<p>Choosing and Using the Progesterone Vaginal Ring: Women’s Lived Experiences in Three African Cities</p>

Abstract

This study explored experiences of selecting and utilizing a newly introduced contraceptive-the progesterone vaginal ring (PVR)-among women seeking a contraceptive method in 3 African capital cities (Abuja, Nairobi, and Senegal). The study explored women's perceptions of, and lived experiences with, using the new product to better understand their reception of a new contraceptive. This understanding will help inform the design of programs to support women in their adoption and continued use of the PVR and other new contraceptives. Patients and Methods: This longitudinal, qualitative study drew on an interpretive phenomenological approach, involving multiple in-depth interviews (IDIs) with 9 study participants over a 6-month period. Participants involved in the study were postpartum women seeking contraceptive services at participating clinics. A total of 25 IDIs were conducted, and a detailed "within-case" and "cross-case" analysis of participants' accounts was carried out to identify similar and dissimilar themes along descriptive, linguistic, and conceptual lines. Results: Four overarching themes emerged from the analysis. These themes circulated around the unconventionality of the PVR, which heightened its desirability among participants; the sense of comfort that women gained from opting to use the PVR over other FP methods; narratives of consideration that centered on women's partners, and that were important for ensuring the sustainability of women's PVR use; and the conundrums that women grappled with as they prepared to disengage from the PVR after two cycles of use. Conclusion: The PVR is an acceptable contraceptive method to postpartum women in urban African settings. However, prior to its introduction into new country contexts, formative data on women's perceptions of, and reactions to, the product need to inform country preparation processes. Such information would be useful for tailoring counseling around this contraceptive, as well as for product marketing and robust uptake of the method.

Husbands’ concerns and experiences with the progesterone vaginal ring in three sub-Saharan African countries: a mixed methods study

“…This was consistent with previous findings regarding the views of women about the method. 2 , 12 Such positive views might contribute to men’s support for their partners to use the method, and thus improve the SRH and rights of women in the study settings. The finding further suggests that husbands could play an important role in promoting PVR if they find the method acceptable, and thus contribute to expanding the SRH and rights of women generally.…”

“…Whereas this view may negate the goal of achieving SRH and rights for women through self-use products such as PVR, a previous study showed that women were also of the view that they needed to inform their partners to ensure harmony in the home. 12 In patriarchal societies such as the study settings, men’s views and perspectives often shape the choices available to women, women’s decision-making, women’s own formation of opinions, and women’s behaviours. 20 , 21 The social position of men in the study communities suggests that their support is crucial for enhancing women’s sustainable use of PVR given the considerable influence they have on the SRH and rights of women.…”

“…While the PVR has potential as a self-care product to enhance women’s autonomy, the effectiveness of self-care interventions for sexual and reproductive health (SRH) may vary by context 8–10 In the case of PVR, the extent to which it could enhance women’s autonomy over their reproductive decision-making and behaviour may be influenced by cultural acceptance of family planning and vaginally-inserted products, unequal gender and power relations within households, the cost of accessing the product, and ease of use. 11 , 12 Studies in SSA further show that socio-cultural norms around gender roles, sexuality, and fertility exert considerable influence on contraceptive use among women and girls in the region. 13–19 …”

Toward an intravaginal device to detect risk of preterm labor: a user-centered design approach in Sub-Saharan Africa

“…These concerns about device use have been mirrored in a study about the SILCS Diaphragm in South Africa, in which it was also highlighted that education and information dissemination could address concerns about the physical properties of the device [ 24 , 25 ]. Studies on vaginal rings have also demonstrated the importance of comfort and partner acceptability with use, and especially the impact on sex [ 28 , 29 ]. Additionally, previous studies suggest that women have regularly been underestimated in their ability to care for and wear cervical barrier devices such as diaphragms appropriately [ 30 , 31 ].…”

High adherence to intermittent and continuous use of a contraceptive vaginal ring among women in a randomized controlled trial in Kigali, Rwanda

“…Whilst increasing choice remains crucial, efficient uptake of existing and new vaginal rings requires an in-depth understanding of user preferences, and barriers and facilitators to acceptability and adherence (8,(14)(15)(16)(17)(18)(19)(20). Multipurpose prevention technologies (MPTs) targeting combination(s) of HIV, other STIs, and unintended pregnancy are currently under development.…”