Women's contraceptive preferences align with method use in Kenya; long-acting preference strongest

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The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception Published June 1, 2026 Medically reviewed June 1, 2026 Study authors: Hardenbergh Leah, Seth Aparna, Richardson Barbra A, Farid Shiza, Udren Jenna I, Rothschild Claire W,… PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider assessing contraceptive attribute preferences to improve method alignment in women living with HIV.

This analysis used baseline survey data from an RCT involving 2599 women living with HIV in Kenya who were using modern contraception. The study examined whether women's stated preferences for specific contraceptive method attributes (long-acting, avoid daily dosing, permit self-discontinuation, concealable) were associated with using methods that had those attributes.

Women who preferred long-acting methods were more likely to use aligned methods (aPR 1.63; 95% CI 1.19-2.24). Preferences for avoiding daily dosing (aPR 1.11; 95% CI 1.07-1.16), permitting self-discontinuation (aPR 1.32; 95% CI 1.14-1.52), and concealability (aPR 1.06; 95% CI 1.01-1.12) also showed positive associations. The study did not report absolute numbers or clinical outcomes such as pregnancy or HIV transmission.

Safety and tolerability were not reported. Limitations were not reported, but the analysis is observational within an RCT, so causality cannot be inferred. The study does not compare interventions.

In practice, these findings suggest that client-centered counseling addressing individual preferences may improve method satisfaction, though no single method can meet all preferences simultaneously.

Study Details

Study typeRct

EvidenceLevel 2

PublishedJun 2026

PMID41435925

View Original Abstract ↓

OBJECTIVE: Understanding alignment of contraceptive preferences and method selection among women living with HIV (WLWH) may improve contraceptive counseling. We examined whether method attribute preferences aligned with method attributes used among WLWH, and identified preference clusters. STUDY DESIGN: We used baseline survey data from WLWH enrolled in a cluster randomized controlled trial of a reproductive health counseling intervention in Kenya. Women using eligible modern contraception at baseline were included (N = 2599). We used Poisson regression models to characterize 11 relationships between method attributes preferred vs. used, and principal component analysis (PCA) to identify preferences clusters. RESULTS: Women who preferred methods that are long-acting (adjusted Prevalence Ratio [aPR]:1.63, 95% Confidence Interval [CI]:1.19-2.24), avoid daily dosing (aPR:1.11, 95% CI:1.07-1.16), permit self-discontinuation (aPR:1.32, 95% CI:1.14-1.52), and are concealable (aPR:1.06, 95% CI:1.01-1.12) were significantly more likely to use aligned methods. Attribute preferences clustered on three dimensions: (1) avoiding heavy bleeding, weight changes, libido changes, and non-hormonal; (2) long-acting, avoiding daily dosing, permitting self-discontinuation, and avoiding intermittent bleeding; and (3) concealability without an effectiveness preference. Immediate return to fertility was modeled independently due to lack of clustering. The first dimension was positively correlated with condom use and inversely with implant use. The second was also positively correlated with condom use, and use of both implants and tubal ligation, while inversely with injectable and oral contraceptive pill use. The third was correlated with injectable use. CONCLUSION: Method attribute preferences do not always align with methods used and may cluster in ways that cannot be satisfied by existing methods. IMPLICATIONS: Preferences for methods that are long-acting, avoid daily dosing, and permit self-discontinuation are widely held and related to method selection, but cannot be met by a single method when held in combination. Client-centered counseling that elicits relative strength of preferences and tailors guidance accordingly may help improve method satisfaction.