Contraceptive preferences play a crucial role in reproductive outcomes such as contraceptive continuation and pregnancy prevention. Current approaches to measuring reproductive preferences in population surveys are limited to exploring only fertility preferences and implicitly assume that contracepting people are using a method they want. Yet, the few studies that have studied this topic suggest otherwise.
In a patient-centered approach to family planning, it is vital to not only ensure access to contraception but to guarantee that women have the option to use the method that best fits their personal circumstances, preferences, and needs. However, there is limited evidence about how contraceptive preferences are measured and whether they fluctuate, especially in the context of low- and middle-income countries (LMICs). Our new study in Studies in Family Planning fills this gap by measuring the extent of changes in women’s contraceptive preferences over a year in Kenya and identified the sociodemographic characteristics, demand- and supply-side factors, and life events associated with these changes.
Data to Track Preferences over Time
Our study examined three rounds of nationally representative longitudinal data collected by the Performance Monitoring for Action (PMA) project from 3,664 reproductive-age women living in Kenya. At every survey round interview, women were asked to report their favorite method of contraception. For users of modern contraception, women were asked if they were using a method they wanted with the following question: “Did you obtain the method you wanted to delay or avoid getting pregnant?” For nonusers of contraception, women were asked if they planned to use contraception to delay or avoid getting pregnant at any time in the future. Those who responded “yes” to the intention to use question were asked a follow up question about the method they planned to use: “What method do you think you will use?.” Women also reported information related to their sociodemographic and economic characteristics, as well as their exposure to family planning information. Our analysis was conducted separately for consistent users and nonusers of contraception because we were interested in assessing the consistency of preferences conditional on the consistency of contraceptive use status.
Are Contraceptive Preferences Stable?
We found that contraceptive preferences are not stable. Over the course of a year, 18 percent of contraceptive users and 46 percent of nonusers reported a change in their preferred method. This indicates that even when women report a consistent contraceptive use status, their contraceptive preferences are still fluid, responding to changes in their lives and environments.
Among users, the most commonly preferred methods were injectables (41 percent at baseline and 44 percent at follow-up), followed by implants (33 percent at baseline and 34 percent at follow-up). Nonusers also showed a preference for implants (40 percent at baseline and follow-up) and injectables (36 percent at baseline and 35 percent at follow-up), indicating a general trend toward long-acting methods. Although the distribution of the preferred methods is similar between baseline and follow-up, we found extensive change at the individual level during the year. For example, women who initially preferred oral pills or condoms were more likely to shift toward injectables and implants. This shift could be attributed to the perceived convenience or effectiveness of long-acting methods compared to short-acting ones. On the other hand, women who preferred permanent or long-acting methods, such as sterilization, implants, and IUDs, were less likely to change their preferences. This suggests that once women commit to a long-term contraceptive strategy, their preferences become more stable.
What Drove the Change in Contraceptive Preferences?
Several factors were found to influence changes in contraceptive preferences.
Life Events: Changes in fertility preferences, pregnancy, childbirth, or changes in marital status were significantly associated with changes in women’s contraceptive preferences. For instance, women who experienced a pregnancy or a shift in their fertility preferences were more likely to change their preferred contraceptive method by a factor of 1.39 and 1.47 among consistent nonusers and by a factor of 1.65 and 1.27 among consistent users, respectively.
Community Perceptions and Norms: Women’s preferences were also shaped by the views of their communities. In areas where using contraception was stigmatized among adolescents, women were more likely to report changes in their preferences by a factor of 1.84 among consistent nonusers. Conversely, in communities where contraception was viewed positively as an instrument toward a better quality of life, consistent nonusers were less likely to change their contraceptive preferences by a factor of 0.61.
Exposure to Family Planning Information: Access to information also played a role. Women who were more knowledgeable about contraceptive methods and had greater exposure to family planning information were less likely to change their preferences. This highlights the importance of family planning programs providing comprehensive, accessible information to help women make informed choices.
Availability of Contraceptive Options: The availability and cost of contraceptive methods in the local health facilities influenced women’s choices. Among consistent nonusers, an increase in the proportion of facilities that charged a fee for family planning services in the cluster was positively associated with a 0.43 increase in the odds of changing their contraceptive preferences.
Implications for Family Planning Programs
These findings have important implications for family planning programs in Kenya and LMIC contexts. The fluidity of contraceptive preferences highlights the need for programs that are flexible and responsive to women’s changing needs. Family planning programs should prioritize ensuring that a broad range of contraceptive methods is available. Women’s preferences may change, and having access to different methods would allow them to switch to a method that better suits their evolving circumstances.
Moreover, programs should empower women to make informed choices about their contraceptive use. This means not only providing access to contraception but also ensuring that women have the knowledge and support to choose a method they prefer and are comfortable with. Similarly, family planning services need to be sensitive to the major life events that we found in our study to influence contraceptive preferences, such as marriage, pregnancy, or changes in fertility preferences. Tailored counseling that considers these events can help women navigate changes in their reproductive goals.
In conclusion “Are Contraceptive Method Preferences Stable? Measuring Change in the Preferred Method among Kenyan Women” offers valuable insights into the dynamic nature of reproductive health needs. It challenges the assumption that women’s contraceptive preferences remain constant over time and emphasizes the importance of providing a patient-centered, adaptable approach to family planning.
Carolina Cardona, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
Dana Sarnak, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
Alison Gemmil, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
Peter Gichangi, International Centre for Reproductive Health, Mombasa, Kenya; Technical University of Mombasa, Mombasa, Kenya; and Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
Mary Thiongo, International Centre for Reproductive Health, Mombasa, Kenya
Philip Anglewicz, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health