Assess Family Planning Needs, Preferences and Behaviors to Inform Innovations in Contraceptive Technologies and Services (Round 17)

THE OPPORTUNITY

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, or who are using so-called traditional methods of contraception.  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; the most common explanations given 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.  However, the above list of reasons for non-use of modern contraception, as well as the measure of unmet need itself, are based on large national surveys.  Consequently, 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 sensitive and thoughtful FP interventions. In short, it is a challenge to effectively and efficiently allocate resources to the development of new methods and improvements in service delivery when the diverse and changing needs, preferences and behaviors of potential users are not well understood.

Responding to this gap between expressed need and use is hindered in the current context of relatively limited funding for family planning programs and for global R&D in new contraceptive technologies. We see an opening to learn about the fundamental motivations of use of modern methods and reasons for non-use of modern contraceptive services and methods, in order to accelerate towards universal access to reproductive health, through the application of such learnings to innovative FP tools, approaches, and program design.

THE CHALLENGE

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. Irregular bleeding, a side effect that is frequently associated with use of hormonal contraceptives, is not acceptable in certain cultural contexts and requires 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 in some for a covert contraceptive and the need to easily and quickly reverse effects of the contraceptive.

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 women, is needed in order to inform development of innovative products and services. 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, with the ultimate objective being to apply such knowledge to the design and development of innovations in family planning methods or services. 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 design or development of new contraceptive technologies or service delivery approaches that enhance family planning access, demand or acceptance and provide for sustained use. Given developments in contraceptive methods and services over the last decades, approaches that were informed by earlier knowledge could be updated with new evidence.

Highly desirable outcomes for successful proposals might include:

• Evidence generated through social or behavioral science methodologies to inform design and development of new contraceptive products, including continuous use or “on-demand” contraception, delivered through any route of administration.
• Evidence generated through social or behavioral science methodologies to inform design and development of innovative approaches to create or satisfy demand for family planning services.
• A deep understanding of the experiences and preferences of specific segments of the population regarding family planning methods and services. 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
• Innovative approaches to greater understanding of reasons for non-use (non-adoption or discontinuation) of contraception and potential means to address barriers to use.

Few of the many specific examples to be considered include:

• Barriers and/or facilitators experienced by specific groups of women or adolescents in accessing or using existing contraceptive methods and services. These could be product-related, social, cultural, or systems-level factors;
• Prevailing norms of contraceptive preferences and use within specific populations or geographies;
• Women’s motivations to use family planning services; motivations to select specific methods, including natural family planning or other traditional methods; reasons why users of traditional methods continue to be reluctant to switch to modern methods;
• 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;
• Common myths and misperceptions related to contraception and family planning; methods; messages that can address such perceptions and beliefs;
• Perception of risk of unplanned pregnancy and/or STI / HIV infection; motivation to seek dual protection or multi-purpose prevention methods;
• Men’s perceptions of contraceptive methods and/or services;
• Men’s willingness to support partner in use of family planning;
• 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;
• 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.