2011 International Conference on Family Planning
29 November–2 December 2011
"Better semi long-acting methods: Acceptability of new contraceptives in development"
Ruth B. Merkatz
An integral component of developing safe and effective contraceptive methods includes measurements of user acceptability. To that end, we conducted acceptability studies with several novel methods including a long acting hormonal contraceptive vaginal ring (CVR) that contains Nestorone® (NES) a new non androgenic progestin, and ethinyl estradiol (EE). Results of that study have served to clarify issues that can affect user acceptance of novel methods, e.g. ease of use, effects on sexual activity, perceived side effects and specifically for CVRs, issues related to ring expulsions.
A questionnaire was developed to evaluate the concept of acceptability among > 1000 women from 13 sites included in the Phase 3 trial of the NES/EE CVR. In eight of the 13 sites, subjects were randomized to respond to questions either in a face to face (FTF) interview or by an audio computerized assisted interview (ACASI).
Findings from the NES/EE CVR acceptability study revealed the vast majority of women found that the CVR was easy to use and did not detract from their sexual activity. Women who reported a higher incidence of feeling the ring, removing the ring (including for sexual activity) as well as being younger in age and having higher gravidity had a significantly increased likelihood of becoming pregnant. There were significant differences in responses to sensitive questions based on interview mode (FTF vs. ACASI).
Acceptability data demonstrated that women who remove the CVR frequently or experience difficulties related to expulsions require clear guidance and counseling on proper use and/or may not be suitable users for vaginal rings. These results are being used to evaluate other novel methods in development. They are also being used to gain insight into user acceptability of vaginal rings in settings such as India where the Population Council is partnering with the Indian Council of Medical Research to evaluate the safety and efficacy of the Progesterone Vaginal Ring (PVR) to improve birth spacing in breastfeeding women. Such studies may be especially important for successful introduction of vaginal rings in developing nations, including in SSA and Asia where use of long term user-controlled CVRs may reduce costs, and improve access and wider distribution of new safe and effective contraceptives.
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