By Alexandra Angel, Technical Advisor, Sexual & Reproductive Health, PSI
As COVID-19 disrupts access to essential healthcare across the globe, it is more important than ever to offer a wide range of voluntary family planning (FP) options including methods that a user can start, stop and fully control herself. Women who normally rely on a method that requires regular interaction with a provider may be most at risk of losing access to FP care during COVID-19. Experts predict a rise in demand for self-care during the pandemic due to stay-at-home orders, strain on health systems and fear of acquiring COVID-19 in healthcare settings.
Enter the Caya™ Diaphragm, a new self-care product available to Nigerien women as of June 2019 that offers contraception without having to see a provider in a healthcare facility. “I like the diaphragm because I can insert it and remove it myself,” explained one of the first women in Niger to use the new product.
Caya Diaphragm and the Appeal of Self-Care
The appeal of self-care is among several benefits of the Caya Diaphragm that have drawn more than 800 women in Niamey, the capital of Niger, to adopt the method over the past year. Through the USAID-funded Expanding Effective Contraceptive Options (EECO) project, WCG Cares and PSI have led a pilot introduction of the Caya™ Diaphragm and accompanying Caya Gel in Niger since June 2019. EECO offers the method as part of voluntary FP services in public facilities, private clinics and through community health workers (CHWs). Users say they appreciate that Caya is a user-controlled, reusable and non-hormonal method that causes no side effects and can be used on-demand.
“I had tried other methods before Caya…which I didn’t like…I heard about the diaphragm and decided to try it. I like that there aren’t any side effects at all! And it’s easy to use and easy to remove.” –Caya user in Niamey, Niger
A new program brief from the EECO project documents the initial lessons learned from Caya’s first introduction in Africa. The brief, Expanding Effective Contraceptive Options: Introducing the Caya Diaphragm in Niger, is available in English and French. Intended for use by those interested in adding Caya into a country’s contraceptive method mix, it is also useful for those exploring the introduction of any FP method into a new market. The brief includes a journey map to reflect the dynamic and diverse ways that clients in Niger move from awareness to advocacy of Caya.
The Caya Diaphragm’s Role in Niger’s FP Method Mix
As the COVID-19 pandemic unfolds, the Caya Diaphragm may come to play a unique role in the FP method mix. Here’s why:
- Caya can be obtained outside of crowded health centers. Due to lockdowns and the increased burden that COVID-19 places on healthcare systems, many women are unable or reluctant to visit healthcare centers. Fortunately, obtaining the Caya Diaphragm doesn’t require a visit. Unlike earlier diaphragm models, Caya is one-size-fits-most, therefore eliminating the need for a provider fitting. Through EECO’s pilot, women can access Caya through CHWs who visit their homes and/or communities.
- As a self-care method, women can continue, pause and stop use of Caya at any time, without the aid of a provider. Some FP methods require frequent visits to a provider for effective continued use. For example, injectables require reinjections from a provider every one to three months; long-acting reversible contraceptives, such as implants, necessitate a clinic visit when women want to stop using them. Caya, on the other hand, is reusable for two years (though the gel, which is necessary for use with Caya, may need to be replaced*) and a woman may pause or stop using it for any reason, whenever she wants and for as long as she wants, with no follow-up visit necessary.
- Caya can serve as an excellent back-up method. An unfortunate implication of COVID-19 is that many women’s usual contraceptive methods may become unobtainable during periods of lockdown or supply chain disruption. In these cases, Caya can act as a temporary back-up solution for some women in addition to its role as the primary method choice for other women. Because a woman can obtain and initiate use of Caya without a clinic visit, she can safely use it during times when a visit to the clinic is impossible or undesirable.
What’s Next For the Caya Diaphragm Rollout?
Over the next year, EECO will continue its Caya pilot introduction in urban Niger, expand into peri-urban areas, complete a mixed-methods user study and launch a pilot introduction in neighboring Benin. The project will monitor changes in Caya uptake during the COVID-19 pandemic, documenting if and how it fills gaps in the broader FP market. Even during this global period of great disruption, providing a woman with access to an FP method that delights and satisfies her remains at the core of EECO’s goals.
For any questions or inquiries regarding the EECO project’s introduction of Caya, please be in touch with Alexandra Angel (firstname.lastname@example.org).
*The Caya Diaphragm is used along with a small amount of gel, such as Caya Gel. At insertion, gel is applied to the rim of the diaphragm. While the Caya Diaphragm is reusable for up to two years, one tube of Caya Gel lasts for approximately 16 uses. In Niger, women commonly replace gel only every few months, citing infrequent sex as the reason gel is not replaced more frequently.