What do women, their spouses and community think about the Progesterone Vaginal Ring?
ESC Congress Library. RamaRao S. May 10, 2018; 208123; ESC152 Disclosure(s): None
Dr. Saumya RamaRao
Dr. Saumya RamaRao
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Abstract
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Objective: The Progesterone Vaginal Ring (PVR) is a contraceptive that breastfeeding women can use in the first year postpartum.  It contains natural progesterone and works by reinforcing the inhibitory effects of breastfeeding on ovulation.  Each ring is used for 3 months after which it is replaced by a new ring thus providing up to 12 months of protection.  Contraceptive vaginal rings are not marketed in Africa and the interest of potential users in these markets is unknown.  We conducted an acceptability study of the PVR to determine if women and their partners and their communities would be interested in this novel contraceptive if it were to be made available.  Design and methods: 189 postpartum women attending public sector health facilities in Kenya, Nigeria and Senegal for family planning, postpartum care, or infant health services participated in the study after screening and informed consent.  All women were counseled on the PVR and its use by trained family planning providers.  All women were to use the PVR for two cycles or up to 6 months of use.   We followed 11 women at months 1, 3 and 6 and collected information on their use experience through in-depth interviews; interviewed those husbands who were willing to be interviewed, and collected information from community influentials through 8 focus group discussions across the countries.   Results: Women the PVR comfortable to use and easy to insert and remove.  The degree of confidence and facility with the ring increases they become more accustomed to it.  Early on, one woman reported feeling the ring slipping but learnt to insert it properly indicating the importance of counseling at initiation.  Initially husbands were apprehension about a vaginal contraceptive and especially if they might feel during sex but these dissipated as well.  Both wives and husbands did not report any change in sexual frequency or enjoyment.  Key opinion leaders were interested and thought the PVR would be suitable for their communities because it relied on breastfeeding to increase the method's effectiveness.  The idea of improving infant health and survival through breastfeeding and birth spacing resonated with them.  Since no women who had discontinued using the PVR was willing to be interviewed, we are limited in our understanding of the drivers behind their decision.  Conclusion: Even in vaginal ring naïve countries, women can use the PVR well, husbands are supportive, and communities engaged.  This innovative method has potential to expand contraceptive choice in many developing countries and address unmet need. 
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