Equating contraceptive use with programmatic success is fundamentally flawed in failing to account for whether individuals desire contraceptive use; this is problematic because nonuse can reflect empowered decision-making and use may reflect an individual's inability to refuse or discontinue a method. A rights-based approach demands respect for individuals’ freedom to weigh options and choose how their desire for pregnancy prevention can be accommodated by available methods and within the context of their own personal, social, and material constraints. We offer an alternative construct, preference-aligned fertility management (PFM), that provides a more holistic indicator of whether one's contraceptive needs are met. PFM is more person-centered and informative for programming than status quo measures of unmet need, demand satisfied, and contraceptive use which define a positive outcome in relation to pregnancy risk rather than one's stated preferences. The PFM approach goes beyond other recent proposals for modifying the concept of unmet need by refraining from judgment of legitimate reasons for nonuse of contraception and offers a straightforward way to capture whether people act in line with their preferences. We conclude with discussion of how we plan to measure PFM in the Innovations for Choice and Autonomy (ICAN) study in Nigeria and Uganda.

中文翻译：

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以偏好为中心的生育管理作为以人为本的避孕措施替代方案

将避孕药具的使用等同于计划成功从根本上是有缺陷的，因为它没有考虑到个人是否希望使用避孕药具；这是有问题的，因为不使用可以反映授权决策，而使用可能反映个人无法拒绝或停止某种方法。基于权利的方法要求尊重个人的自由权衡选项，并选择如何通过可用的方法并在他们自己的个人、社会和物质限制的背景下满足他们对预防怀孕的愿望。我们提供另一种结构，即偏好对齐生育管理 (PFM)，这提供了一个更全面的指标，表明一个人的避孕需求是否得到满足。PFM 比未满足的需求、满足的需求和避孕药具使用的现状措施更以人为本，并且为规划提供更多信息，后者定义了与怀孕风险相关的积极结果，而不是一个人的既定偏好。PFM 方法通过避免判断不使用避孕的正当理由，超越了最近修改未满足需求概念的其他建议，并提供了一种直接的方法来捕捉人们的行为是否符合他们的偏好。最后，我们讨论了我们计划如何在尼日利亚和乌干达的选择和自主创新 (ICAN) 研究中衡量 PFM。