Development and Validation of a Measure of Contraceptive Acceptability in Cameroon and Kenya

Lotus McDougal, Center on Gender Equity and Health, UCSD
Peter Kisaakye, Makerere University
Emma Woks, EVIHDAF
Elizabeth Larson, Center on Gender Equity and Health, UC San Diego
Paul Bukuluki, Makerere University
Jean Christophe Fotso, EVIHDAF
Symon Wandiembe, Makerere University
Hidayatou Mohamadou, EVIHDAF - Evidence for Sustainable Human Development Systems in Africa.
Dinah Amongin, Makerere University School of Public Health
Junior Agbor, EVIHDAF
Caroline Deignan, Matchboxology
Shannon Pryor, Save the Children
Sadia D Parveen, USAID
Paul Gitonga, Independent researcher
Caroline Teh Monteh, Independent consultant
Courtney McLarnon, GEH, UCSD
Esther Spindler, Consultant, GEH/UCSD
Madeleine Short Fabic, US Agency for International Development (USAID)

Current family planning measures are limited in their ability to explain the transition from contraceptive desire to contraceptive demand. Contraceptive acceptability, or the degree of willingness to use a contraceptive method when pregnancy is not desired, can bridge this divide. This paper shares the results of a mixed-methods study to draft, pilot, and assess reliability and validity of a measure of contraceptive hesitancy. Data were collected in March-May 2024 in two sites each in Cameroon and Kenya. We conducted cognitive interviews (n=8/country) and a quantitative survey (n=102 in Cameroon, n=109 in Kenya) with adult women and men. Internal reliability was assessed using exploratory factor analysis. Construct validity was assessed using multivariable regressions adjusting for study site, gender, and age. The final three-item Contraceptive Acceptability Scale had strong reliability (Cameroon a=0.85, Kenya a=0.79), and demonstrated construct validity with current contraceptive use (OR=1.74, p=0.01), contraceptive desire (OR=1.47, p=0.06), contraceptive agency (OR=1.58, p=0.07), and reproductive empowerment (?=0.41, p<0.001). The Contraceptive Acceptability Scale is a reliable, valid, and brief measure focused on access, provider trust, and family responsibility. This scale is an important programmatic and evaluation tool with which to better support reproductive choice and agency in family planning programs and interventions.

Keywords: Family Planning and Contraception, Sexual and Reproductive Health and Rights, Gender Dynamics, Mixed methods research

See extended abstract.