PubMed · 3240157
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J Richters, B Donovan. 1988. Barrier methods. Contraception and STD prophylaxis.. https://pubmed.ncbi.nlm.nih.gov/3240157/
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Contraceptive prevalence has been central to family planning research over the past few decades, but researchers have given surprisingly little consideration to method mix, a proxy for method availability or choice. There is no 'ideal' method mix recognized by the international community; however, there may be reason for concern when one or two methods predominate in a given country. In this article method skew is operationally defined as a single method constituting 50% or more of contraceptive use in a given country. Of 96 countries examined in this analysis, 34 have this type of skewed method mix. These 34 countries cluster in three groups: (1) sixteen countries in which traditional methods dominate, most of which are in sub-Saharan Africa; (2) four countries in which female sterilization predominates (India, Brazil, Dominican Republic and Panama); and (3) fourteen countries that rely on a single reversible method (the pill in Algeria, Kuwait, Liberia, Morocco, Sudan and Zimbabwe; the IUD in Cuba, Egypt, Kazakhstan, Kyrgyz Republic, Moldova, Turkmenistan and Uzbekistan; and the injectable in Malawi). A review of available literature on method choice in these countries provides substantial insight into the different patterns of method skew. Method skew in some countries reflects cultural preferences or social norms. Yet it becomes problematic if it stems from restrictive population policies, lack of access to a broad range of methods, or provider bias.
OBJECTIVES: FemCap is a silicone-rubber barrier contraceptive approved for marketing in the United States. To address reported problems with removal and dislodgment, the device's developer added a strap to the device and increased the height of the brim. This trial assessed whether the new design reduced removal difficulties and had any effects on dislodgment, genital pain/discomfort, safety, and acceptability. METHODS: Women used the strapped device for 8 weeks with follow-up visits at 2 and 8 weeks. Outcome measures were obtained through diary cards, questionnaires, and naked eye examination. Data from these 120 women were compared with data from 419 women who used the unstrapped FemCap in a previous contraceptive effectiveness study. RESULTS: The strapped device was not significantly easier for users to remove than the unstrapped device. Similar odds of dislodgment and cervical/vaginal irritation were seen with the two devices. Both female and male participants were significantly more likely to report pain/discomfort with use of the strapped device. Female users of the strapped device were significantly more likely to say they disliked their device. In six weeks, two pregnancies were observed, but pregnancy was not an endpoint in the study and no conclusions should be drawn regarding pregnancy rates. CONCLUSIONS: The modifications to the FemCap did not significantly improve the ease of device removal and appears to have resulted in significantly more female and male partner pain/discomfort and decreased acceptability, compared with the unstrapped device.
OBJECTIVE: To compare by electron microscopy the surface of vaginal contraceptive rings before and after use. METHODS: A single ring was worn for 28 days by a volunteer with normal vaginal flora. This worn ring was then cut in half, with one half placed directly into fixative and the other half rinsed to remove visible mucus prior to being placed into the fixative. Another ring was taken directly from the package and placed in fixative. The surfaces of the three ring samples were studied by scanning electron microscopy at varying magnifications to ascertain if there was penetration of bacteria into the vinyl polymer or if the ring surface was altered with 1 month of use. RESULTS: The ring half placed directly into fixative with visible mucus had cellular debris on its surface but no evidence of material penetration. The other half of the ring worn for 28 days and rinsed before fixation had a similar surface appearance to the unused ring. CONCLUSIONS: The surface of the ethylene vinyl acetate contraceptive vaginal ring is remarkably uniform and after 1 month of use was without visible evidence of erosion, embedded bacteria or structural changes compared to an unused ring.