Abstract
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. 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. 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. 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.
Highlights
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
Because little is known about diaphragm continuation, there is an urgent need to close the continuation research gap that Caya is available and potentially wellsuited to family planning (FP) programs in lowresource settings
In countries with fewer contraceptive options, the addition of a new method is associated with greater increases in overall contraceptive use.[1]
Summary
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. 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. Les diaphragmes n'ont jamais été largement disponibles en Afrique de l'Ouest, une région où l'utilisation des contraceptifs est très faible en raison en partie des contraintes du système sanitaire ainsi que la faible demande d'autres méthodes modernes de contraception. Méthodes: Des femmes au Niger ont participé à des sondages (n=150) et à des entretiens approfondis (n=25) 6 mois après l’adoption du Caya. Discussion: Le diaphragme Caya a le potentiel d'être un ajout précieux à la gamme d'options contraceptives, en particulier dans les contextes où les niveaux d'opposition aux autres méthodes modernes sont élevés
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