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Short abstract:

This paper explores how novel digital contraceptive technologies contribute to existing tensions between stakeholders over the definition and application of ‘contraceptive acceptability’, despite the overarching user-centred approach to contraceptive provision and care.

Long abstract:

Once understood as a quality inherent to the technology, contraceptive acceptability has evolved in recognition that contraception is a highly relational choice dependent on individual, interpersonal and socio-cultural contexts. Policy makers and contraceptive providers have thus, in principle, adopted a user-centred approach to provision as a move away from a ‘one-size-fits-all’ model. Yet users often refer to modern pharmaceutical contraceptives as a ‘necessary evil’, signalling the need to prevent pregnancy despite the ‘un-acceptability’ of available methods. Indeed, in practice, pharmaceutical companies have made little attempt to increase contraceptive acceptability and research reveals that providers continue to prioritise efficacy over other user-defined ‘acceptable’ qualities, such as non-hormonal and user-controlled.

A new landscape of digital contraceptive technologies, including tracking apps and wearables, has emerged with ‘user acceptability’ front and centre. ‘Femtech’ companies leading this development claim to be user-led and user-centric in meeting multiple user-defined contraceptive priorities. While promising, novel risks regarding efficacy, accountability, and safety have prompted criticism, predominantly from healthcare providers, who argue that these technologies are unacceptable methods of pregnancy prevention.

Here, I present findings from an online document analysis of novel digital contraceptives and qualitative workshops with a diverse group of potential users. The findings traverse different stakeholders - including developers, providers, media outlets, and users - to examine ‘acceptability’ for who, by who, why, in what contexts, and with what effect. Doing so reiterates questions regarding the practical value and use of ‘acceptability’ as a goalpost for contraceptive development and more widely.