Preferences for characteristics of contraceptive methods: a large, multi-country discrete choice experiment

Nearly half of global pregnancies are unintended. Contraceptive use is preference-sensitive, including concerns about convenience, privacy and side effects (eg, irregular bleeding, weight gain). We conducted a multi-country study examining women's preferences for attributes of current and potential future modern hormonal contraceptives using a discrete choice experiment (DCE).

Between April and October 2022, we recruited nationally representative samples of women of reproductive age from seven countries (Burkina Faso, Nigeria, Ethiopia, Kenya, Zambia, Pakistan and the USA) using multi-stage random cluster sampling from national census enumeration areas. The DCE comprised six attributes of hormonal contraceptives: format (ie, mode of administration: injection, implant, etc), dosing interval, provider-administration versus self-administration, effect on menstruation, effect on weight and time from discontinuation until return to fertility. Mixed logit models were fitted separately by country to estimate the relative preference weights (β) for each attribute level.

Across 20 068 participants, format was the strongest driver of preferences. Injectables were most preferred in Kenya (β=0.44, 95% CI 0.25 to 0.63), Pakistan (β=0.55, 95% CI 0.29 to 0.81), Ethiopia (β=0.64, 95% CI 0.38 to 0.90) and Zambia (β=0.39, 95% CI 0.20 to 0.58). Oral pills were most preferred in the USA (β=0.78, 95% CI 0.58 to 0.98), Burkina Faso (β=0.43, 95% CI 0.27 to 0.59) and Nigeria (β=0.55, 95% CI 0.40 to 0.70). Intrauterine devices and vaginal rings were less preferred in all countries. Menstrual bleeding changes and dosing interval were secondary drivers, with longer-acting methods modestly preferred and ongoing irregular bleeding modestly non-preferred. Avoiding weight gain was significantly preferred in several countries, most strongly in Pakistan (β=0.56, 95% CI 0.44 to 0.67) and the USA (β=0.42, 95% CI 0.31 to 0.53).

In this large, multi-country study, reproductive-age participants expressed strong, heterogeneous preferences for contraceptive format, and in some settings, avoiding weight gain side effects. These findings can support preference-aligned contraceptive product development.