Giving Method Acceptability Research its Due in Contraceptive Development
by Joanne Kochuk, Contraceptive Technology Innovation, FHI 360
While contraceptive technology development rightly focuses on product safety and efficacy, we continually learn—sometimes the hard way—that acceptability factors play a major role in determining whether women or men use family planning (FP) methods over the long-term. Research on method acceptability is both complex and nuanced since members of the study population – current or potential contraceptive users – bring unique life situations, country context, product preferences and tolerance levels to the discussion. Recently, the CTI Exchange invited several thought leaders to share their insights on this important topic in a recently completed blog series.
Introducing the series with her blog, “Acceptability: Moving from Tolerable to Desirable,” Elizabeth Tolley, PhD, of FHI 360 notes that women need a broad range of desirable products to choose from and switch between, to meet their reproductive needs as their lives change. She challenges product developers to ask different questions and explore new angles when developing ideal product attributes for their new products in the pipeline.
Kate Guthrie, PhD, from Brown University and the Miriam Hospital, suggests that well-designed user experience (i.e., perceptibility) studies should inform contraceptive development to increase product acceptability and user uptake/continuation in her blog, “Method Choice–What’s Your Brain Got to Do with it?”
In their blog, “Hypothetically speaking, if We Build it, Will They Come?” Rebecca Callahan, PhD, and Aurélie Brunie, PhD, both of FHI 360, share findings of their recently completed assessment of user preferences for six long-acting family planning methods either under development or being piloted for scale-up. Concerns about changes in monthly bleeding patterns, worries about the impact of contraceptive use on future fertility, and hesitancy about implants that biodegrade or are inserted vaginally are illustrative of the range of issues that can influence user acceptability
Expanding on the issue of how women perceive menstrual bleeding changes, Laneta Dorflinger, PhD, from FHI 360, challenges the concept that women need to bleed in her blog, “Today’s Dreams, Tomorrow’s Reality? Contraceptive Technologies that Reliably Eliminate Menses.” She calls on researchers to support development of contraceptive options that rapidly and reliably eliminate menstrual bleeding so that women are not limited in their daily activities nor in realizing their dreams.
In “Seizing an Opportunity to Collect User Experience Data” Amelia Mackenzie, MPH, from FHI 360 posits that the clinical trial setting provides the first opportunity to collect data based on actual user experience, rather than on researcher assumptions. Ms. Mackenzie suggests that acceptability data gleaned there could inform marketing and promotion strategies, programmatic planning, counseling guidelines and policy recommendations.
The series then explored three sub-categories of method acceptability: multi-purpose technologies (MPTs), products that are acceptable to adolescents, and male contraceptive products.
Laura Dellplain, MHS, and Vanetta Thomas, MPH, from USAID’s Initiative for Multipurpose Prevention Technologies, address the complex nature of MPT acceptability in their blog, “Putting Women’s Voices at the Heart of MPT Development.” They note that key acceptability questions remain unanswered, including 1) do women value HIV prevention and pregnancy prevention differently by women? 2) would a contraceptive component of an MPT make the HIV prevention component more or less attractive? and 3) does stigma surrounding HIV deter women from using a contraceptive MPT?
Then Marta Pirzadeh, MPH, at FHI 360 and Fariyal F. Fikree, MD, MPH, DrPH, from Pathfinder reflect on the unique challenges faced by adolescents seeking family planning methods. In “Through the Eyes of a 16-year-old Zambian Girl,” they encourage product development researchers and FP service providers to work harder to create adolescent-friendly products and services.
Finally, Kevin Eisenfrats, CEO of Contraline, shares his thoughts about the need for a male non-hormonal contraceptive in his blog, “Finding an Acceptable Long-acting Reversible Male Contraceptive.” He notes that popularity of existing male methods (i.e., condoms and vasectomy) remains stagnant while interest among men in taking control of their fertility remains high. This disconnect should inform the need for increased research investment in acceptable, long-acting, non-hormonal methods for men.
Globally, over 214 million women in developing countries do not want to get pregnant but are not using modern contraceptive methods. For some, accessibility of FP services and affordability of products are key barriers. For many others, existing methods are not acceptable. “The contraceptive research world is realizing that method acceptability must be considered, early and often, in the product development cycle,” says Gregory S. Kopf, PhD, Director of Research and Development for FHI 360’s Contraceptive Technology Innovation department. “It is encouraging to see funders, including the National Institutes of Health, the U.S. Agency for International Development, and the Bill & Melinda Gates Foundation recognize the importance of combining the biomedical and behavioral elements when investing in new methods research. With a renewed commitment to method acceptability, we can begin to the dial away from ‘good enough.’ Millions of women and men are counting on it.”