P132 The Cervical Cap: An Under-Researched, Under-Utilized Technology to Improve Women's Reproductive Health

Wednesday, March 10, 2010
Pre-Function Lobby & Grand Ballroom D2/E (M4) (Omni Hotel)
Erica Gollub, DrPH1, Jessy Devieux, PhD2, Valerie Pelletier, MD1 and Robert Malow, PhD3, 1Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, 2AIDS Prevention Program, Florida International University, Miami, FL, 3Public Health, Florida International University, Miami, FL

Background: Female-controlled barrier methods for STI prevention and contraception have been enthusiastically endorsed by many populations of women globally.  Like the contraceptive diaphragm, the cervical cap covers the cervix, but the conical shape, and adherence via gentle suction, render it theoretically more protective.

Objectives: To review evidence on the cervical cap, as a tool for improved reproductive health.  Varied applications include:  contraception, disease prevention, fertility-enhancement, microbicide delivery.

Methods: We will review two lines of evidence: (1) literature review, and (2) our team’s experience among various populations at high HIV/STI risk (drug users, immigrants, Haitian-Americans, HIV + women).

Results: Acceptability has been high in worldwide trials of various diaphragms.  Trials of the cap are far more limited, despite distinct differences (discreet and extended wear, softness and esthetic appeal, high portability).  Contraceptive trials of varied cervical caps have resulted in positive user experiences and acceptable effectiveness.  Overall, participants consider diaphragms and caps to be safe, and relatively easy to learn with quality counseling. But awareness of the cervical cap is low, and provider bias against the method is strong.   In one prior study, 10% of street-recruited, drug-using women in a behavioral intervention trial requested cervical cap appointments at a neighborhood FP clinic.  Qualitative evidence from HIV+ women in a short-term study indicated high method acceptability and an interest in dual use applications.  Recent data will be presented from Haitian-American women’s responses to the cap for contraception and disease-reduction.

Conclusions: The cervical cap is an age-old device with significant contemporary public health applications that are not being realized. The device has been both understudied and underpromoted to groups at high risk of both unintended pregnancy and STI.  

Implications for Programs, Policy, and/or Research: Findings call for enhanced provider and user training, as well as scaled-up research on disease reduction applications for this device.

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