Attributes and Trade-Offs Impacting Contraceptive Choice: A Discrete Choice Experiment

To quantify the preferences and trade‑offs of women selecting contraception and of providers prescribing contraception, and to identify the attributes most influential in their decision‑making.

A discrete choice experiment (DCE) evaluated seven randomized attributes: effectiveness, mode of administration, return to fertility, cardiovascular (CV) risk, immediate postpartum eligibility, breastfeeding compatibility, and amenorrhea risk. Participants across the United States (US) were recruited from February-May 2025 using web-based market research panels. Women completed 12 choice tasks. Providers completed a DCE for three patient profiles to capture context‑specific decision‑making. A total of 307 women and 305 healthcare providers (HCPs) were included. Women were eligible if they were 18-49 years old, resided in the US, and considered using prescription contraception in the past 12 months. HCPs were eligible if they specialized in obstetrics and gynecology or family medicine, practiced in the US for at least 2 years, prescribed contraception in their routine practice, had familiarity with all contraceptive options, and had written at least 50 contraception prescriptions annually.Relative importance (RI), reflecting the overall contribution of each attribute to decision‑making, and willingness to trade-off (WTT) estimates were derived from preference weights (or marginal utilities for continuous attributes). Preferences were estimated using conditional logistic regression.

Women most valued effectiveness (RI=30.7%), followed by low CV risk (RI=24.0%). Trade-offs favored daily oral consumption (WTT=3.04) but not a delayed return to fertility (WTT=-2.05). When considering long-acting reversible contraception (LARC), women favored arm placement over uterine placement (WTT=-0.51). HCPs prioritized effectiveness irrespective of patient profile (range of RI=37.0%-40.1%) and consistently preferred LARC attributes over those of oral or injectable methods.

Incorporating stated preferences into shared decision-making, supported by education emphasizing autonomy across all methods, provides an opportunity to align contraceptive care with women's goals.