A focus on contraceptive preferences is essential to the provision of person‐centered care. Adolescent girls and young women (AGYW) in the WHO African Region experience disparities in contraceptive access and use and reproductive health outcomes. Despite increasing recognition of AGYW needs as unique, their preferences are understudied, limiting strategies to improve contraceptive care access and quality among marginalized youth populations. We designed and conducted a discrete choice experiment among five hundred 15–20‐year‐old AGYW in Kisumu, Kenya, to examine the relative importance of trade‐offs between contraceptive methods and service delivery attributes. Participants answered eight choice sets including three alternatives: two hypothetical contraceptive options characterized by seven attributes (effectiveness, bleeding pattern, duration of use, privacy, access location, counseling source, and cost) and a “no method” opt‐out. We used random‐parameters logit models to estimate preference weights and trade‐offs among alternatives. The bleeding pattern was the most important determinant of stated choice, with a strong preference for unchanged or irregular bleeding over heavier bleeding or amenorrhea. Participants preferred the lowest chance of method failure as well as the longest duration of use (one year) over daily use or use during/after sex. Parous AGYW were more likely to prefer the longest duration of use. The ability to keep method use completely private was also an influential choice, particularly among 15–17‐year‐olds. AGYW traded effectiveness and increased cost for preferred bleeding patterns and privacy. The opt‐out “no method” alternative was chosen only 2.7 percent of the time, indicating a strong preference for pregnancy prevention. Our findings highlight key insights for enhancing the person‐centeredness of contraceptive care for AGYW: Kenyan AGYW place a high value on preferred menstrual bleeding patterns, high method effectiveness, longer duration of use, and the ability to keep method use private. Preference data can inform programs, including contraceptive decision‐support interventions, to improve AGYW access to quality preference‐sensitive contraceptive services.

中文翻译：

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探索青少年的避孕偏好和权衡：肯尼亚一项离散选择实验的结果


关注避孕偏好对于提供以人为本的护理至关重要。WHO 非洲区域的少女和年轻妇女 （AGYW） 在避孕药具的获取和使用以及生殖健康结果方面存在差异。尽管人们越来越认识到 AGYW 需求是独一无二的，但他们的偏好却没有得到充分研究，这限制了改善边缘化青年群体获得避孕护理的机会和质量的策略。我们在肯尼亚基苏木的 500 名 15-20 岁的 AGYW 中设计并进行了一项离散选择实验，以检查避孕方法和服务提供属性之间权衡的相对重要性。参与者回答了八组选择，包括三个选项：两个假设的避孕选项，其特征是七个属性（有效性、出血模式、使用持续时间、隐私、访问位置、咨询来源和成本）和一个“无方法”选择退出。我们使用随机参数 logit 模型来估计替代方案之间的偏好权重和权衡。出血模式是所述选择的最重要决定因素，与较重的出血或闭经相比，强烈偏好未改变或不规则的出血。与日常使用或期间/之后使用相比，参与者更喜欢方法失败的可能性最低以及使用时间最长（一年）。经产 AGYW 更可能更喜欢最长的使用时间。将方法使用完全保密的能力也是一个有影响力的选择，尤其是在 15-17 岁的青少年中。AGYW 以效率和增加的成本换取了首选的出血模式和隐私。选择退出“无方法”替代方案的概率仅为 2.7%，表明对预防妊娠的强烈偏好。 我们的研究结果强调了提高 AGYW 避孕护理以人为本的关键见解：肯尼亚 AGYW 高度重视首选的月经出血模式、高方法有效性、更长的使用时间以及保持方法使用私密的能力。偏好数据可以为包括避孕决策支持干预在内的计划提供信息，以改善 AGYW 获得对质量偏好敏感的避孕服务的机会。