Understanding women’s preferences for long-acting reversible contraceptives in Gondar, Ethiopia: a discrete choice experiment

Ousman Ambaw (), Amare Minyhun, Tsegaw Amare Baykeda, Haimanot Wubale Tewabe, Endalew Minwuye Andargie, Yihalem Abebe Belay, Dessie Tarko Ambaw and Lei Si
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Ousman Ambaw: University of Gondar
Amare Minyhun: University of Gondar
Tsegaw Amare Baykeda: University of Gondar
Haimanot Wubale Tewabe: University of Gondar
Endalew Minwuye Andargie: Debre Berhan University
Yihalem Abebe Belay: Debre Markos University
Dessie Tarko Ambaw: University of South Australia
Lei Si: Western Sydney University

Health Economics Review, 2025, vol. 15, issue 1, 1-14

Abstract: Abstract Background In Ethiopia, limited use of long-acting reversible contraceptives (LARCs) contributes to unintended pregnancies, unsafe abortions, and preventable maternal deaths. Despite their proven effectiveness, LARCs remain underutilized. Evidence on women’s preferences and willingness to pay (WTP) is scarce. This study examined women’s stated preferences, WTP, and trade-offs regarding LARC use in Gondar. Methods An institution-based cross-sectional study was conducted among 344 contraceptive users, generating 8,256 observations. A discrete choice experiment (DCE) with 24 choice tasks, divided into two blocks, was employed. Each task presented two unlabeled alternatives defined by six key attributes, identified through literature review and expert consultation. Data were analyzed using mixed logit models to estimate preference strength and WTP based on model coefficients. Results The analysis revealed that provider type significantly influenced women’s preferences. Women showed the highest WTP for LARCs provided by midwives [528 ETB (10.15 USD)], compared to services offered by doctors [285 ETB (5.48 USD)] and health officers [215 ETB (4.13 USD)]. Preferences were also shaped by side-effect profiles: methods associated with slight weight gain [155 ETB (2.98 USD)], high effectiveness [80 ETB (1.54 USD)], and absence of bleeding [74 ETB (1.43 USD)] were positively valued. Conversely, heavy menstrual bleeding led to the largest reduction in WTP [–688 ETB (–13.24 USD)], indicating a significant barrier to LARC uptake. Longer-acting methods also reduced WTP [–139 ETB (–2.68 USD)], possibly reflecting concerns about long-term commitment or side effects. Cost sensitivity was evident, as increases of 100 ETB (1.92 USD) or 500 ETB (9.92 USD) further reduced uptake likelihood. Conclusion Women’s preferences for LARCs are influenced by provider type, side effects, and cost. Enhancing LARC services by prioritizing midwife-led delivery, addressing side effects such as heavy menstrual bleeding, and considering women’s WTP can increase uptake. These findings highlight the need for affordable, user-centered contraceptive services in Ethiopia.

Keywords: Long-acting reversible contraceptives; Contraceptive preferences; Discrete choice experiment; Willingness to pay; Ethiopia (search for similar items in EconPapers)
Date: 2025
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DOI: 10.1186/s13561-025-00683-y

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