User Perspectives on Contraceptive Side Effects and Side Benefits
Photo Credit: Tishina Okegbe
Post written by guest blogger Rebecca Callahan, PhD, Associate Director in the Product Development Introduction department, FHI 360
Contraceptives are consumer products. However, very little consumer research has informed the design and development of new contraceptive products. Initially, the hormonal contraception field was driven - or constrained - by what was technically feasible for steroid delivery. In more recent years, the field has suffered from a lack of investment from the pharmaceutical industry, which is not incentivized to develop new methods in the face of high regulatory hurdles and enjoys comfortable profits with the status quo. As a result, options available to women at the end of 2019 don’t look much different than they did 25 years ago. While marketers have focused more recently on “lifestyle benefits” of oral contraceptives (OCs), for example, reduced acne or improved mood, they have not fully explored what women really want in their contraceptive methods – including non-contraceptive attributes.
And the market for contraceptives is huge! The majority of women in the world have used a method of contraception at some point in their lives and contraceptive prevalence is growing in most regions of the world. In the United States, more than 99% of women who have ever had sex have used a method at least once.
Thanks largely to publicly-funded socio-behavioral research efforts, we do know a little about what women want (or don’t want) in their contraceptives. Survey data from around the world consistently find that fear of side effects and health concerns lead women to either discontinue method use or to never use modern contraception. The most commonly cited negative side effects include changes to menstrual bleeding patterns, weight gain and weight loss, headaches and dizziness, and mood changes. As part of a mixed-method study in Burkina Faso and Uganda aimed at gauging women’s attitudes toward several new methods currently in development, colleagues and I asked women participating in focus group discussions to rank several method characteristics as more or less important for them when choosing a method. In both countries, the characteristics that most frequently ranked among the top three were that the method not cause side effects like headache or abdominal pain, regular menstruation would be maintained, and their partner like it. Other important characteristics included that the method could be use discreetly, used postpartum, and that it allow a rapid return to fertility. Other studies have similar findings. For example, in a qualitive exploration of user preferences for a potential contraceptive microarray patch (MAP) women reported that they would prefer a method that could be used discreetly with few side effects. When deciding between two hypothetical MAPs with varying characteristics, effect on menstruation was the most important characteristic driving product preference with users preferring a method that did not affect menstruation.
Many women do appreciate the menstrual effects, specifically amenorrhea, or the cessation of menstruation, afforded by continual use of OCs and the hormonal intrauterine system (IUS). However, most of the data on women’s attitudes toward these methods come from high income countries, where these methods are more frequently used. For example, in an Australian study of hormonal IUS users, three quarters indicated that the prospect of amenorrhea was an incentive for choosing to use the method. Emerging evidence from developing country contexts suggests that many women desire reduced bleeding, while attitudes about amenorrhea remain mixed – with some women viewing cessation of bleeding as attractive and others reporting they find it undesirable.
But what else do contraceptive users want? Or not want? What does the ideal contraceptive look like? The answer to the last question almost certainly varies by an individual’s stage of life, contraceptive experience, lifestyle, and fertility desires, among a multitude of other factors. Figuring out what will better meet the range of a user’s needs is crucial for designing new products that individuals will want to use not just because they prevent pregnancy but because they fit their lives, and maybe even improve them!
To read more on this topic, check out the CTI Exchange blog series on method acceptability.