Developing acceptable contraceptive methods: Mixed-method findings on preferred method characteristics from Burkina Faso and Uganda

Abstract

Background: Unmet need remains high in developing regions. New contraceptive technologies may improve uptake and use. This study examines desirable product characteristics. Methods: We added a module to the female questionnaire of the PMA2020 surveys in Burkina Faso and Uganda and conducted 50 focus group discussions (FGDs) with women, 10 FGDs with men, and 37 in-depth interviews (IDIs) with providers across the two countries. FGDs with women and IDIs with providers included a semi-structured ranking exercise on pre-selected product characteristics. Results: Effectiveness, duration, few side effects, cost, and access were the characteristics most commonly reported as important in choosing a method by survey respondents across both countries. Half or more of women surveyed in each country would like a method that lasts at least one year, while 65% in Burkina Faso and 40% in Uganda said they would use a method causing amenorrhea. Qualitative findings show that women want methods with minimal and predictable side effects. Reactions to increased bleeding were negative, especially in Burkina Faso, but perspectives on reduced bleeding were more mixed. Women and providers preferred methods that are discreet and not user-dependent, and associate duration with convenience of use. Some women in Uganda expressed concerns about the invasive nature of long-acting methods, and cost was an important consideration in both countries. In the ranking exercise, discreet use and few side effects often ranked high, while causing amenorrhea and not requiring a pelvic exam often ranked low. Conclusion: Product development should consider user preferences for success in these settings.

What About Methods for Men? A Qualitative Analysis of Attitudes Toward Male Contraception in Burkina Faso and Uganda

“…The larger research was focused on collecting attitudes on specific contraceptive method attributes; reactions to six new contraceptive methods in development; and reasons for method preference among women, men, and family planning providers and program staff. 19,20 Married women in both Burkina Faso and Uganda had rates of modern contraceptive use close to the average rates in Western and Eastern Africa at the time of the original study (25% and 32%, respectively); 21,22 some 3% used male condoms in Burkina Faso and 6% used them in Uganda. In this article, we analyzed the data gathered through focus groups to explore support among men and women for male-directed contraceptive methods, to identify potential facilitators and barriers to using new male methods, and to gain insight into desirable characteristics of these methods.…”

“…The methodology for this study has been described in detail elsewhere. 19,20 To be eligible to participate, women had to be aged 15-17 and married or aged 18-49, while men had to be 18 or older. One woman aged 50 participated in the study; no man younger than 23 did so.…”

“…18 This article presents a secondary analysis of qualitative data from a larger study conducted in 2016 of user preferences for new contraceptive methods in Burkina Faso and Uganda: These countries were chosen for their geographic locations-in Western and Eastern Africa, respectively-and because the original research team included an additional module of questions on new contraceptive method acceptability in the Performance Monitoring and Accountability 2020 country surveys. 19,20 Qualitative research was conducted in the same two countries. The larger research was focused on collecting attitudes on specific contraceptive method attributes; reactions to six new contraceptive methods in development; and reasons for method preference among women, men, and family planning providers and program staff.…”

Seeking synergies: understanding the evidence that links menstrual health and sexual and reproductive health and rights

“… 49 One recent study found that 65% of women in Burkina Faso and 40% of women in Uganda would use a method that pauses bleeding. 52 Adolescents and young adults may be especially interested in limiting or controlling the timing of menstruation with hormonal contraception. 53 , 54 …”

“…49 One recent study found that 65% of women in Burkina Faso and 40% of women in Uganda would use a method that pauses bleeding. 52 Adolescents and young adults may be especially interested in limiting or controlling the timing of menstruation with hormonal contraception. 53,54 Various factors may contribute to an individual's preferences for or willingness to tolerate changes to normal bleeding patterns, including age, region, marital or cohabitation status, previous use of hormonal contraception, experience of menstruation, desire to prevent pregnancy and individual and cultural attitudes and beliefs about menstruation.…”