Beyond Acceptability: Reorienting Research on Contraceptive Choice

INTEREST in contraceptive acceptability research began in the mid-1970s when it became clear that access to and knowledge of new contraceptive methods were not enough to ensure their use. Although the initial impulse that gave rise to this research was a desire to expand contraceptive prevalence, there was also a commitment on the part of some investigators to make the scientific enterprise more accountable to the end user. As early as 1977, Marshall argued that the goal of acceptability research should be to provide administrators and biomedical scientists with information allowing them ‘to modify technology and programs to fit people, rather than modifying people to fit technology and programs’.1 While laudable, it is yet unclear how successfully acceptability research has achieved this goal. Although important advances have been made in recent years, the field of acceptability research remains in flux. Some investigators – such as those profiled in this volume – have adopted sophisticated approaches to understanding user preferences and decision-making. Others still work from outdated paradigms that view acceptability as something static and intrinsic to a method. Historically, there has been lack of clarity regarding the very concept of acceptability – how to understand it, how to measure it, and what it means. Some argue that the purpose of acceptability research is to estimate a product’s market potential and/or to predict likely patterns of use if a method were introduced into a public sector programme. Others talk in terms of helping biomedical investigators to determine which of several lines of research would most likely lead to the most popular product and/or meet women’s needs. Still others talk in terms of modifying the design of prototype products already under development, or uncovering negative attitudes or other ‘barriers’ that could be addressed through education or service delivery modifications. Although these goals are not mutually exclusive, they do refer to distinctly different research objectives that are frequently confused in the contraceptive literature. Feminist researchers and advocates have likewise voiced a number of concerns about the ways in which ‘acceptability’ has been Beyond Acceptability: Reorienting Research on Contraceptive Choice