Do Women Find the Progesterone Vaginal Ring Acceptable? Findings from Kenya, Nigeria, and Senegal

RamaRao, Saumya; Obare, Francis; Ishaku, Salisu Mohammed; Mane, Babacar; Clark, Heather; Liambila, Wilson; Unumeri, Godwin; Birungi, Harriet; Diop, Nafissatou; Rajamani, Deepa; Townsend, John

doi:10.1111/sifp.12046

Cited by 18 publications

(53 citation statements)

References 20 publications

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“…Across studies, a smaller proportion of women reported ‘liking’ the VR (52.9 to 62.6%) [58, 79], with a higher proportion of users ‘liking’ the VR with increased duration of use [58, 75]. In observational studies, ‘satisfaction’ was mostly high, with most studies reporting satisfaction greater than 90% [29, 36, 70]. In one observational study, satisfaction was higher among women who completed at least two cycles of use compared to those who discontinued [70].…”

Section: Resultsmentioning

confidence: 99%

“…In observational studies, ‘satisfaction’ was mostly high, with most studies reporting satisfaction greater than 90% [29, 36, 70]. In one observational study, satisfaction was higher among women who completed at least two cycles of use compared to those who discontinued [70]. Five contraceptive observational studies in the past decade reported that 92 to 100% of users would recommend the VR or found it acceptable [29, 36, 38, 42, 70], whereas a smaller proportion of women recommended VRs in studies from the 1980s [77, 80].…”

Section: Resultsmentioning

confidence: 99%

“…In one observational study, satisfaction was higher among women who completed at least two cycles of use compared to those who discontinued [70]. Five contraceptive observational studies in the past decade reported that 92 to 100% of users would recommend the VR or found it acceptable [29, 36, 38, 42, 70], whereas a smaller proportion of women recommended VRs in studies from the 1980s [77, 80]. VR acceptability findings were supported by conference proceedings [35, 43].…”

Section: Resultsmentioning

confidence: 99%

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Vaginal ring acceptability and related preferences among women in low- and middle-income countries: A systematic review and narrative synthesis

et al. 2019

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The vaginal ring (VR) is a female-initiated drug-delivery platform used for different indications, including HIV pre-exposure prophylaxis (PrEP). We conducted a systematic review of VR acceptability, values and preferences among women in low- and middle-income countries (LMIC) to inform further investment and/or guidance on VR use for HIV prevention. Following PRISMA guidelines, we used structured methods to search, screen, and extract data from randomized controlled trials (RCTs) and observational studies reporting quantitative outcomes of acceptability of the VR for any indication published 1/1970-2/2019 (PROSPERO: CRD42019122220). Of 1,110 records identified, 68 met inclusion criteria. Studies included women 15–50+ years from 25 LMIC for indications including HIV prevention, contraception, abnormal bleeding, and menopause. Overall VR acceptability was high (71–98% across RCTs; 62–100% across observational studies), with 80–100% continuation rates in RCTs and favorable ease of insertion (greater than 85%) and removal 89–99%). Users reported concerns about the VR getting lost in the body (8–43%), although actual expulsions and adverse events were generally infrequent. Most women disclosed use to partners, with some worrying about partner anger/violence. The VR was not felt during intercourse by 70–92% of users and 48–97% of partners. Acceptability improved over time both within studies (as women gained VR experience and worries diminished), and over chronological time (as the device was popularized). Women expressed preferences for accessible, long-acting, partner-approved methods that prevent both HIV and pregnancy, can be used without partner knowledge, and have no impact on sex and few side effects. This review was limited by a lack of standardization of acceptability measures and study heterogeneity. This systematic review suggests that most LMIC women users have a positive view of the VR that increases with familiarity of use; and, that many would consider the VR an acceptable future delivery device for HIV prevention or other indications.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Vaginal ring acceptability and related preferences among women in low- and middle-income countries: A systematic review and narrative synthesis

et al. 2019

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“…These may be more appropriate FP methods to women who are experiencing sexual violence but cannot live separately from abusive husbands. Similarly, female condoms and progesterone vaginal ring(PVR) can also enhance women’s control over their fertility [42]. However, availability and use of female condoms and PVR is very limited in Nepal [35] and needs to be promoted in future.…”

Section: Discussionmentioning

confidence: 99%

Sexual violence as a predictor of unintended pregnancy among married young women: evidence from the 2016 Nepal demographic and health survey

