Using the 5C Vaccine Hesitancy Framework to Elucidate and Measure Contraceptive Acceptability in sub-Saharan Africa

<h3>Key Messages</h3> There is a gap between goals of supporting reproductive agency and empowerment within family planning programs and measures able to track progress toward those goals. Commonly used family planning measures are beset by imprecise terminology and oversimplification and are often not person centered. Measuring contraceptive acceptability, which offers a means of understanding if and how contraceptive desire translates into contraceptive demand, requires a conceptual framework identifying the diverse factors that contribute to it. In assessing how the 5C framework of vaccine hesitancy (confidence, calculation, constraints, complacency, and collective responsibility) may inform our conceptualization of contraceptive acceptability in sub-Saharan Africa, we found that it has relevance, with confidence, calculation, and constraints appearing particularly salient. However, contraceptive acceptability is informed by additional social and gendered factors, including gender roles, gendered power dynamics, and social norms. This work represents a first step toward developing and testing a measure of contraceptive acceptability that can more precisely diagnose and support the achievement of self-determined reproductive goals and track progress toward those goals within family planning programs and at individual, community, and population levels.