Bill & Melinda Gates Foundation

Barriers Are Back: Female Barrier Methods, That Is

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March 06, 2013

Female contraceptive barrier methods are back.

In the wake of the London Family Planning Summit and other initiatives, methods like diaphragms and female condoms are again being discussed by policymakers and family planning (FP) providers as valuable methods. Why? Because they expand women’s options for nonhormonal contraception.

These methods are a physical “barrier” between the cervix and sperm. Inserted into the vagina, diaphragms are soft cup-like devices that cover the cervix, and female condoms are thin sheaths that line the vagina. They both provide effective protection from unintended pregnancy. In addition to helping prevent pregnancy, female condoms protect from sexually transmitted infections (STIs), including HIV. Like all barrier methods, diaphragms and female condoms are effective only when used.   

Diaphragms and female condoms have many benefits. They provide safe, effective protection from unintended pregnancy, with few—if any—side effects. Almost all women can use these methods. As user-initiated methods, women use them only when needed, making them a good choice for women who have infrequent sex.

Here are three reasons why these methods are getting a fresh look.

Promising potential to reduce unmet need

Millions of women in developing countries want to avoid a pregnancy but aren’t using a modern method. Lack of access to information and services is a major hurdle, but so are method-related concerns. According to the Guttmacher Institute, 7 in 10 women with unmet need in sub-Saharan Africa, South Central Asia, and Southeast Asia give reasons for not using contraception that could be addressed by a more appropriate method. The two reasons most frequently cited? Side effects and infrequent sex. Female barrier methods can help women address both of these concerns.

Importance for women living with and at risk of HIV

Ongoing discussions about the potential link between hormonal contraceptives and HIV risk underscore the importance of expanding the contraceptive mix to include nonhormonal methods. Women agree. During a recent consultation on hormonal contraception and HIV conducted by the Athena Network and a consortium of partners, hundreds of grassroots women called out for a wider method mix—one that includes greater access to female condoms. Female condoms are a crucial choice for women at risk of HIV, and they are vital to the health and well-being of women living with HIV. They can be used to reduce HIV-positive women’s chances of STI infection, reexposure to HIV, and transmission of HIV or other STIs to partners.


New technologies are being introduced

Innovations in female contraceptive barrier technology will help expand protection options for women. Two products being introduced are the SILCS Diaphragm and the Woman’s Condom. Both were developed through a user-centered design process led by PATH, a nonprofit global health organization, and research colleagues in multiple countries. The SILCS Diaphragm is a single-size, contoured diaphragm that addresses issues that have limited diaphragm use. This new single-size device should be easy to provide because no pelvic exam is required to determine the appropriate diaphragm size. Special features make it easy to insert and remove. The Woman’s Condom is a new female condom that is designed for improved acceptability and ease of use. Both products are poised to fill gaps in the unmet need for family planning, especially in developing countries where women lack access to nonhormonal barrier methods.

Making their comeback

Female barrier methods are not the right choice for every woman, but they are a good option for some. These methods are appropriate for women seeking nonhormonal, user-initiated protection from unintended pregnancy.  While diaphragms do not offer as much protection from STIs as female condoms, evidence suggests they protect from some STIs, especially cervical infections. Female condoms provide dual protection, similar to male condoms. Demand for female condoms is growing, especially as women learn about this method and health care providers become comfortable counseling about them. Over the past ten years, international shipments of female condoms to developing countries have increased markedly. In just the last quarter of 2012, Zimbabwe and Malawi each ordered more than one million female condoms.

In spite of this growing momentum, we still have significant work ahead to ensure that women and health care providers have the information, skills, and supplies to expand access to these new methods. Awareness about these methods is generally low. Diaphragms have not been promoted in recent decades and are no longer included in developing-country FP programs, and female condoms have not been well integrated into family planning or HIV/AIDS programs in developing countries.

So for the sake of women’s choices and lives, let’s continue working together to make sure the female barrier comeback is not just rhetoric but reality. 

 

 
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