Is the SILCS Diaphragm appropriate for women in India?
ESC Congress Library. Kilbourne - Brook M. 05/28/14; 50461; A-044 Disclosure(s): Support for the SILCS project is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of the HealthTech Cooperative Agreement # AID-OAA-A-11-00051. The contents are the responsibility of PATH and do not necessarily reflect the views of USAID or the US Government.
Ms. Maggie Kilbourne - Brook
Ms. Maggie Kilbourne - Brook
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Abstract
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Objective: Evaluate opportunities and challenges for future introduction in India of the SILCS Diaphragm, a single-size contraceptive barrier, using a systems approach.


Method: Desk research and key-informant interviews among policymakers, regulatory representatives, health officials, providers, and reproductive health organizations in India characterized the national policy and programmatic environments. Focus group discussions (FGDs) in the states of Karnataka and Rajasthan explored regional differences and perceptions among potential users and their partners (married women and sex workers from both urban and rural areas).


Results: Interviews with 22 national-level stakeholders and 9 FGDs were conducted between November 2012 and April 2013. National-level stakeholders expressed strong support for SILCS to expand the contraceptive mix for young women seeking reversible methods for birth spacing. Training and integration into service delivery were not considered problematic. A phased introduction along with awareness campaigns is recommended since knowledge of diaphragms in India is low.


Across both urban and rural FGDs, women were enthusiastic about a contraceptive method that has no systemic side effects and is under their control. Sex workers already use male condoms with clients and will not switch to a method that is less protective from HIV and sexually transmitted infections, although they would welcome SILCS to use with regular partners. While some stakeholders felt that rural women would find the use of SILCS difficult, this perception was not borne out by rural women.


Some stakeholders would like SILCS introduced in the public-sector program where contraception is free, but most agreed that introduction through private not-for-profit clinics should be a first step. All recommended that SILCS be positioned as a contraceptive method appropriate for any woman and not be targeted to high-risk groups which could stigmatize its use.


Since no contraceptive gel is currently available in India, clinical testing of gel will be required as well as local acceptability data.


Conclusions: SILCS would be welcomed in India as an addition to the limited contraceptive options. Broad agreement suggests SILCS be introduced slowly through nongovernmental sectors (not-for-profit clinics, social and commercial marketing). Stakeholders suggest a bridging study in India to raise awareness of SILCS and better understand consumer interest. This reusable barrier method could help address unmet need for family planning, especially among women concerned about systemic side effects from hormonal methods and intrauterine devices. Despite the widespread enthusiasm among stakeholders, SILCS introduction will be delayed until an appropriate contraceptive gel is registered and available in India.

Objective: Evaluate opportunities and challenges for future introduction in India of the SILCS Diaphragm, a single-size contraceptive barrier, using a systems approach.


Method: Desk research and key-informant interviews among policymakers, regulatory representatives, health officials, providers, and reproductive health organizations in India characterized the national policy and programmatic environments. Focus group discussions (FGDs) in the states of Karnataka and Rajasthan explored regional differences and perceptions among potential users and their partners (married women and sex workers from both urban and rural areas).


Results: Interviews with 22 national-level stakeholders and 9 FGDs were conducted between November 2012 and April 2013. National-level stakeholders expressed strong support for SILCS to expand the contraceptive mix for young women seeking reversible methods for birth spacing. Training and integration into service delivery were not considered problematic. A phased introduction along with awareness campaigns is recommended since knowledge of diaphragms in India is low.


Across both urban and rural FGDs, women were enthusiastic about a contraceptive method that has no systemic side effects and is under their control. Sex workers already use male condoms with clients and will not switch to a method that is less protective from HIV and sexually transmitted infections, although they would welcome SILCS to use with regular partners. While some stakeholders felt that rural women would find the use of SILCS difficult, this perception was not borne out by rural women.


Some stakeholders would like SILCS introduced in the public-sector program where contraception is free, but most agreed that introduction through private not-for-profit clinics should be a first step. All recommended that SILCS be positioned as a contraceptive method appropriate for any woman and not be targeted to high-risk groups which could stigmatize its use.


Since no contraceptive gel is currently available in India, clinical testing of gel will be required as well as local acceptability data.


Conclusions: SILCS would be welcomed in India as an addition to the limited contraceptive options. Broad agreement suggests SILCS be introduced slowly through nongovernmental sectors (not-for-profit clinics, social and commercial marketing). Stakeholders suggest a bridging study in India to raise awareness of SILCS and better understand consumer interest. This reusable barrier method could help address unmet need for family planning, especially among women concerned about systemic side effects from hormonal methods and intrauterine devices. Despite the widespread enthusiasm among stakeholders, SILCS introduction will be delayed until an appropriate contraceptive gel is registered and available in India.

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