Acceptability of and preferences for long-acting injectable hormonal contraception among US women: evidence from a national cross-sectional online survey.

Background: Long-acting injectable (LAI) hormonal contraception offers a promising approach to meet women's pregnancy prevention needs. We sought to understand acceptability of and preferences for LAI hormonal contraception among US women, to optimize the design of a sustained-release LAI in development - including which durations to pursue.

Methods: We implemented a national cross-sectional online survey including a discrete choice experiment (DCE) with women ages 18-44 years currently using or interested in using contraception. Recruitment was via Prime Panels. DCE attributes included potential duration of effectiveness (6/12/24-months), effect on menses, side effects, and timing of return-to-fertility after use. We used mixed-multinomial logit models to analyze the data.

Results: Women (n = 1,029) were 28.6 years old on-average, from 49 US states. 30.9% were Black/African American; 11.6% Hispanic/Latina. 71.6% were nulliparous; 49.0% did not want a(nother) child. Common current contraceptive methods were birth control pills (37.4%), male condoms (35.7%), and withdrawal (19.8%); 18.9% reported having had an unintended pregnancy. In the DCE, women had strong negative preferences for: may cause heavier/unpredictable periods, mild headaches/nausea, slight weight gain, and delayed return-to-fertility (6-12 vs. 3 months), and positive preferences for: may cause no period, and shorter/lighter periods (all p < 0.001). Women also preferred the 12-month to the 6-month duration (p = 0.03). When asked directly about their interest in an LAI with no/minimal side effects/effects on menses and quick return-to-fertility, 92.4% expressed interest, with two-thirds preferring a longer duration (12 or 24-months), and one-third the 6-month duration. Preference for the 6-month duration (vs. 12 or 24) was most highly associated with wanting a child within five years, and higher discomfort with hormones (both p < 0.001).

Conclusions: US women report high interest in an LAI. Interest substantially decreases if the LAI may cause unwanted effects such as heavier/unpredictable periods, mild headaches/nausea, slight weight gain, or delayed return-to-fertility. While longer duration (12 + months) is preferred overall, having a 6-month option appears important especially for women who may want to get pregnant within the next few years, and those concerned about hormones (to try it before using a longer duration).