# Non-Preferred Contraceptive Method Use in Low-Resourced Settings: Exploring Inappropriate Medical Contraindications and Person-Centered Care

> **NIH NIH F31** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2024 · $37,329

## Abstract

PROJECT SUMMARY/ ABSTRACT
Family planning prevents unwanted pregnancy and reduces maternal and child mortality in low-resourced
settings; however, women in these settings encounter unnecessary medical barriers to contraceptive care.
Inappropriate medical contraindications (IMCs) occur when providers deny eligible women their preferred
contraceptive method without an evidence-based medical rationale. This medical barrier to family planning use
is difficult to identify using traditional survey methods and has been understudied for the last 20 years. The
applicant’s previous research suggests non-preferred method use is one indicator of IMCs, as 55% of non-
preferred method users reported a ‘medical reason’ for nonuse. Further, qualitative data on medical reasons
for non-use revealed IMC application by providers. Non-preferred method use is undesirable, as it can lead to
dissatisfaction, discontinuation, and unplanned pregnancies. Identifying interventions that effectively reduce
non-preferred method use and IMCs is an important contribution to global public health. The applicant’s long-
term objective is to identify effective and scalable interventions for reducing medical barriers to contraceptive
care for women living in low-resource settings. The proposed project will 1) estimate the impact of two social
accountability interventions on non-preferred method use at the population level; 2) determine the frequency
and elucidate the nature of non-preferred method use due to IMCs using innovative mystery client data
collected among 137 public-sector Kenyan facilities, and 3) use qualitative methods to investigate provider
perspectives on non-preferred method use and IMCs to explore key factors. The applicant hypothesizes that
social accountability interventions, in which community oversight motivates providers to improve their
performance, could increase patient-centeredness of care and therefore reduce non-preferred method use. To
test this hypothesis, Aim 1 will use difference-in-difference methods to analyze pre- and post-intervention data
from a randomized controlled experiment assessing two social accountability interventions in Kisumu, Kenya.
Aim 2 will use mixed methods to analyze mystery client data collected from all public facilities in Kisumu,
Kenya. Aim 3 proposes in-depth interviews with family planning providers in Kisumu, where the applicant will
build a new skill – standardized vignettes – to understand and contextualize provider decision-making around
IMCs. These data collection methods will overcome major methodological challenges that have prevented
research into IMCs in the past 20 years. Results will contribute important new information for improving
contraceptive care in low-resource settings. Additionally, the proposed rigorous training and research plans will
support the applicant in developing specialized subject knowledge, building mixed methods expertise, and
advancing in their development as an independent researcher.

## Key facts

- **NIH application ID:** 10903358
- **Project number:** 1F31HD113329-01A1
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Stephanie Roslyn-Isabelle Chung
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $37,329
- **Award type:** 1
- **Project period:** 2024-08-18 → 2026-08-17

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10903358

## Citation

> US National Institutes of Health, RePORTER application 10903358, Non-Preferred Contraceptive Method Use in Low-Resourced Settings: Exploring Inappropriate Medical Contraindications and Person-Centered Care (1F31HD113329-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10903358. Licensed CC0.

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