Acharya¹,

Paudel

Silwal

2019

BMC Pregnancy Childbirth

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Background Sexual violence in marital relationship is higher among women married at young age. Although sexual violence has been found to increase risk for unintended pregnancy, there is a limited published data from Nepal linking sexual violence with unintended pregnancy. The current study aimed to investigate association of partner sexual violence with unintended pregnancy among young married women who experienced child birth in last 5 years. Methods Using data from Nepal Demographic and Health Survey, we studied the prevalence of sexual violence and unintended pregnancy, and their association among 560 married women (weighted sample) of 15–24 years who gave childbirth in last 5 years of the survey. We used multivariate logistic regression to analyse the association of sexual violence and other factors with unintended pregnancy. Analysis was conducted considering inverse probability weighting, clustering, and stratification to provide unbiased estimates of the population parameters. Results Nearly a quarter of women (22.7%) reported to have experienced unintended pregnancy in the last 5 years of the survey and almost one in 10 women (9%) reported to have ever experienced sexual violence from their husbands. Women who ever experienced sexual violence from their husbands were at 2.3 times higher odds to report an unintended pregnancy (aOR = 2.3; 95% CI = 1.1–4.8) compared to women who did not experience sexual violence from their husbands independent of important socio-demographic variables and ever use of contraception. Conclusion The strong association of sexual violence within marital relationship with unintended pregnancy among young women in Nepal necessitates the provision of comprehensive sexual and reproductive health services. Women need routine assessment, and referral to appropriate services for sexual violence to reduce unintended pregnancy and its consequences.

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“…Both quantitative and qualitative data were collected and the results of the quantitative data analysis have been published. 10 , 11 In the quantitative study, a total of 247 women were screened across all country sites. Of these, 76% (n=189) met the eligibility criteria and provided informed consent to participate in the study.…”

Section: Introductionmentioning

confidence: 99%

<p>Choosing and Using the Progesterone Vaginal Ring: Women’s Lived Experiences in Three African Cities</p>

Undie¹,

RamaRao²,

Mbow³

2020

PPA

Self Cite

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This study explored experiences of selecting and utilizing a newly introduced contraceptive-the progesterone vaginal ring (PVR)-among women seeking a contraceptive method in 3 African capital cities (Abuja, Nairobi, and Senegal). The study explored women's perceptions of, and lived experiences with, using the new product to better understand their reception of a new contraceptive. This understanding will help inform the design of programs to support women in their adoption and continued use of the PVR and other new contraceptives. Patients and Methods: This longitudinal, qualitative study drew on an interpretive phenomenological approach, involving multiple in-depth interviews (IDIs) with 9 study participants over a 6-month period. Participants involved in the study were postpartum women seeking contraceptive services at participating clinics. A total of 25 IDIs were conducted, and a detailed "within-case" and "cross-case" analysis of participants' accounts was carried out to identify similar and dissimilar themes along descriptive, linguistic, and conceptual lines. Results: Four overarching themes emerged from the analysis. These themes circulated around the unconventionality of the PVR, which heightened its desirability among participants; the sense of comfort that women gained from opting to use the PVR over other FP methods; narratives of consideration that centered on women's partners, and that were important for ensuring the sustainability of women's PVR use; and the conundrums that women grappled with as they prepared to disengage from the PVR after two cycles of use. Conclusion: The PVR is an acceptable contraceptive method to postpartum women in urban African settings. However, prior to its introduction into new country contexts, formative data on women's perceptions of, and reactions to, the product need to inform country preparation processes. Such information would be useful for tailoring counseling around this contraceptive, as well as for product marketing and robust uptake of the method.

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Do Women Find the Progesterone Vaginal Ring Acceptable? Findings from Kenya, Nigeria, and Senegal

Cited by 18 publications

References 20 publications

Vaginal ring acceptability and related preferences among women in low- and middle-income countries: A systematic review and narrative synthesis

Vaginal ring acceptability and related preferences among women in low- and middle-income countries: A systematic review and narrative synthesis

Sexual violence as a predictor of unintended pregnancy among married young women: evidence from the 2016 Nepal demographic and health survey

<p>Choosing and Using the Progesterone Vaginal Ring: Women’s Lived Experiences in Three African Cities</p>

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