A New Contraceptive Diaphragm in Niamey, Niger: A Mixed Methods Study on Acceptability, Use, and Programmatic Considerations

Abstract

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. n 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. n 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.

Couple-Years of Protection Indicator: New Global Guidance for Updating Existing Methods and Adding New Methods

“…Aside from design improvements to increase comfort and usability, Caya comes in just 1 size, thereby eliminating the need for a fit exam—a key barrier to use in low-resource settings. 6 , 9 …”

“…8 The only additional data source is a study conducted from 2019–2021 in Niger that estimated a 76.7% 6-month continuation rate. 6 …”

“…Aside from design improvements to increase comfort and usability, Caya comes in just 1 size, thereby eliminating the need for a fit exam-a key barrier to use in low-resource settings. 6,9 Two studies conducted post-2011 were identified in our literature search. In 2015, a randomized controlled trial was conducted with a single-size diaphragm used with a contraceptive gel.…”

“…Since 2011, notable developments in the modern contraceptive method mix led the CYP working group in the USAID Office of Population and Reproductive Health to recommend a CYP update for 4 methods: Caya diaphragm, Levoplant, the hormonal IUD, and the POP blister pack of 35 pills ( Table ). These methods were selected based on their alignment with the 3 primary reasons for CYP update previously listed: (1) Caya diaphragm is newly available in LMICs 6 ; (2) A regulatory body changed the duration of efficacy for Levoplant (from 4 to 3 years) and the hormonal IUD (from 5 to 7 years); and (3) The presentation of POP blister packs changed from 28 pills to 35 pills per pack (for USAID-procured packs). The guidance outlined in this article is intended for USAID-funded programming and, therefore, applies to USAID-procured commodities.…”

Reversible female contraceptives: historical, current, and future perspectives

“…The diaphragm can be inserted 6 h prior to intercourse and can be left inside the vaginal cavity for 6 h after intercourse, with a maximum duration of use for 24 h [164]. The newest iteration is a onesize-fits-most contoured diaphragm (Figure 4) that does not require a fitting by a provider, but still requires a prescription [165][166][167][168].…”