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Harris DM, Dam A, Morrison K, Mann C, Jackson A, Bledsoe SM, Rowan A, Longfield K. Barriers and Enablers Influencing Women's Adoption and Continuation of Vaginally Inserted Contraceptive Methods: A Literature Review. Stud Fam Plann 2022; 53:455-490. [PMID: 35922382 PMCID: PMC9545114 DOI: 10.1111/sifp.12209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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 18 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 2010 and September 2020. 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 13,848 results, with 182 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.
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Affiliation(s)
- Danielle M Harris
- Danielle M. Harris is Senior Program Manager, Kate Morrison is Program Manager, and Shannon Bledsoe is Executive Director, Catalyst Global, Carlsbad, CA, United States
| | - Anita Dam
- Anita Dam is Technical Advisor for the Introduction & Access of HIV Prevention Technologies, United States Agency for International Development (USAID), Global Health Technical Professionals Program, Washington, DC, USA
| | - Kate Morrison
- Danielle M. Harris is Senior Program Manager, Kate Morrison is Program Manager, and Shannon Bledsoe is Executive Director, Catalyst Global, Carlsbad, CA, United States
| | - Chastain Mann
- Chastain Mann is Chief Executive Officer, Mann Global Health, Columbus, North Carolina, USA
| | - Ashley Jackson
- Ashley Jackson is Team Lead for Sexual & Reproductive Health, Primary Health Care Program, PATH, Seattle, Washington, USA
| | - Shannon M Bledsoe
- Danielle M. Harris is Senior Program Manager, Kate Morrison is Program Manager, and Shannon Bledsoe is Executive Director, Catalyst Global, Carlsbad, CA, United States
| | - Andrea Rowan
- Andrea Rowan is Independent Consultant and Kim Longfield is Founder and Principal, Databoom, Washington, DC, USA
| | - Kim Longfield
- Andrea Rowan is Independent Consultant and Kim Longfield is Founder and Principal, Databoom, Washington, DC, USA
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A Biopsychosocial Model for the Counseling of Hormonal Contraceptives: A Review of the Psychological, Relational, Sexual, and Cultural Elements Involved in the Choice of Contraceptive Method. Sex Med Rev 2019; 7:587-596. [DOI: 10.1016/j.sxmr.2019.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 12/22/2022]
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Kashyap C, Mohanty IR, Thamke P, Deshmukh YA. Acceptance of Contraceptive Methods Among Postpartum Women in a Tertiary Care Center. J Obstet Gynaecol India 2017; 67:91-97. [PMID: 28405115 PMCID: PMC5371516 DOI: 10.1007/s13224-016-0924-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/13/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In India, a large proportion of women with an unmet need for contraception are within their first year after childbirth. Therefore, concentrating efforts to educate postpartum women on the importance of attending contraceptive clinics could have a proportionally bigger impact on increasing postpartum contraception usage. METHODS Hundred and seventy-eight (178) women were followed up to determine the proportion of postpartum women who attended the family planning clinics for contraceptive counseling. The reason for non-attendance, choice and effectiveness of contraceptive method selected was determined. RESULTS Out of 178 postpartum women who were followed up, only 12 (6.8 %) attended the contraceptive clinic. IUD, POPs and Inj-DMPA are the preferred contraceptive methods selected by postpartum women. Hundred percent of the postpartum women who attended contraceptive selected a contraceptive method as compared to only 44 % of the postpartum women who did not attend a contraceptive clinic. Only 29.2 % of these postpartum women selected highly effective contraceptive methods as compared to 83.3 % by the postpartum women who attended family planning clinics. The common reasons cited for not attending contraceptive clinic was found to be time constraint (43.9 %) followed by 'stay far away' (39 %), followed by 'already have information' (9.7 %). CONCLUSIONS Family planning service that is scheduled to be delivered at the 6-week postpartum is rarely attended. The common reason cited by postpartum women for poor attendance in these family planning clinics was time constraint.
