Comparing Women's Contraceptive Preferences With Their Choices in 5 Urban Family Planning Clinics in Ghana

BACKGROUND: Concern about contraceptive side effects is a common reason reported by women for not using contraception or discontinuing use. We sought to characterize women's preferences related to method characteristics and side effects and to examine whether their adopted method was consistent with their stated preferences. METHODS: Between June 1, 2015, and August 31, 2015, we surveyed women attending 5 urban family planning clinics in Kumasi and Accra, Ghana, before and after their counseling sessions. All women attending these clinics were approached to gauge their interest and eligibility for inclusion. Before counseling, women were asked about desired method characteristics and bothersome and intolerable side effects. After counseling, women were asked about method adoption and the counseling received about side effects. We then used crosstabs to compare the side effects women were counseled to expect, as well as those they reported would be intolerable, with their adopted methods to determine consistency between women's preferences and choices. RESULTS: In total, 414 and 411 women completed the pre- and post-counseling surveys, respectively. The analysis sample consisted of 336 participants who adopted a method and were matched between the 2 surveys. The 3 most commonly chosen methods were the implant (n=135, 40.1%), injectables (n=109, 32.4%), and the intrauterine device (IUD) (n=52, 13.4%). The large majority (at least 87%) of method adopters chose a method that was well matched with their desired duration of effectiveness. Consistency between women's expressed intolerable side effects and their chosen methods was substantially lower: at least 70% of women choosing the implant, IUD, or injectables had stated they would stop using a method if they experienced those side effects that are in fact common with their respectively chosen methods. While 65.0% of those who adopted a method reported they were counseled to expect side effects, substantially less were counseled to expect the side effects common with use of their adopted method. CONCLUSION: Women's choice of contraceptive methods generally matched their stated preferences related to desired duration of effectiveness but not to potential side effects, and most women reported they were not counseled to expect the side effects common with use of their chosen method. Providers need to address potential side effects during counseling both to ensure women choose methods that will be a good fit with their desires and to reassure them that commonly experienced side effects are not harmful.