Preference-Aligned Fertility Management as a Person-Centered Alternative to Contraceptive Use-Focused Measures.

TitlePreference-Aligned Fertility Management as a Person-Centered Alternative to Contraceptive Use-Focused Measures.
Publication TypeJournal Article
Year of Publication2023
AuthorsHolt, K, Galavotti, C, Omoluabi, E, Challa, S, Waiswa, P, Liu, J
JournalStud Fam Plann
Volume54
Issue1
Pagination301-308
Date Published2023 Mar
ISSN1728-4465
KeywordsContraception, Contraception Behavior, Contraceptive Agents, Family Planning Services, Female, Fertility, Humans, Nigeria, Pregnancy, Uganda
Abstract

Equating contraceptive use with programmatic success is fundamentally flawed in failing to account for whether individuals desire contraceptive use; this is problematic because nonuse can reflect empowered decision-making and use may reflect an individual's inability to refuse or discontinue a method. A rights-based approach demands respect for individuals' freedom to weigh options and choose how their desire for pregnancy prevention can be accommodated by available methods and within the context of their own personal, social, and material constraints. We offer an alternative construct, preference-aligned fertility management (PFM), that provides a more holistic indicator of whether one's contraceptive needs are met. PFM is more person-centered and informative for programming than status quo measures of unmet need, demand satisfied, and contraceptive use which define a positive outcome in relation to pregnancy risk rather than one's stated preferences. The PFM approach goes beyond other recent proposals for modifying the concept of unmet need by refraining from judgment of legitimate reasons for nonuse of contraception and offers a straightforward way to capture whether people act in line with their preferences. We conclude with discussion of how we plan to measure PFM in the Innovations for Choice and Autonomy (ICAN) study in Nigeria and Uganda.

DOI10.1111/sifp.12228
Alternate JournalStud Fam Plann
PubMed ID36723038