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Contraceptive Pearl: Contraceptive Counseling Through the Lens of Reproductive Justice

Contraceptive counseling is an art. We adapt and improve as we learn from our patients and our colleagues. The SisterSong Women of Color Reproductive Justice Collective defines reproductive justice as the “human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.”

The United States has a long history of sterilization abuse, as well as forced and coerced use of long-acting reversible contraceptives, disproportionally imposed on people with low incomes, people with disabilities, sex workers, immigrants, and people who are currently or were previously incarcerated. Sadly, these abuses continue today. The Center for Investigative Reporting uncovered nearly 150 female inmates who were illegally sterilized in California prisons from 2006 to 2010. And there are numerous stories of unwanted sterilization that go unreported.

Optimal contraceptive counseling involves asking patients what matters most to them, and respecting their preferences. Starting with open-ended questions is a great idea. Patients’ priorities regarding birth control vary widely. Examples of top priorities can include:

  • Minimizing menstrual bleeding
  • Avoiding hormones
  • Hiding the birth control method from a parent or partner
  • Lowering the risk of STIs
  • Maximizing efficacy
  • Cost and other issues related to access
  • Impact on pleasure and sex life

It is vital that patients preserve autonomy in selecting a method and in choosing when to use it. RHAP offers patient handouts in a variety of languages, and also has a friendly, patient-centered online interface that allows patients to learn more about the different forms of contraception.



RHAP Birth Control Choices Fact Sheet

Bedsider Method Explorer




American Academy of Family Physicians (AAFP). (2018) Six simple steps to shared decision-making. Retrieved from

Dehlendorf, C., et al. (2017). Shared decision-making in contraceptive counseling. Contraception, 95(5):452-455. Retrieved from

Johnson, C. (2013). Female inmates sterilized in California prisons without approval. Reveal: The Center for Investigative Reporting. Retrieved from

Krase, K. (2014). History of forced sterilization and current US abuses. Our Bodies Ourselves. Retrieved from

Patel, P. (2017) Forced sterilization of women as discrimination. Public Health Reviews, 38(15). Retrieved from

SisterSong Women of Color Reproductive Justice Collective. Reproductive Justice. Retrived from

JR, Bennett AH, Karasz A, Gold M. Taking the provider “out of the loop:” Patients’ and physicians’ perspectives about IUD self-removal. Contraception. 2018 Oct 1;98(4):288-91.

Foster DG, Grossman D, Turok DK, Peipert JF, Prine L, Schreiber CA, Jackson AV, Barar RE, Schwarz EB. Interest in and experience with IUD self-removal. Contraception. 2014 Jul 1;90(1):54-9.

Raifman S, Barar R, Foster D. Effect of knowledge of self-removability of intrauterine contraceptives on uptake, continuation, and satisfaction. Women’s Health Issues. 2018 Jan 1;28(1):68-74.



The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.

Contraceptive Pearls

This monthly clinical e-newsletter highlights evidence-based best practice for contraceptive care

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