Meeting Preferences for Specific Contraceptive Methods: An Overdue Indicator

Abstract

Fertility surveys have rarely asked people who are using contraception about the contraceptive method they would like to be using, implicitly assuming that those who are contracepting are using the method they want. In this commentary, we review evidence from a small but growing body of work that oftentimes indicates this assumption is untrue. Discordant contraceptive preferences and use are relatively common, and unsatisfied preferences are associated with higher rates of method discontinuation and subsequent pregnancy. We argue that there is opportunity to center autonomy and illuminate the need for and quality of services by building on this research and investing in the development of survey items that assess which method people would like to use, as well as their reasons for nonpreferred use. The widespread adoption of questions regarding method preferences could bring indicators of reproductive health services into closer alignment with the needs of the people they serve.

Unfulfilled and method‐specific contraceptive preferences among reproductive‐aged contraceptive users in Arizona, Iowa, New Jersey, and Wisconsin

“…10 Our findings on method-specific preferences among women with unfulfilled In their recent commentary advocating for contraceptive preference metrics to be more widely adopted as contraceptive indicators, Burke and Potter outline key recommendations for conducting research that incorporates these metrics. 9 These include asking about method-specific preferences, delinked from specific conditions, and including a second question asking about reasons for nonuse of preferred method. The contraceptive preference metrics examined in our analysis meet these criteria, supporting the widespread utility of these findings across a variety of state-based settings.…”

“…Data are representative of reproductive-aged women in Arizona, Iowa, New Jersey, and Wisconsin, and the contraceptive preference metrics examined in our study largely align with recommended best practices for research into people's contraceptive desires. 9 At the same time, our study does not include data for preferences among nonusers of contraception, leaving much unknown about the extent and types of barriers to T A B L E 3 Reasons for not using preferred method among respondents who had unfulfilled contraceptive preferences. Respondent's partner or family influences method choice or ability to get preferred method.…”

“…In their recent commentary advocating for contraceptive preference metrics to be more widely adopted as contraceptive indicators, Burke and Potter outline key recommendations for conducting research that incorporates these metrics 9 . These include asking about method‐specific preferences, delinked from specific conditions, and including a second question asking about reasons for nonuse of preferred method.…”

“…To that end, a growing body of research has begun to document people's contraceptive preferences in a variety of settings, as well as factors associated with these preferences. Burke and Potter (2023) recently provided an overview of key findings from 11 studies that examined contraceptive preferences within the United States since 2000. 9 From this commentary and subsequent research since it was published, about 1 /4 of reproductive-aged contraceptive users at the national level 10,11 and about 25%-33% at the state-level in Ohio 12 and Wisconsin 13 have unfulfilled contraceptive preferences.…”

“…Public health goals related to contraception in the United States, such as those enumerated in Healthy People 2030, 8 have focused primarily on metrics of contraceptive use versus nonuse and identifying which methods are being used. However, recent scholarship has highlighted that focusing exclusively on whether and what contraception is being used obfuscates whether the methods being used represent those preferred by the user 9 . Incorporating a person‐centered lens into the setting of, and tracking progress toward, public health goals related to contraception is an important step forward in aligning our program and policy efforts with helping people to achieve reproductive autonomy and guarding against supporting programs that perpetuate or replicate reproductive injustices of the past.…”