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A new contraceptive diaphragm in Niamey, Niger : a mixed methods study on acceptability, use, and programmatic considerations

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Introduction

Diaphragms have never been widely available in West Africa, a region with very low contraceptive use due in part to health system constraints and low demand for other modern methods of contraception. Research has demonstrated the single-size Caya contoured diaphragm to be a safe and effective barrier method of nonhormonal, self-care contraception, offering features that improve upon the design of traditional diaphragms. No studies have measured continuation of Caya. In Niamey, Niger, this pilot introduction study explored Caya acceptability, use, and programmatic considerations.

Methods

Women in Niger participated in surveys (n=150) and in-depth interviews (n=25) 6 months after adopting Caya. In-depth interviews were also conducted with men in the community (n=15) and family planning providers (n=15). We conducted descriptive analysis of the percentage of adopters who continued to use the method at 6 months and women’s reasons for discontinuation among women who completed the 6-month follow-up survey. We used deductive thematic analysis of in-depth interview data from women, men, and providers to understand program elements and other factors associated with acceptability.

Results

Six months after initiation, 76.7% (95% confidence interval=0.70, 0.83) of 150 survey respondents reported continued use of Caya. Top reasons for use included: Caya causes no side effects for most users, works on demand, and is reusable for up to 2 years. Roughly one-quarter of women interviewed reported inconsistent use. Some men supported their partner’s use; in other cases, women used Caya without informing or involving their partners. Providers described Caya as compatible with the needs of many women and credited pelvic models with enabling effective counseling.

Discussion

The Caya diaphragm has the potential to be a valuable addition to the range of contraceptive options, especially in settings with high levels of opposition to other modern methods.

Key Findings

  • Community health workers and facility-based providers in the public and private sectors successfully added the Caya diaphragm to their offering and found this new self-care contraceptive method of interest to many clients, including women who had never used modern contraception.
  • Women and men described a unique value proposition for Caya: the product causes no side effects for most users, works on demand, and is reusable for up to 2 years.
  • Most women who adopted Caya continued to use it after 6 months. The top reasons for discontinuation were the desire for pregnancy and concerns about effectiveness of the method.

Key Implications

In settings where health systems are overstretched and opposition to other methods of contraception is high, national stakeholders and their partners should consider adding the Caya diaphragm to the range of contraceptive options offered by community health workers and facility-based family planning providers. Introduction efforts should begin on a small scale with close monitoring to determine whether to further expand access.

Publised on February 22, 2022 in GHSP

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