The User Perspective: An Evolutionary Step in Contraceptive Service Programs

Abstract

There is cumulative evidence of large gaps in perception between those who design and implement contraceptive service programs and those who use or want to use contraceptives and related family planning services. In several dozen selected countries, recent studies have shown low continuation rates. Too many people who accept a contraceptive method quickly discontinue use, often complaining of side effects for which there is no clinical evidence. The president of the Population Council, George Zeidenstein, discusses the necessity of designing programs based on the perceptions and responses of individual users. Since women are likely to remain the principal users of contraceptives they should be included at the decision making level of every program design. Women's views about availability, choice, self-selection, responsiveness, learning opportunities, and integration in life experiences cannot be postulated; they must be known from the source. Greater user perspective requires innovative program evaluation. Emphatic attention should be paid to sustained use, use-effectiveness, and extended use-effectiveness. Traditional methods of contraception should be given more attention with the idea of incorporating them into modern programs. Elimination of the waste represented by noncontinuing acceptance will make user-oriented research cost-effective.