Is the diaphragm a viable option for women in Turkey?

Context: In Turkey where contraceptive prevalence is about 65%, a large num ber of couples rely on withdrawal and the IUD. Although the country has had a national family planning program for 35 years, the diaphragm has not bee n introduced as a contraceptive option. Methods: Diaphragms were offered to women as a contraceptive option during counseling sessions at four family planning clinic sites in western Turkey:two public-sector clinics (one in C apa, Istanbul, the other in Irmir) and two private-sector clinics tone in l ncirli, Istanbul, the other in Denizli). Women who chose the diaphragm were interviewed at enrollment and were invited for follow-up visits with a phy sician at two weeks and at any time thereafter Demographic information was also collected from an additional 740 women who chose another contraceptive method and focus-group discussions were conducted with diaphragm users and their partners, with users of other methods and with service providers. Re sults: Overall, 166 women selected the diaphragm, and 161 enrolled in the s tudy initial acceptance rates were higher at the two private clinics (14% a nd 6%) than at the public clinics (3% and 1%). At the public-sector clinics , diaphragm users were better educated and more likely to be professionally employed than were women who selected other contraceptive methods. In Capa , 42% of women who chose the diaphragm were university graduates, compared with 7% of those who chose another method. Despite differences between the two private clinics in clients' educational levels, no such differences exi sted between diaphragm accepters and users of alternative methods at each s ite. Among women who chose the diaphragm, 47% said they had sex four times or more per week compared with 29% of those using another contraceptive. Mo re than half of the women who selected the diaphragm (59%) cited safety and freedom from side effects as the reason for their choice of contraceptive. A similar percentage of clients who used other methods (58%) cited effecti veness. Fifty percent of diaphragm users had discontinued by six months, an d 66% had done so by 12 months. Conclusion: A small proportion of clients i n both private- and public-sector clinics were interested in using the diap hragm and found it acceptable. In less-developed countries the diaphragm ma y be a viable contraceptive option when providers are able to provide adequ ate information and support.