Assessing the acceptability, service delivery requirements, and use-effectiveness of the diaphragm in Colombia, Philippines, and Turkey

The diaphragm is not available in many countries, despite the recommendatio ns of numerous authors that it has important advantages as a woman-controll ed method that offers some protection against sexually transmitted diseases , and one that is safe and free of side effects. An interagency tram collab orated to introduce the diaphragm in Colombia, the Philippines, and Turkey, using the same protocol to assess the acceptability, service delivery requ irements and use-effectiveness of the method. Eighteen public and private s ector service delivery sites were involved and a total of 550 women were en rolled in the study. Provider training aimed to improve the quality of care with which all methods were delivered and included counseling about sexual ity and reproductive health risks. The cumulative 12-month pregnancy rare o f 10.1 (SE 1.7) per 100 woman-years is on the low End of previous studies o f the diaphragm, and the 12-month continuation rate (57.2 [SE 2.4] per 101) compares favorably with that for oral contraceptives and the intrauterine device. Focus group discussions conducted with clients and providers indica ted that the method was an important alternative for some women, particular ly those who had experienced health problems with other methods or were una ble to negotiate condom use with their partners. Provider biases diminished as they observed the strategic niche that the diaphragm filled for their c lients. While providing the diaphragm requires training and good client-pro vider interaction, the requirements are consistent with those called for in the Programme of Action of the international Conference on Population and Development (ICPD, 1994). With proper attention to quality of care, the dia phragm can be successfully offered in resource-poor settings. (C) 2001 Else vier Science Inc. All rights reserved.