There is wide variability in contraceptive choices and preferences among different populations. None of the commonly available contraceptive methods is perfect, and each method has its own merits and limitations. Important factors that commonly determine women’s contraceptive choice include effectiveness, safety and side effects, affordability and accessibility, user friendliness as well as non-contraceptive benefits. The relative importance of these attributes varies between different users and is influenced by one’s own fertility planning as well as her physical, social and cultural circumstances. While effectiveness is emphasised by most providers, the acceptance and satisfaction is greatly determined by the perceived or actual safety and side effect profile. Menstrual bleeding changes may positively or negatively affect method satisfaction and continuation.
Concerns about weight gain, effects on sex life and other side effects are also important reasons for method discontinuation, and these may be exaggerated by myths and misconceptions. Affordability and accessibility do vary with specific populations. Improved user-friendliness can be conferred by promoting the use of long-acting reversible contraceptives which are generally easy to use, more “forgettable” and less user-dependent. Non-contraceptive benefits such as improvement of menstruation-related symptoms and acne by hormonal methods and prevention of sexually transmitted infections by condoms are additional merits to some users. Healthcare providers generally have great influence on the contraceptive choice of most women. The tiered-effectiveness approach combined with shared decision making can be a useful way of contraceptive counselling. Within the effectiveness framework, the most effective methods are discussed first, while addressing the user’s own concerns, preferences and reproductive goals. This aims at achieving the optimal balance between effectiveness and other attributes based on the user’s personal circumstances.