Use of self home-made diaphragm for protection against pregnancy and sexually-transmitted infections: case report | ICRH

Authors and affiliation: 

A. Schroth (ICRH-Kenya), S. Luchters (ICRH-Kenya), M.F. Chersich (ICRH-Kenya) and I. Jao (ICRH-Kenya)M. Temmerman (ICRH-Ghent)

Ranking: 

A1

PubMedID: 

PMID: 17633583

Published: 

East Afr Med J. 2007 Jan; 84(1):35-7.

Publication Date: 

01/01/2007

Background: About 40% of Kenyan women of reproductive age are currently using contraception. However, the existing contraceptive method mix does not fully address the needs of women, many of whom have an unmet need for family planning and for protection against HIV and other sexually transmitted infections (STI). Although both male and female condoms provide dual protection against pregnancy and STI, they require male co-operation, and acceptability and uptake of these methods remains poor. In response to these concerns, research initiatives have increasingly focused on female controlled methods that may be used without male knowledge and/or co-operation, such as vaginal microbicides and cervical barriers including the diaphragm. Case Report: The woman, a participant in a study investigating diaphragm acceptability among women in Mombasa, Kenya, completed nine years of school, is divorced, and has had three first-trimester miscarriages and four live births. She earns about 80US$ per month from baking and selling foodstuffs and, following her divorce, as a female sex worker. She developed a home-made diaphragm in response to a number of factors: she feared she may acquire an STI as several of her friends had; negotiating condom use was often unsuccessful; and no alternatives were available for simultaneous protection against STI and pregnancy. Discussion: Physical barriers covering the cervix have been used for centuries to prevent pregnancy. Ancient texts document use of lemon halves, beeswax plugs and crocodile-dung. Mass production of the diaphragm began more than a hundred years ago and by the 1940s, it was the most commonly used contraceptive method in several countries. With development of more effective and coitus-independent contraception, diaphragm use decreased markedly and, at present, is not included in the contraceptive method mix in many countries. In these settings, little is known about use of homemade diaphragms. Conclusions: This case report further demonstrates that women have an unmet need for dual protection against pregnancy and STI, and benefit from female controlled methods. Though an isolated report, it adds to existing evidence that the diaphragm is potentially an invaluable technology for women, protecting against unintended pregnancy and possibly against STI. Inclusion of the diaphragm in the contraceptive method mix should be reconsidered, particularly if ongoing studies demonstrate the diaphragm to be effective in reducing acquisition of HIV and other STI. This would assist women in high-HIV burden areas to protect themselves against HIV and other STI, although existing cultural beliefs have to be considered during promotion of the diaphragm and similar devices.