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. 2025 Sep;56(3):482-510.
doi: 10.1111/sifp.70030. Epub 2025 Aug 3.

Capturing the Dynamic Nature of Choice: Qualitative Perspectives on Contraceptive Acceptability from Cameroon and Kenya

Caroline Deignan, Angela Odiachi, Peter Kisaakye, N I Emma Woks, Dinah Amongin, Esther Spindler, Junior Agbor Ayuk Agbor, Paul Bukuluki, Alex Bagabo, Eresi Awor, Madeleine Short Fabic, Courtney McLarnon, Rebecka Lundgren, Shannon Pryor, Elizabeth Larson, Jean Christophe Fotso, Hidayatou Mohamadou, Leah Saleta, Lotus McDougal

Capturing the Dynamic Nature of Choice: Qualitative Perspectives on Contraceptive Acceptability from Cameroon and Kenya

Caroline Deignan et al. Stud Fam Plann. 2025 Sep.

Abstract

Although empowerment-focused reproductive health measures have expanded in recent years, gaps exist in measuring person-centered contraceptive desire and demand. We address this gap by examining the degree to which individuals feel that contraception is acceptable. This study explores women's and men's experiences of contraceptive acceptability and tests the applicability of the "5C" framework of vaccine hesitancy to contraceptive demand and behaviors. We conducted 60 in-depth interviews and 12 focus group discussions with women and men in Kenya and Cameroon. A multi-country team thematically coded and analyzed data using inductive and deductive approaches. Our findings show that three domains of the "5C" vaccine hesitancy framework were particularly salient to participants' experiences of contraceptive acceptability. Perceptions of contraceptive safety and effectiveness (confidence), personal and others' experiences with contraception (calculation), and contraceptive services quality (constraints) all influenced contraceptive acceptability. Additionally, three new domains emerged: family responsibility, partner engagement, and childbearing expectations. Taken together, these six domains comprise the construct of contraceptive acceptability, which influences contraceptive demand and consequent contraceptive behaviors. This work offers a conceptual underpinning to inform the development of a contraceptive acceptability measure that centers choice and agency in family planning programs and research.

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Conflict of interest statement

Caroline Deignan, Angela Odiachi, Peter Kisaakye, N.I. Emma Woks, Dinah Amongin, Esther Spindler, Junior Agbor Ayuk Agbor, Paul Bukuluki, Alex Bagabo, Eresi Awor, Courtney McLarnon, Rebecka Lundgren, Shannon Pryor, Elizabeth Larson, Jean Christophe Fotso, Hidayatou Mohamadou, Leah Saleta, and Lotus McDougal have no conflicts of interest. During manuscript writing, Madeleine Short Fabic was employed by USAID, which financially supported the initial draft of this manuscript; her input into objective interpretation of findings for this manuscript was not influenced by her employment with the funding institution.

Figures

FIGURE 1
FIGURE 1
Conceptual framework for the development and validation of a scale on contraceptive acceptability
See this image and copyright information in PMC

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