Assessing country preparedness
Since diaphragms have not been included in developing-country family planning programs in recent decades, PATH is conducting country assessments to evaluate regulatory, family planning policy, and programmatic issues that will influence future introduction.
An important part of these assessments will be hearing from family planning providers and potential consumers their perceptions about the SILCS Diaphragm. This will help identify where SILCS might fit in the contraceptive method mix in each country and identify those users who would be the most interested in using SILCS.
In 2010, PATH partnered with researchers from Mbarrara University to conduct a country assessment in Uganda. Uganda has high levels of unmet need for contraception, a limited contraceptive method mix, and low rates of male condom use. The national family planning program is strained by limited resources and experiences stockouts and inconsistent supply of some methods.
Stakeholders interviewed recognized the value of expanding the method mix to include a reusable barrier such as SILCS. They believed that some women might choose SILCS as a primary method for contraception while other women would use SILCS as a back-up when other methods, such as contraceptive injectables, are not available. Stakeholders suggested that SILCS be launched through the private, not-for-profit clinics to gain familiarity with this method and demonstrate that women in Uganda want and can use SILCS. This assessment also confirmed that contraceptive gel is no longer available in Uganda. The issue of what contraceptive gel to use with SILCS, or whether it is necessary to use contraceptive gel, must be decided before SILCS introduction can occur.
In collaboration with MatCH, a reproductive health research group in Durban, PATH is currently implementing a similar assessment in South Africa. This assessment will evaluate SILCS introduction opportunities both as a nonhormonal contraceptive and as a reusable delivery system for microbicide gel.
Contraceptive prevalence is relatively high in South Africa, with a contraceptive prevalence of just over 60 percent, yet a large proportion of pregnancies are unplanned, and teenage pregnancy is a major health concern. Unsafe sex is one of the most important risk factors relating to disability, disease, or death. The need for female-initiated methods of protection is being recognized due to the feminization of HIV. Despite strong counseling, a large proportion of women are still unable to negotiate condom use.
PATH is currently working with Ashodaya Samithi—a community organization of sex workers based in Mysore, Karnataka—and an independent consultant to conduct a health systems assessment to understand the potential of SILCS as a nonhormonal barrier method to improve women’s reproductive health in India.
Contraceptive prevalence where this assessment will occur is 50%-60%, but female sterilization is the most commonly used method (90%). Birth spacing methods have not been as widely promoted. Access to a single-size diaphragm could improve options for women who have an unmet need for birth spacing.
This assessment involves national stakeholder interviews in Delhi, followed by key-informant interviews with stakeholders and providers in the states of Mysore and Rajasthan. Perspectives of potential users and male partners will be assessed through focus group discussions. The diaphragm was available previously in India on a limited basis. At a 2008 stakeholder meeting convened in Delhi to discuss the potential for reintroduction of the diaphragm in India, a majority of participants agreed the diaphragm has significant potential to improve contraceptive use among Indian women. PATH and its partners will build upon this work to better understand the unique opportunities and challenges to introducing SILCS in India.
- Desktop review of the policy, research, and regulatory environment in South Africa relating to future introduction of the SILCS
- SILCS in South Africa: Opportunities for introduction as a barrier contraceptive and as an MPT (Presentation)
- Is the SILCS Diaphragm appropriate for women in India? (Poster presentation)