ACCEPTABILITY OF AND PREFERENCES FOR LONG-ACTING INJECTABLE HORMONAL CONTRACEPTION: RESULTS FROM A NATIONAL ONLINE SURVEY WITH US WOMEN

Abstract

Objectives

We conducted end-user research to optimize design of a sustained-release microsphere-based etonogestrel long-acting injectable (LAI) in development targeting 6- or 12-month windows of protection, steady hormone dose, and rapid return-to-fertility.

Methods

We implemented a national online survey including a discrete choice experiment (DCE) in June-July 2023, with cis-gender women ages 18-44 years. DCE attributes included duration of effectiveness (6/12/24-months), effect on menses, side-effects, and post-use return-to-fertility timing. Data analysis employed mixed-multinomial logit models.

Results

1,029 participants completed the survey (mean age 28.6 years, from 49 US states; 30.9% Black/African American; 11.6% Hispanic/Latina; 71.6% nulliparous; 49.0% not wanting a(nother) child). 35.7% currently use birth-control pills (37.4%); 35.7% male condoms; 19.8% withdrawal. In the DCE, participants strongly negatively preferred (in order-of-magnitude): may cause heavier/unpredictable periods, mild headaches/nausea, slight weight-gain, and delayed return-to-fertility (6-12-months vs. 3-months). Participants positively preferred: may cause no period, and shorter/lighter periods. Women significantly preferred 12-month to 6-month duration (p<0.03). Most participants (92.4%) were interested in using the LAI if it had no/minimal side-effects/heavier bleeding and quick return-to-fertility. Two-thirds preferred a 12/24-month duration; one-third a 6-month. Preference for 6-month duration was associated with wanting a child within five years, and higher discomfort with hormones (both p<0.001).

Conclusions

While most women report interest in an LAI, interest substantially decreases if it may cause heavier/unpredictable periods, other side-effects, or delayed return-to-fertility. Longer duration (12+ months) is preferred; a 6-month option appears important for women wanting to get pregnant relatively soon, and those concerned about hormones.