Barriers and Enablers Influencing Women's Adoption and Continuation of Vaginally Inserted Contraceptive Methods: A Literature Review

Abstract

Most vaginally inserted methods have limited availability and use despite offering characteristics that align with many women's stated preferences (e.g., nonhormonal and/or on demand). The objective of this review was to identify enablers and barriers to women's adoption and continuation of vaginally inserted contraceptive methods in low-and middle-income countries (LMICs). We searched three databases (PubMed, Embase, and Web of Science) and  websites using keywords related to five vaginally inserted contraceptive methods (diaphragm, vaginal ring, female condom, copper intrauterine device [IUD], hormonal IUD) and terms associated with their adoption and continuation. Searches were limited to resources published between January  and September . Studies eligible for inclusion in our review presented results on women's use and perspectives on the enablers and barriers to adoption and continuation of the vaginally inserted contraceptive methods of interest in LMICs. Relevant studies among women's partners were also included, but not those of providers or other stakeholders. Data were coded, analyzed, and disaggregated according to a framework grounded in family planning (FP) literature and behavioral theories common to FP research and program implementation. Our initial search yielded , results, with  studies ultimately included in the analysis. Across methods, we found common enablers for method adoption, including quality contraceptive counseling as well as alignment between a woman's preferences and a method's duration of use and side effect profile. Common barriers included a lack of familiarity with the methods and product cost. Notably, vaginal insertion was not a major barrier to adoption in the literature reviewed. Vaginally inserted methods of contraception have the potential to fill a gap in method offerings and expand choice. Programmatic actions should address key barriers and enable voluntary use.   Danielle M. Harris et al.are unintended (Sully et al. 2020). As a result of unintended pregnancies, some women and their families experience severe social, economic, and health consequences (Singh, Sedgh, and Hussain 2010). Women cite a number of reasons for not using contraception despite wanting to avoid unintended pregnancy: concerns about side effects and health risks; infrequent sex; opposition to contraception; and breastfeeding and/or delayed menstruation postbirth (Sedgh, Ashford, and Hussain 2016). For some, these reasons for nonuse of contraception may reflect misconceptions, stigma, social norms, or other factors, while for others, these reasons may reflect a lack of access to methods that suit their needs and preferences.Expanded access to a wide range of modern contraceptive methods is well-established as a global health priority, recognizing that diverse options are needed to meet women's varying contraceptive needs and preferences (WHO 2014). Despite efforts to broaden options, only two or three methods account for most contraceptive use in LMICs. The predominant methods...

LALAPG variant of the Human Contraception Antibody (HCA) reduces Fc-mediated effector functions while maintaining sperm agglutination activity

“…Male contraception and new non-hormonal products for women may fill this gap and allow greater control of reproduction. A new contraceptive product that is low-cost, easily accessible, user-controlled, non-invasive, reversible, safe, and unobtrusive during intercourse might be popular among women who presently do not consistently use effective contraception methods due to their high cost, limited access and undesirable side effects [ 2 , 3 ]. A promising new contraceptive candidate is the Human Contraception Antibody (HCA), an antisperm antibody currently in clinical development as a topical non-hormonal contraceptive for women [ 4 ].…”

Preferred product attributes of a multipurpose vaginal ring: Findings from a phase 1 trial

“…Indeed, a recent literature review assessing barriers and enablers to women's uptake and use of vaginal contraception suggested that concerns about vaginal insertion as a disincentive to a product's The star (*) denotes a probability value < 0.05 using a χ 2 test of association. demand are likely overestimated (23). Indeed, numerous studies suggest that intravaginal practices are common and are engaged in for cleaning purposes, sexual pleasure, and fertility control (24)(25)(26).…”

“…Across 68 studies, including both clinical trial and observational designs of different types of vaginal rings, most women rated their IVR experience as highly acceptable, and insertion and removal as easy ( 18 , 22 ). Indeed, a recent literature review assessing barriers and enablers to women's uptake and use of vaginal contraception suggested that concerns about vaginal insertion as a disincentive to a product's demand are likely overestimated ( 23 ). Indeed, numerous studies suggest that intravaginal practices are common and are engaged in for cleaning purposes, sexual pleasure, and fertility control ( 24 – 26 ).…”