Women around the world lack awareness about most of the vaginally inserted contraceptive methods. This poses the biggest barrier to their use, researchers found. Product cost is another major barrier to adoption, as are unsupportive partner attitudes and women’s concerns about insertion.1
The most important enabling factor to a person’s use of vaginally inserted contraceptives is counseling from a trained provider or community health worker.
“We’re constantly thinking about what will make women interested or not interested in this given contraceptive method,” says Danielle Harris, MPH, MA, lead study author and deputy director of product introduction at Catalyst Global in Carlsbad, CA.
Harris and colleagues performed a literature review to see if the common assumption about women’s attitudes toward these contraceptives was correct: Do women in some low-income and middle-income nations shy away from the intrauterine device (IUD), diaphragm, internal condom, and hormonal vaginal ring because they are concerned about inserting a device in their vagina?
“We wanted to look further into that widely held assumption,” Harris says.
They found that the insertion is not problematic for most women. “When there is some initial discomfort, it’s usually overcome with practice and time,” Harris explains.
The findings suggest providers should discuss the pros and cons of vaginally inserted devices with patients and ensure the women who choose one have the information they need to use the method successfully.
“If you work in family planning, it’s an important reminder that quality counseling is really the bedrock of women having choice and agency in choosing their contraceptive method,” Harris explains. “Quality counseling means you tell women about all the methods available to them. When they select a method, you make sure they know all the information about it and know the anticipated side effects and how to manage them.”
Harris and colleagues did not study the experiences of women in the United States, but some of their findings also may be relevant to people here.
Most of the literature on vaginally inserted contraceptives involved the copper IUD, which has been studied for longer than most other types of vaginally inserted contraception. Women in high-income, low-income, and middle-income nations may have heard of this method. But other devices, such as the vaginal ring, internal condom, and the modern diaphragm, are less well known.
“The thing about the diaphragm is it’s a really good option for some women, but it’s not widely available everywhere — not in low- and middle-income countries, for sure,” Harris says. “It does seem like the tide is turning where there is an interest in nonhormonal methods like the Caya diaphragm, in particular.”
The Caya diaphragm was designed to be one-size-fits-all, which reduces the number of times a woman may have to visit a clinic to obtain the contraceptive. It is an on-demand device that is easily cleaned and reused for up to two years, Harris explains.
Patients’ requests for the copper IUD are increasing, partly due to a growing minority of women desiring nonhormonal contraception, says Stephanie Delkoski, DNP, APRN, WHNP-BC, a clinical assistant professor at the University of Minnesota School of Nursing.
“[Recently], we had two out of 14 patients that had the copper IUD,” Delkoski recalls. “They said, ‘I have heavier bleeding, cramping takes two ibuprofens, and there’s acne.’ But they didn’t want to add any hormones.”
There is a similar trend of young women requesting lower doses of hormone in their contraception, Delkoski notes. “I’ve seen a trend in the last five years of people wanting to go no hormone or less hormone,” she says. “Some patients will like the 19.5 mg levonorgestrel IUD [Kyleena], as opposed to the 52 mg levonorgestrel IUD.”
The Kyleena lasts for five years and is appealing to people who are concerned about the side effects of progesterone or who want a smaller IUD because it may be easier to insert.
There also has been a resurgence in requests for a diaphragm, specifically the Caya diaphragm. When Delkoski began practice in 2016, there were no requests or interest in a diaphragm for contraception. Now, she sees a patient every few months who is interested in that method.
For patients whose partners do not use condoms, there are few nonhormonal contraceptive options besides the copper IUD. Among those available, the diaphragm and contraceptive gel are gaining interest among young women, Delkoski notes. Some women may want a device to use only when they have sex.
Investigators who studied the Caya diaphragm found that most women who used that method continued to use it after six months. Also, the investigators found the product causes no side effects for most users and works on demand. Providers said Caya was compatible with the needs of many women, and they believed using pelvic models helped enable effective counseling.2
“Having more options is always better,” Harris notes. “If you have women looking for a nonhormonal, on-demand method, Caya is a very good one, but I don’t know what the supply chain is for that.”
REFERENCES
- Harris DM, Dam A, Morrison K, et al. Barriers and enablers influencing women’s adoption and continuation of vaginally inserted contraceptive methods: A literature review. Stud Fam Plann 2022;53:455-490.
- Jackson A, Angel A, Mahamadou Bagourme A-R, et al. A new contraceptive diaphragm in Niamey, Niger: A mixed methods study on acceptability, use, and programmatic considerations. Global Health Sci Pract 2022;10:e2100532.
Women around the world lack awareness about most of the vaginally inserted contraceptive methods. This poses the biggest barrier to their use, researchers found. Product cost is another major barrier to adoption, as are unsupportive partner attitudes and women’s concerns about insertion. The most important enabling factor to a person’s use of vaginally inserted contraceptives is counseling from a trained provider or community health worker.
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