Paper co-authored with Steve Kretschmer, Allie Gugliotti, and Filza Sikander. Presented at the 18th European Society of Contraception and Reproductive Health Congress in Belgrade, Serbia in May 2026
Background
Contraceptive providers are pivotal gatekeepers in ensuring equitable access to contraception. Providers’ perceptions of product attributes such as safety, convenience, privacy, and return to fertility, substantially influence which methods are emphasized in counseling and ultimately adopted by clients. The objective of this analysis was to systematically assess how providers prioritize among a broad set of contraceptive product attributes, and how these provider preferences and perceptions vary across geographies and provider types.
Methods
In 2023, in-person surveys were conducted with n~10,000 providers across five countries - Pakistan, Burkina Faso, Ethiopia, Kenya, and Nigeria (boosted sample for North-South split). Multi-stage random cluster samples stratified by urban-rural were drawn with probability proportional to size (PPS) to support survey estimates across public, private, NGO, and retail providers in both urban and rural settings. Providers were asked to rate the relative importance of a wide array of contraceptive product attributes, such as self-administration at home, can be kept a secret, used only when needed, long acting dosage, foreign object in body, infection risk, as well as hormonal side effects such as changes in menstrual cycles, breast milk production, weight gain, and wait time before return to fertility. Arguably, all these product attributes are important; our methodology aimed to reveal which ones were more vs. less valued by providers.
Results
Among all product attributes, providers rated as most important that contraceptives should offer no infection risk and quick return to fertility, followed by contraceptives should not cause reduction in breast milk or changes in menstrual cycles. Conversely, providers placed least importance on whether contraceptives can permit self-administration at home, or can be kept secret, or used only when needed. Differences between countries emerged a lot stronger than differences within country, suggesting that cultural norms affect provider perceptions much more than clinical training, years of experience, or service setting. For example, providers in Pakistan were much more concerned about side effects of weight gain while providers in Northern Nigeria were the least concerned. These country differences persisted across all provider types. Across all countries, providers with higher proportions of clients complaining about irregular bleeding and heavy bleeding tend to place more importance on contraceptives having no impact on menstrual cycles. These effects were most pronounced in Kenya and Southern Nigeria.
Conclusions
Providers’ ratings indicate clear prioritization of clinical safety and reproductive outcomes over convenience and secrecy. The strongest preferences for no infection risk and rapid return to fertility suggest primary concern with avoiding adverse clinical events. The next highest importance placed on avoiding reductions in breast milk and changes in menstrual cycles underscores providers’ sensitivity to hormonal side effects. In contrast, the relatively lower importance assigned to self-administration, secrecy, or on-demand use implies that providers value contraceptive options with no hormonal side effects over user autonomy, convenience or privacy. By quantifying the relative importance providers assign to product attributes, we generate evidence relevant for future product development, and provider-focused training and interventions in contraceptive counseling.