Is the diaphragm a viable option for women in Turkey?

Context: In Turkey where contraceptive prevalence is about 65%, a large number of couples rely on withdrawal and the IUD. Although the country has had a national family planning program for 35 years, the diaphragm has not been introduced as a contraceptive option. Methods: Diaphragms were offered to women as a contraceptive option during counseling sessions at four family planning clinic sites in western Turkey:two public-sector clinics (one in Capa, Istanbul, the other in Irmir) and two private-sector clinics tone in lncirli, Istanbul, the other in Denizli). Women who chose the diaphragm were interviewed at enrollment and were invited for follow-up visits with a physician at two weeks and at any time thereafter Demographic information was also collected from an additional 740 women who chose another contraceptive method and focus-group discussions were conducted with diaphragm users and their partners, with users of other methods and with service providers. Results: Overall, 166 women selected the diaphragm, and 161 enrolled in the study initial acceptance rates were higher at the two private clinics (14% and 6%) than at the public clinics (3% and 1%). At the public-sector clinics, diaphragm users were better educated and more likely to be professionally employed than were women who selected other contraceptive methods. In Capa, 42% of women who chose the diaphragm were university graduates, compared with 7% of those who chose another method. Despite differences between the two private clinics in clients' educational levels, no such differences existed between diaphragm accepters and users of alternative methods at each site. Among women who chose the diaphragm, 47% said they had sex four times or more per week compared with 29% of those using another contraceptive. More than half of the women who selected the diaphragm (59%) cited safety and freedom from side effects as the reason for their choice of contraceptive. A similar percentage of clients who used other methods (58%) cited effectiveness. Fifty percent of diaphragm users had discontinued by six months, and 66% had done so by 12 months. Conclusion: A small proportion of clients in both private- and public-sector clinics were interested in using the diaphragm and found it acceptable. In less-developed countries the diaphragm may be a viable contraceptive option when providers are able to provide adequate information and support.