Acceptability of the Diaphragm Among Low-Income Women in Sao Paulo, Brazil

Abstract

Between January 1989 and December 1992 in Osasco health district of Sao Paulo Brazil interviews were conducted with 1744 low-income women aged 15 years to more than 30 years at five public health clinics to determine the prevalence of diaphragm use and acceptability of the diaphragm. All the women chose a contraceptive method after attending an educational session on all contraceptive methods. The most common contraceptive methods chosen included the IUD (30.8%) oral contraceptives (OCs) (29.3%) and condoms (20.3%). 11.3% chose the diaphragm which was considerably higher than expected since it had only recently been introduced in Brazilian public health clinics. Diaphragm users were older and better educated than OC users (odds ratio [OR] = 1.8 p = .0018; and OR = 2.5 p = 0.00001 respectively). They were more likely than IUD users to use contraception for birth spacing than birth limiting (OR = 1.5 p = 0.0179). The leading reason for choosing the diaphragm was concern over health (35%) followed by easy to use (16.3%). The overwhelming key reason for not choosing the diaphragm was the perceived difficulties in handling it. About 46% of women who chose the diaphragm had discontinued use within three months. Discontinuation rates for the other methods were lower (29% for the condom 27% for the minipill 16% for OCs and 4% for the IUD). The two key reasons for discontinuation of the diaphragm were: contraception no longer needed (15.2%) and difficulties in inserting and removing the diaphragm (15.2%). Improved training and preparation of health professionals are likely to be key to expanding contraceptive options for Brazilian women in general and to making the diaphragm a viable alternatives for low-income women in particular. Yet current structural weaknesses in the Brazilian public health system do not guarantee the ongoing support needed to allow diaphragm users to resolve their initial problems with the methods or the level of educational efforts to adequately inform diaphragm users.