Diaphragm method contraceptors: implications for service organization and delivery.

Despite dissemination of modern contraceptive techniques among college women, unplanned pregnancy and pregnancy termination rates remain a major health issue. An investigation of 495 college women who use the diaphragm method of contraception was conducted in order to estimate pregnancy occurrence, to better understand factors related to successful use, and to profile service utilization patterns. Data were collected by medical record audit and client survey. Fifteen percent of the diaphragm clients reported a diaphragm-related pregnancy; clinical effectiveness was estimated to be 88% with a rate of 9.75 pregnancies per 100 woman years of diaphragm use. A variety of demographic, personal history, and behavioral variables were found to be related to three dependent variables: pregnancy, consistent diaphragm use, and accurate diaphragm use. Review of clinic service utilization for this group of patients demonstrated considerable resource use, including frequent switching of prescription contraception methods. Considering all pregnancies, diaphragm related or not, 27% of the study subjects reported at least one unplanned pregnancy. Abortion was elected in 98% of these cases. There is general agreement about the need to focus on education, information, and service measures to reduce the incidence of unintended fertility. Many universities have family planning services available, yet unsuccessful outcome continues to be a concern. Specific and practical protocols for service implementation need clearer definition. Thus, the implications of this research for the content and organization of clinic services are discussed with reference to counseling and education and other systems strategies.