High acceptability of a contraceptive vaginal ring among women in Kigali, Rwanda

Abstract

Background: Introduction of contraceptive vaginal rings (CVRs) could expand the contraceptive method mix reducing the unmet need for family planning in Rwanda, but data on acceptability of CVRs from low and middle-income countries are lacking.

Methods: This study explores acceptability of contraceptive vaginal ring (NuvaRing) use in Kigali, Rwanda using a mixed methods approach. We collected quantitative and qualitative data before, during and after conducting a clinical trial, using Case Report Forms, Interviewer Administered Questionnaires, In Depth Interviews and Focus Group Discussions. We analyzed the data using an existing theoretical framework including product attributes, relationship attributes and sexual encounter attributes as well as the contextual environment.

Results: Our data showed that initial worries reduced over time with actual ring use and ring insertions and removals were described as easy. Most women did not feel the ring during daily activities, appreciated the lack of perceived negative side effects and the increased lubrication. Relationship attributes and sexual encounter attributes such as sexual comfort played a significant role in ring acceptability of the participants and their partners. The contextual environment including Rwandan cultural norms around sexuality positively influenced the acceptance of the NuvaRing. Overall satisfaction was high.

Conclusions: Acceptability of the Nuvaring was high among study participants and represents a promising option that could contribute to lowering the unmet need for family planning in Rwanda.

Fig 1. Flow chart of the study process detailing screen failure rates.

The study screen flow is presented detailing screen failure rates.

Fig 2. Flow chart of quantitative and qualitative data collection in the Ring Plus study.

Quantitative and qualitative data collected before, during and after study end are presented.

Fig 3. Theoretical framework used for data collection and analysis as adapted from Van der Straten et al [38] and Merkatz et al [40].

The framework proposed by van der Straten et al [35] was used for data collection and analysis; elements of the NES/EE CVR acceptability model by Merkatz et al [37] such as side effect and bodily changes were added.