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COMMENTARY
Open Access

Recognizing and Addressing the Contraceptive Hesitancy-Acceptability Continuum: Adopting Lessons Learned From the Immunization Field

Madeleine Short Fabic and Amy Ong Tsui
Global Health: Science and Practice December 2024, 12(6):e2400220; https://doi.org/10.9745/GHSP-D-24-00220
Madeleine Short Fabic
aU.S. Agency for International Development, Washington, DC, USA.
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  • For correspondence: mshort@usaid.gov
Amy Ong Tsui
bJohns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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  • FIGURE 1
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    FIGURE 1

    Spectrum of Vaccine Hesitancy

    Source: Violette and Pullaguara.17

  • FIGURE 2
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    FIGURE 2

    Vaccination Hesitancy Over Timea in the United States

    aAmong 3,349 U.S. survey respondents at baseline (August 9 to December 8, 2020) and follow-up (March 2 to April 21, 2021).

    Source: Seigler et al.22

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    TABLE.

    5Ca Scale Vaccine Hesitancy Short-Form Questions and Possible Questions for Contraceptive Hesitancy-Acceptability

    Short-Form Questionsb
    Original Vaccine HesitancyAdapted Contraceptive Hesitancy-Acceptability
    Confidence

    I am completely confident that vaccines are safe.

    • Vaccinations are effective.

    • Regarding vaccines, I am confident that public authorities decide in the best interest of the community.

    I am confident that contraceptives are safe.

    • Contraceptives are effective.

    • Regarding contraceptives, I am confident that health providers prioritize my best interest.  

    Constraints

    Everyday stress prevents me from getting vaccinated.

    • For me, it is inconvenient to be vaccinated.

    • Visiting the doctor makes me feel uncomfortable; this keeps me from being vaccinated.

    Circumstances in my life prevent me from using contraceptives.

    • For me, it is difficult to access contraceptives.

    • Visiting health providers makes me feel uncomfortable; this keeps me from using contraception.

    Complacency

    Vaccination is unnecessary because vaccine-preventable diseases are not common anymore.

    • My immune system is so strong; it also protects me against diseases.

    • Vaccine-preventable diseases are not so severe that I should be vaccinated.

    Contraception is unnecessary because I am unlikely to have an unplanned pregnancy.

    • My body is unlikely to be fertile; I do not need to worry about unplanned pregnancy.

    • Contraception is unnecessary because an unplanned pregnancy would not be a problem for me.

    Calculation

    When I think about getting vaccinated, I weigh benefits and risks to make the best decision possible.

    • For each and every vaccination, I closely consider whether it is useful for me.

    • It is important for me to fully understand the topic of vaccination before I get vaccinated.

    When I think about using contraceptives, I weigh benefits and risks to make the best decision possible.

    • For each and every form of contraception, I closely consider whether it will be suitable for me.

    • It is important for me to fully understand the topic of contraception before I use contraception.

    Collective responsibility

    When everyone is vaccinated, I don’t have to get vaccinated, too.

    • I get vaccinated because I can also protect people with a weaker immune system.

    • Vaccination is a collective action to prevent the spread of diseases.

    It is my partner’s responsibility to contracept, so I don’t have to.c

    • I use contraception so I can take better care of my family.

    • Contraception is an action that can improve the well-being of individuals, families, and communities.  

    • a Instructions for the 5C are: “Please evaluate how much you disagree or agree with the following statements.” (1=strongly disagree, 2=moderately disagree, 3=slightly disagree, 4=neutral, 5=slightly agree, 6=moderately agree, 7=strongly agree). The items used for the short scale are in bold font.

    • b Items related to each of the short-form questions are bulleted beneath each short-form question. Adapted questions are provided for illustrative purposes only; they must be tested and validated.

    • c Partner responsibility and collective responsibility do not involve equivalent actors but have in common a perception of shared responsibility for others’ health (e.g., the degree to which an individual perceives vaccination or contraception as part of their responsibility to others).

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Global Health: Science and Practice: 12 (6)
Global Health: Science and Practice
Vol. 12, No. 6
December 20, 2024
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Recognizing and Addressing the Contraceptive Hesitancy-Acceptability Continuum: Adopting Lessons Learned From the Immunization Field
Madeleine Short Fabic, Amy Ong Tsui
Global Health: Science and Practice Dec 2024, 12 (6) e2400220; DOI: 10.9745/GHSP-D-24-00220

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Recognizing and Addressing the Contraceptive Hesitancy-Acceptability Continuum: Adopting Lessons Learned From the Immunization Field
Madeleine Short Fabic, Amy Ong Tsui
Global Health: Science and Practice Dec 2024, 12 (6) e2400220; DOI: 10.9745/GHSP-D-24-00220
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  • Article
    • INTRODUCTION
    • WORLD HEALTH ORGANIZATION STRATEGIC ADVISORY GROUP OF EXPERTS ON IMMUNIZATION RECOMMENDATIONS
    • VACCINATION AND CONTRACEPTION SIMILARITIES
    • CONTRACEPTIVE HESITANCY-ACCEPTABILITY CONTINUUM FRAMEWORK
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