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 Bedsider.org also has a friendly, patient-centered online interface that allows patients to learn more about the different forms of contraception.
Dehlendorf, C., et al. (2017). Shared decision-making in contraceptive counseling. Contraception, 95(5):452-455. Retrieved from https://www.contraceptionjournal.org/article/S0010-7824(17)30002-1/abstract.
Johnson, C. (2013). Female inmates sterilized in California prisons without approval. Reveal: The Center for Investigative Reporting. Retrieved from https://www.revealnews.org/article/female-inmates-sterilized-in-california-prisons-without-approval/.
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.