Monday, August 12th, 2019
The Importance of Comprehensive Contraceptive Counseling
by Eden Blackwell
It has been nearly 60 years since birth control pills became available to women in the United States. Since that time many forms of birth control have been approved by the Food and Drug Administration (FDA). Over time, some methods have been pulled from the market due to safety concerns, some have lost favor as newer, easier to use methods were developed, and for some types of birth control, medical guidance has changed about who should use it. All the while, generations of sexually active women have been trying to understand information, of varying quality, about a spate of options, in order to identify and obtain methods of birth control that make sense for them. Choices about birth control methods are informed by highly individual preferences and, potentially, limitations like medical concerns, finances, or partner preferences.
A recent survey of women of reproductive age in Mississippi was undertaken to better understand the factors associated with their decisions to use or not use birth control. Survey responses made it very clear that women use methods they know about. This rather obvious finding on the surface could have implications that are less apparent. If women rely on what they feel they know enough about, they may be limited to just those methods when something more appropriate could be available. Few of the surveyed women, for example, reported knowledge about IUDs and implants, birth control methods that are the most effective reversible methods available, and only a small percentage were using these methods.
How do women know how a given birth control method stacks up according to the factors that are important to them? In the same survey, respondents identified their top three sources of information used in decision making (see below). For both women who have given birth (parous) and women who have not (nulliparous), the most frequently cited source of information was a gynecologist or ob-gyn. In addition, “other healthcare provider” was the fourth most cited source after friends or peers and a mother or mother figure.
Healthcare providers play a critical role in women’s use of birth control. More than just writing prescriptions or inserting devices, providers are key sources of information, and their recommendations guide patient choice. More than half of the women without children in the survey agreed with the statement “Only health care professionals (like doctors and nurses) can tell me what I should do and not do to avoid getting pregnant.”
High quality, patient-centered conversation about the pros and cons of birth control methods supports women in making empowered decisions about the course of their lives. Successful initiatives across the country have made such counseling a key intervention in efforts to reduce unintended pregnancy. The Contraceptive Choice Project in Missouri, for example, counseled participants on all available, reversible methods of birth control by effectiveness. Notably, over 70% of participants chose the most effective methods and reported high rates of user satisfaction and continued use of chosen methods at one- and two-year follow-up appointments. Unintended pregnancy among program participants also dropped considerably.
The best method of birth control is the one a woman will use correctly and consistently, and the choice of which method to use is highly personal based on individual life circumstances. Providing comprehensive and accurate information about what methods can help women achieve their own reproductive plans is crucial to ensuring access to effective contraception.