Acceptability: Listening to What Women Want

By: John Townsend, Population Council

Providing a range of safe and effective contraceptive methods that enable women to plan their families promotes gender equality and female empowerment.  But if manufacturers and designers don’t take women’s preferences and life contexts into account, a new product could fail to meet their needs and end up as a waste of the considerable resources required for product development and regulatory approval. Putting client acceptability at the center of product development isn’t just good business practice; it also reinforces the client’s rights as the principal agent in decision making.

Family Planning 2020’s Rights & Empowerment Principles for Family Planning includes Acceptability as a core principle of rights-based reproductive healthcare:

Acceptability:  Health care facility personnel, trained providers and developers of contraceptive methods are respectful of medical ethics and individual preferences, are sensitive to gender and life-cycle requirements and respect confidentiality.

The Population Council understands the importance of listening to the voices of women on the acceptability of innovations, either in products or in the way they are delivered. When looking to introduce the new progesterone contraceptive vaginal ring (CVR) in sub-Saharan Africa, we led consultations in Kenya, Nigeria, and Senegal to help us understand and address women’s needs and preferences in family planning.

The progesterone CVR is a soft, flexible ring made of silicone that provides a safe, effective, and comfortable method of contraception for breastfeeding women.  Each ring provides 3 months of protection against an unplanned pregnancy.  The method can be used for up to one year after childbirth, when a woman is at highest risk of an unplanned poorly-spaced pregnancy.

Contraceptive use is traditionally low in the post-partum period, but many women would welcome extra support from technology in spacing their next pregnancy. The progesterone CVR helps to prevent ovulation and enhances the natural contraceptive effect of exclusive breastfeeding, something women in our consultations appreciated and welcomed.

Among the women who participated in our acceptability study in sub-Saharan Africa, 84% reported being ‘very satisfied’ with the ring, while the remaining 16% were ‘satisfied’; they also reported that the vaginal ring did not interfere with sexual activity and that their partners were supportive of its use. Most (80%) of the women involved in the study said that they had already recommended the progesterone CVR to a friend or family member. Women particularly valued the fact that the products were user-initiated and controlled and did not require a medical provider for insertion or removal.

The progesterone CVR is already approved for use in eight Latin American countries, and in June 2015 the World Health Organization added it to the Essential Medicines List and to the Medical Eligibility Criteria for contraceptive use. Through the addition of new microbicide technologies, it’s possible that the next generation of vaginal rings could help protect women against sexually transmitted infections and HIV as well as unplanned pregnancies.

The voices, participation, and perspectives of women are invaluable for the Population Council as we seek to make sure that contraceptive products are user-centric in their designs, features, and ease of use. The next step in Population Council’s introductory study of the progesterone CVR in Africa is exploring issues of preference and price of the product with providers and procurers. With an affordability analysis complete, postpartum women in sub-Saharan Africa may be one step closer to accessing a new method that will suit their unique needs and address their preferences.