Assess Family Planning Needs, Preferences and Behaviors to Inform Innovations in Contraceptive Technologies (Round 18)

ROADBLOCKS

In recent decades, there have been tremendous improvements in the reproductive health of men and women in the developing world and increases in the use of modern methods of family planning. Nonetheless, many women, couples and adolescents do not or are not able to access information, supplies and services that could facilitate preventing unplanned pregnancies and planning the number and timing of desired pregnancies. Current modern contraceptive methods are safe and effective when used according to directions; however, there are over 200 million women in the developing world who report that they want to space or limit their childbearing but also report not currently using these methods. Such unmet need for modern contraception is estimated to be approximately 30% among women in union in Sub-Saharan Africa and approximately 20% among women in union in Southern and Southeastern Asia, with considerable variation among countries.^[1]. Unmet need is disproportionately high in segments of the population, including among unmarried or nulliparous women, adolescents and other groups.

Reasons for unmet need vary; in large national surveys, the most common explanations women give for non-use of family planning methods in regions where such need is highest include health concerns or side effects, infrequent sex, breastfeeding or post-partum, poor access to family planning supplies and services, partner reluctance and prohibitive costs. Approximately 70% of unmet need is attributable to method-related barriers and new contraceptive methods will be essential to overcome these barriers and increase user uptake and satisfaction. While these data convey the breadth and basic characteristics of unmet need and non-use, more precise and contextualized data could be valuable to inform the design of truly transformational new contraceptive technologies. It is a challenge to effectively and efficiently allocate the limited available resources to the development of new methods when the diverse and changing needs and perspectives of potential users, providers or program managers are not well understood.

We see an opening to learn about the fundamental needs, preferences and motivations of use of modern contraceptive methods, in order to accelerate towards universal access to reproductive health through the application of such learnings to the development of innovative FP methods and products.

BARRIERS TO UPTAKE

Many women or couples do not use contraception because the methods and services available to them do not satisfy their preferences or needs, which are widely variable. Several specific barriers include those that are method-related. Changes in uterine bleeding patterns, a side effect that is frequently associated with use of hormonal contraceptives, are not acceptable in certain cultural contexts and may require resources to manage; other side effects may also be intolerable to some women. For those whose income is limited, perceived or real cost (especially of more expensive methods) is an especially important issue. Skilled health care workers are often unavailable in resource poor settings so options that allow for non-medical delivery of some methods might increase access to contraception or circumvent provider biases. Additional barriers for women arise from differing contraceptive needs depending on stage of life and childbearing desire, the need for a discreet or covert contraceptive and the need to easily and quickly reverse the effects of the method.

Large population-based surveys (e.g. DHS) provide some evidence regarding reasons for unmet need, but again, a more precise or detailed understanding of these reasons, among specific groups of users (or potential users, providers or program managers / policy makers), is needed in order to inform development of innovative products. Overall, increasing contraceptive access and acceptance requires more effort on both the demand and supply dimensions of the field, in order to meet the specific needs of women and men of reproductive age - including adolescents - in an appropriate, safe, culturally sensitive and cost-effective manner.

What we are looking for:

The goal of this call is to support the generation of primary knowledge and evidence to improve our understanding of needs, preferences and behaviors among specific groups of contraceptive users and non-users, including service providers, to inform the design and development of innovations in family planning methods. We seek proposals that are novel, well-designed and that will provide robust and reliable data; creative, cost-effective approaches to data collection will be regarded positively. Proposals should include a description of how the results could be applied to the eventual design or development of new contraceptive technologies that enhance family planning access, demand or acceptance and provide for sustained use.

Highly desirable outcomes for successful proposals might include:

• Evidence generated through social, cognitive or behavioral science methodologies to inform design and development of new contraceptive products, delivered through any route of administration, for sustained or "on-demand" contraception.
• A deep understanding of the needs, preferences and perspectives of specific segments of the population regarding existing and future family planning methods. Populations of interest might include, among others:
  • Women who want no more children
  • Adolescents, ages 15-19
  • Nulliparous women
  • Current users of modern contraception
  • Current non-users of modern contraception
  • Women with heath concerns; women who don’t use contraception due to side effects
  • Women seeking to prevent both pregnancy and STI/HIV infection
  • Married men
  • Unmarried men
  • Family planning service providers

A few of the many specific examples to be considered include:

• Product-related barriers and/or facilitators experienced by specific groups of women or adolescents in accessing or using existing contraceptive methods and services;
• Product-related reasons for non-use (non-adoption or discontinuation) of current methods among specific populations;
• Perceptions of menstrual effects of methods, including irregular bleeding and amenorrhea;
• Prevailing norms of contraceptive preferences and use within specific populations or geographies;
• Women’s motivations to use family planning methods; motivations to select specific methods, including modern methods, natural family planning or other traditional methods;
• Interest in using a permanent method of contraception among women and/or couples who have completed their desired family size;
• Desired attributes of contraceptive methods, among specific groups of users or non-users of contraceptives, including route of administration, duration of action, service delivery point, desired non-contraceptive benefits, or other features; the potential of contraceptive attributes to influence uptake and continued use of any given method;
• Men’s needs and perceptions of existing or future contraceptive methods;
• Men’s willingness to use a family planning method and desired attributes of contraceptive methods, including route of administration, duration of action, service delivery point, or other features;
• Provider perceptions of the range of contraceptive methods currently available; provider comfort with specific methods and attitudes toward administering contraceptive methods to different groups of women or to adolescents.

We will not consider funding for:

• Research relevant only to developed world settings and populations;
• Development of new contraceptive methods or research exploring the acceptability of an individual method in development;
• Biomedical research;
• Large survey-based research;
• Secondary analysis of existing large survey-based data sources (e.g. DHS).

Grants will be selected on ability to create impact in the context of our existing global health priorities.

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^[1]United Nations, Department of Economic and Social Affairs, Population Division (2015). Model-based Estimates and Projections of Family Planning Indicators 2015. New York: United Nations