Potential user interest in new long-acting contraceptives: Results from a mixed methods study in Burkina Faso and Uganda

Abstract

Method-related concerns represent an important cause of contraceptive non-use and discontinuation. User preferences must be incorporated into the design of new contraceptive technologies to ensure product success and improve family planning outcomes. We assessed preferences among potential users in Burkina Faso and Uganda for six contraceptive methods currently under development or ready for introduction: a new copper intra-uterine device (IUD), a levonorgestrel intra-uterine system, a new single-rod implant, a biodegradable implant, a longer-acting injectable, and a method of non-surgical permanent contraception. Questions were added to nationally-representative PMA2020 household surveys that asked 2,743 and 2,403 women in Burkina Faso and Uganda, respectively, their interest in using each new method. We assessed factors associated with interest through multivariable logistic regression models. We conducted qualitative interviews and focus groups with 398 women, 78 men, and 52 family planning providers and key informants to explore perceived advantages and disadvantages of the methods. Respondents expressed interest in using all new methods, with greatest interest in the longer-acting injectable (77% in Burkina Faso, 61% in Uganda), followed by a new single-rod implant. Least interest was expressed in a new copper IUD (26% Burkina Faso, 15% in Uganda). In both countries, women with less education had higher odds of interest in a longer-acting injectable. Interest in most new methods was associated with desiring a method lasting longer than one year and acceptance of lack of menstrual bleeding as a contraceptive side effect. Perceived advantages and disadvantages were similar between countries, including concerns about menstrual side effects and fear of the biodegradable nature of the biodegradable implant. Potential users, their partners, and providers are interested in new longer-acting methods, however, familiar forms including the injectable and implant may be the most immediately acceptable. A biodegradable implant will require clear counseling messages to allay potential fears.

Impact of experiencing specific side-effects on contraceptive switching and discontinuation in Uganda: Results from a longitudinal PMA Survey

“…Our nding that increased menstrual bleeding was associated with discontinuation aligns with a growing body of literature, highlighting the importance of contraceptive-induced bleeding changes (1,21). Excessive bleeding arose as a major barrier to contraceptive use in previous qualitative research in Uganda (18,37,38); that excessive bleeding was strongly associated with discontinuation, but not with switching, indicates that women who experience this side-effect may be reluctant to switch to new methods, instead preferring to discontinue use altogether. The experience of excessive bleeding may present practical challenges to menstrual hygiene management.…”

“…We did not nd signi cant effects with discontinuation or switching among women who reported less bleeding, although irregular bleeding was shown to reduce the risk of switching. Evidence from qualitative studies in Africa suggests that amenorrhea and irregular bleeding are often viewed negatively and associated with concerns about future fertility, particularly among nulliparous women (21), however recent qualitative evidence in Uganda found that the potential for lighter periods as a side-effect of contraception was viewed favorably by women (38). Of note, however, we did not distinguish between less bleeding and cessation of bleeding.…”

Impact of Experiencing Specific Side-Effects on Contraceptive Switching and Discontinuation in Uganda: Results from a Longitudinal PMA Survey

“…Excessive bleeding arose as a major barrier to contraceptive use in previous qualitative research in Uganda (22,35,36); that excessive bleeding was strongly associated with discontinuation, but not with switching, indicates that women who experience this side effect may be reluctant to switch to new methods, instead preferring to discontinue use altogether. The experience of excessive bleeding may be additionally problematic in environments like Uganda, where myths and misperceptions around the harmful impacts of contraception, including effects on future fertility and on overall health, are widespread (22,37,38).…”

“…This belief carries profound social consequences and, therefore, may greatly reduce motivation to use contraception (17,39) We did not nd signi cant effects with discontinuation or switching among women who reported less bleeding, although irregular bleeding was shown to reduce the risk of switching. Evidence from qualitative studies in Africa suggests that amenorrhea and irregular bleeding are often viewed negatively and associated with concerns about future fertility, particularly among nulliparous women (11), however recent qualitative evidence in Uganda found that the potential for lighter periods as a side effect of contraception was viewed favorably by women (36). Zimmerman and colleagues found that two-thirds of sexually active women in Uganda strongly agreed that not having a menstrual period as a result of contraceptive use was unhealthy, but agreement was not strongly associated with either discontinuation or switching (Under Review).…”

Clinical trial to evaluate pharmacokinetics and pharmacodynamics of medroxyprogesterone acetate after subcutaneous administration of Depo-Provera

“…A longer-acting injectable could facilitate use, improve continuation, possibly increase effectiveness, and provide women with greater choice. Six months is a target duration from a safety perspective for a hormonal method that cannot be discontinued immediately in case of unwanted side effects or emerging medical contraindications and is preferred by both users and providers ( 5 ). While efforts are under way to develop novel sustained drug delivery technologies that hold promise for the development of a new 6-month injectable contraceptive product ( 6 , 7 ), the adaptation of existing methods for novel uses is an appealing, cost-efficient approach to expedite availability of new contraceptive options.…”