were determined by PSI Technical Services Department and Dr. Paul Blumenthal, PSI Global Medical Director.


The Critical Clinical Steps for IUD Insertion Services are:

A.            Counseling and Screening

  1. Stocks and makes available a range of appropriate methods or offers referral on where to get other methods
  2. Provides comprehensive information, including side effects, of chosen method
  3. Correctly determines that client is not pregnant
  4. Correctly assesses medical eligibility for method
  5. Provides client with information on the “danger signs”
  6. Gives client information on what to do/where to go in case of complications or questions (provide her phone number, a hotline number, telling her to come directly to the clinic, etc)

B.            Clinical-IUD Insertion

  1. Washes hands or uses hand sanitizer before and after insertion
  2. Puts on non-sterile or HLD/sterile exam gloves before bimanual exam
  3. Correctly performs bi-manual exam to assess size and position of the uterus
  4. Performs speculum exam properly
  5. Gently grasps cervix with tenaculum or vulsellum forceps
  6. Correctly sounds the uterus to determine depth of the uterus
  7. Inserts the IUD using the withdrawal and no touch technique
  8. Cuts strings and then removes the speculum

C.            Post-insertion/Infection Prevention

  1. Decontaminates and properly disposes of waste materials
  2. Decontaminates all instruments by soaking in 0.5% chloride solution for 10 minutes
  3. Thoroughly washes and rinses all instruments
  4. Sterilizes or high-level disinfects (HLD) all instruments