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Affiliation(s)
- Charusheela Kashyap
- Department of Pharmacology, Mahatma Gandhi Mission Medical College, Kamothe, Navi Mumbai, Maharashtra India
| | - Ipseeta Ray Mohanty
- Department of Pharmacology, Mahatma Gandhi Mission Medical College, Kamothe, Navi Mumbai, Maharashtra India
| | - Pratima Thamke
- Department of Obstetrics and Gynecology, Mahatma Gandhi Mission Medical College Hospital for Women and Children, Kalamboli, Navi Mumbai, Maharashtra India
| | - Y. A. Deshmukh
- Department of Pharmacology, Mahatma Gandhi Mission Medical College, Kamothe, Navi Mumbai, Maharashtra India
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Chhabra HK, Mohanty IR, Mohanty NC, Thamke P, Deshmukh YA. Impact of Structured Counseling on Choice of Contraceptive Method Among Postpartum Women. J Obstet Gynaecol India 2016; 66:471-479. [PMID: 27821990 PMCID: PMC5080220 DOI: 10.1007/s13224-015-0721-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/01/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND OF THE STUDY In India, although a number of contraceptive choices are available, the usage of contraceptive methods among postpartum women is rather low. The current study intended to determine the impact of "structured contraception counseling" on women's decision making on selection of contraceptive methods and the reasons behind the selection of a contraceptive method. METHODS One-hundred-and-seventeen postpartum women in the age group of 18-35 years, requesting contraception, were enrolled in the study. "Structured contraception counseling" was provided using a standardized protocol with balanced and comprehensive education material on the available hormonal and nonhormonal contraceptive methods. Questionnaires with information on the women's pre- and post-counseling contraceptive choice, her perceptions, and the reasons behind her postcounseling decision were filled by the participating women. RESULTS Maximum women enrolled for the study were in the age group of 21-25 years. In pre-counseling, 36 % postpartum women selected a contraceptive method, 23.1 % a nonhormonal method, and 12.8 % a hormonal method. After "structured contraception counseling," 92.25 % of women chose a contraceptive method. There were significant differences between the women's choices of contraceptive methods in the pre- and post-counseling sessions, respectively [progesterone-only pills (POP): 5.1 vs. 38.46 %, (p < 0.001); injectable-depot medroxy progesterone acetate (DMPA): 2.56 vs. 21.356 %, (p < 0.01); and intra uterine device (IUD): 10.28 vs. 23.92 %, (p < 0.001). 38.46 % chose a POP, 21.36 % injectable-DMPA, and 23.9 % the IUD]. CONCLUSION "Structured contraception counseling" using standardized protocol resulted in significant improvements in the selection of contraceptive methods by postpartum women.
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Affiliation(s)
| | - Ipseeta Ray Mohanty
- Department of Pharmacology, Mahatma Gandhi Mission Medical College, Kamothe, Navi Mumbai, 410 218 Maharashtra India
| | - Nimain C. Mohanty
- Department of Pediatrics, Mahatma Gandhi Mission Medical College Hospital for Women and Children, Kalamboli, Navi Mumbai, Maharashtra India
| | - Pratima Thamke
- Department of Obstetrics and Gynecology, Mahatma Gandhi Mission Medical College Hospital for Women and Children, Kalamboli, Navi Mumbai, Maharashtra India
| | - Y. A. Deshmukh
- Department of Pharmacology, Mahatma Gandhi Mission Medical College, Kamothe, Navi Mumbai, 410 218 Maharashtra India
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Gambera A, Corda F, Papa R, Bastianelli C, Bucciantini S, Dessole S, Scagliola P, Bernardini N, de Feo D, Beligotti F. Observational, prospective, multicentre study to evaluate the effects of counselling on the choice of combined hormonal contraceptives in Italy--the ECOS (Educational COunselling effectS) study. BMC WOMENS HEALTH 2015; 15:69. [PMID: 26329464 PMCID: PMC4557636 DOI: 10.1186/s12905-015-0226-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 08/17/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adequate counselling on contraceptive methods can help users choose the most appropriate method. The aim of this study was to assess the effects of structured counselling provided by gynaecologists on selection of a combined hormonal contraception method. METHODS Women aged 18-40 years (n = 1871) who were considering the use of a combined hormonal contraception method (pill, transdermal patch or vaginal ring) underwent a structured counselling session in which gynaecologists provided comprehensive information. Pre- and post-counselling questionnaires on combined hormonal contraception choice were completed by participants. RESULTS After counselling, many women (38 %) selected a combined hormonal contraception method that was different from the originally intended one. Preferences for the transdermal patch approximately doubled (from 3.2 % pre-counselling to 7 %; p < 0.0001) and those for the vaginal ring increased four-fold (from 5.2 to 21.2 %; p < 0.0001), while preference for the pill remained unchanged (from 64.5 % [pre-] to 64.1 % [post-counselling]). The proportion of undecided women decreased from 18 to 2.1 % (p < 0.0001). The main reasons for choosing a method were related to ease of use (all methods), and preferences for administration frequency (daily, weekly or monthly). The number of patients requiring post-counselling contact with the physician's office was low (5.1-6.9 %), as was the incidence of adverse events (1.8-3.1 %). CONCLUSIONS Counselling has a significant impact on women's choice of combined hormonal contraception and encourages them to consider alternative methods to combined oral contraceptives. Moreover, it also enables women to use their chosen method with confidence. TRIAL REGISTRATION NCT01181778 , Trial registration date: August 12, 2010.
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Affiliation(s)
| | - Fedela Corda
- Centro Donna c/o Ospedale Binaghi, Cagliari, Italy.
| | - Rosetta Papa
- UOC Tutela Salute Donna- ASL Napoli 1 CENTRO, Naples, Italy.
| | - Carlo Bastianelli
- Policlinico Umberto I, Dipartimento di Ginecologia e Ostetricia, Rome, Italy.
| | - Sandra Bucciantini
- Azienda Universitaria Careggi, Divisione Clinica Ostetrica, Florence, Italy.
| | - Salvatore Dessole
- A.O.U. di Sassari Macrostruttura Materno Infantile Clinica Ostetrico Ginecologica, Sassari, Italy.
| | | | - Nadia Bernardini
- MSD Italia S.r.L., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ, USA.
| | - Daniela de Feo
- MSD Italia S.r.L., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ, USA.
| | - Fabiola Beligotti
- MSD Italia S.r.L., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ, USA.
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