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

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.