Making Diaphragms Cool Again: Bringing an Old Method to a New Audience

By Alexandra Angel, Technical Advisor, SRH, PSI

There is no single, perfect contraceptive method for all. Contraceptive users have preferences and needs that are varied, unique and personal. Access to a range of options, however, has been shown to increase overall contraceptive use by ensuring that each person is able to find a method that works best for them.

Niger, a country in francophone West Africa, has the highest fertility rate in the world; on average, Nigerien women give birth seven times. Existing contraceptive options haven’t gained traction in Niger due to both low consumer interest and health system constraints. For some women, there may not yet be an available method that suits their lifestyle and preferences. Enter the Caya diaphragm. Research, led by Catalyst Global (formerly WCG Cares) and Population Services International (PSI) with funding from USAID, suggests that Caya, a single-size, reusable diaphragm, is a compelling option for women dissatisfied with available method options.

In 2019, the USAID-funded Expanding Effective Contraceptive Options (EECO) project piloted the Caya diaphragm in Niger, a country with a low modern contraceptive prevalence rate and high opposition to Family Planning (FP). While diaphragms have been around globally, since – oh, since our grandmothers were using contraception! – the Caya diaphragm offers innovative new features that make it easier and more comfortable to use. It comes in just one size, fitting most women; this eliminates the need to visit a provider to be fitted for the correct size (as is necessary for other diaphragm models). Might Caya be an attractive option in a context like Niger? Based on our research, we think so.

EECO’s study, published earlier this year by Global Health Science and Practice, details the acceptability and continued use of Caya in Niamey, Niger. Spoiler: Caya was well-received by users, potential male partners, and providers! While the method isn’t for everyone – we know such a thing doesn’t exist! – Caya is a good fit for those looking for a method that they control, use only on-demand, and that is free from hormones.

While our research was conducted in just Niger (though a similar study is also underway in Benin), some lessons are more broadly applicable.  Here’s what you should know:

  • Women and men said that Caya was an attractive method to them because it offered a combination of benefits not otherwise available to them. Because it is non-hormonal, Caya causes no side effects for most users. It also works on demand and is reusable for up to two years.
  • Most participants who adopted Caya during our study were continuing to use Caya when surveyed six months later! The most common reason for discontinuation was desire for pregnancy.
  • Community health workers and providers successfully added Caya to their offering and they found this self-care method was of interest to many clients and a valuable addition to the contraceptive mix.
  • In settings where health resources are stretched, where FP use is low, and where opposition to modern methods (especially hormonal ones) remains high, Caya can fill an important gap in the contraceptive method mix.

Caya isn’t expected to suddenly become the most commonly used contraceptive method in Niger, but that’s not the goal. Instead, we hope that Caya can be an exciting option for women who wish to prevent pregnancy but aren’t finding a method that satisfies their needs and preferences among the previously available options.

Resources Referenced in this Article:

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