Push and pull factors shaping hormonal contraceptive decision-making: A scoping review of global qualitative research

Decisions to use, avoid, switch, or discontinue hormonal contraception are shaped by a range of social, cultural, relational, and embodied factors. Our objective was to review global qualitative evidence on the push and pull factors influencing individuals' decisions regarding hormonal contraception, and to synthesize these influences across diverse global contexts.

We conducted a scoping review following JBI guidance and report it according to preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews. We searched six databases for English-language qualitative studies published between 2014 and 2024. Fifty studies met the inclusion criteria. We extracted data using a structured form and synthesized it using a thematic analytic approach to identify cross-cutting push and pull factors.

We developed five interrelated themes relating to different dimensions of contraceptive decision-making: embodied experiences; relational and social influences; cultural and symbolic meanings; concerns about fertility and reproductive futures; practical, structural and system-level factors. Multiple factors operated simultaneously as discouraging and enabling influences - experiences of side effects, menstrual changes, concerns about "naturalness," partner dynamics, community norms, provider interactions, access barriers, and the need for privacy. Decisions reflected ongoing negotiation between anticipated harms, perceived benefits, and broader desires for autonomy, well-being, and reproductive control.

Decision-making about hormonal contraception is dynamic, contextually situated, and shaped by interrelated embodied, relational, cultural, and structural factors. While researchers and clinicians often attribute concerns about hormonal contraception to misinformation, our findings suggest that such concerns often reflect experiential and contextual realities. Person-centered counseling, engagement with users' experiences, and policies and practices that address cost, access, and method choice are essential to support contraceptive autonomy.