Most vaginally inserted methods have limited availability and use despite offering characteristics that align with many women's stated preferences (e.g., nonhormonal and/or on demand). The objective of this review was to identify enablers and barriers to women's adoption and continuation of vaginally inserted contraceptive methods in low- and middle-income countries (LMICs). We searched three databases (PubMed, Embase, and Web of Science) and 18 websites using keywords related to five vaginally inserted contraceptive methods (diaphragm, vaginal ring, female condom, copper intrauterine device [IUD], hormonal IUD) and terms associated with their adoption and continuation. Searches were limited to resources published between January 2010 and September 2020. Studies eligible for inclusion in our review presented results on women's use and perspectives on the enablers and barriers to adoption and continuation of the vaginally inserted contraceptive methods of interest in LMICs. Relevant studies among women's partners were also included, but not those of providers or other stakeholders. Data were coded, analyzed, and disaggregated according to a framework grounded in family planning (FP) literature and behavioral theories common to FP research and program implementation. Our initial search yielded 13,848 results, with 182 studies ultimately included in the analysis. Across methods, we found common enablers for method adoption, including quality contraceptive counseling as well as alignment between a woman's preferences and a method's duration of use and side effect profile. Common barriers included a lack of familiarity with the methods and product cost. Notably, vaginal insertion was not a major barrier to adoption in the literature reviewed. Vaginally inserted methods of contraception have the potential to fill a gap in method offerings and expand choice. Programmatic actions should address key barriers and enable voluntary use.

中文翻译：

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影响女性采用和继续阴道插入避孕方法的障碍和促成因素：文献综述

尽管提供符合许多女性声明的偏好（例如，非激素和/或按需）的特征，但大多数阴道插入方法的可用性和使用有限。本综述的目的是确定低收入和中等收入国家 (LMIC) 女性采用和继续使用阴道插入避孕方法的促成因素和障碍。我们搜索了三个数据库（PubMed、Embase 和 Web of Science）和 18 个网站，使用与五种阴道插入避孕方法（隔膜、阴道环、女用避孕套、铜宫内节育器 [IUD]、激素 IUD）相关的关键字和与其相关的术语采用和延续。搜索仅限于 2010 年 1 月至 2020 年 9 月期间发布的资源。符合纳入我们审查条件的研究提供了关于女性 对 LMIC 中感兴趣的阴道插入避孕方法的采用和继续使用的促成因素和障碍的使用和观点。还包括女性合作伙伴的相关研究，但不包括提供者或其他利益相关者的研究。根据以计划生育 (FP) 文献和计划生育研究和项目实施常见的行为理论为基础的框架对数据进行编码、分析和分类。我们最初的搜索产生了 13,848 个结果，其中 182 项研究最终被纳入分析。在各种方法中，我们发现了方法采用的共同推动因素，包括优质的避孕咨询以及女性偏好与方法的使用持续时间和副作用特征之间的一致性。常见的障碍包括不熟悉方法和产品成本。尤其，在所审查的文献中，阴道插入并不是采用的主要障碍。阴道插入的避孕方法有可能填补方法产品的空白并扩大选择。计划行动应解决关键障碍并实现自愿使用。