The blog of the Urban Institute
February 20, 2020

Why Selecting Contraception Should Be More Like Shopping for Furniture

February 20, 2020

You have an appointment with a gynecologist because you want to start using contraception but aren’t sure which method is right for you.

In the waiting room, there’s a stack of assorted magazines and a wall full of pamphlets.  You’re curious but afraid to grab the trifold with “Birth Control Facts” written in large yellow font. What if someone who knows your parents sees? They’ll know you’re sexually active, and you could get in trouble.

It’s embarrassing to be the youngest person there. You fear others waiting will think, “If you don’t know your options, you shouldn’t be having sex” or “Look at that fast little girl.”

A nurse calls your name, interrupting your thoughts. You grab the pamphlet on your way to the back.

The nurse takes your vitals, completes your intake form, and leaves you in a small white room. You read over the pamphlet as you wait. It’s informative, but you still have questions. And it doesn’t match concerns you have based on what you’ve heard from your peers.

The doctor enters the room, checks your chart, and says, “So, you’re here to start birth control.” You reply yes, but that you’re not sure what kind.

The doctor immediately suggests an implant, but you know you do not want something placed inside you. The doctor tries to change your mind, insisting it’s the most effective option. You’re flustered, so you shut down and listen quietly.

Silence. Then the doctor asks, “Well, what about the pill?”

You don’t think you’ll remember to take it consistently, but you also don’t want to leave without getting anything. You agree, and the doctor writes you a prescription. You leave feeling dissatisfied and more confused than when you entered.

This hypothetical scenario matches the experience of many women in the US—especially young women of color

Black and Hispanic women are more likely to rate their family planning visits unfavorably, report feeling pressured to limit their family size, and be encouraged to adopt long-acting contraceptives.

Some women who experience such pressure only accept their providers’ contraceptive suggestions to end the uncomfortable encounter, and they’ll often quickly discontinue the method.

These negative clinical interactions may lead women to avoid accessing health care or make them skeptical of providers’ recommendations, both of which can be harmful to their health.

Why can’t selecting contraception be more like shopping for furniture?

You walk into a furniture store knowing you want a bed, but you’re a bit overwhelmed by the vast options. Luckily, an associate greets you and asks if you need help or have any questions.

You explain that you want a bed but don’t know which one. The knowledgeable associate runs through your options—sizes, styles, box spring versus slats—and offers pros and cons based on your preferences and living situation. You now feel fully informed and confident in your decision.

Obviously, there are differences between selecting furniture and selecting contraception. For one, a sales associate’s job is to encourage customers to make a purchase, and clinicians’ demands are more complex. But women’s reproductive health, rights, and justice are at stake, and for some, it’s a matter of life and death. There are ways to ensure more women feel educated and supported to make the right decisions for them.

Exploring evidence-based strategies for contraceptive counseling

Contraceptive counseling is a discussion in which a provider assesses a patient’s family planning needs and provides information accordingly.

A growing body of research provides recommendations for quality contraceptive counseling, and a key element of these suggestions are principles of shared decisionmaking.

The shared decisionmaking model regards patients as experts on their preferences while providers contribute medical knowledge. This approach allows for a method selection perfectly grounded in facts and personal values. With shared decisionmaking, women have reported feeling more satisfied with their contraceptive counseling experience and method selection.

Although these findings are promising, a gold standard has yet to be established. More research on approaches (PDF), tools, and training will help medical institutions establish regulations for contraceptive care and inform reimbursement policies. Nevertheless, there is evidence to support that a shared decisionmaking model is the right step to supporting patients while yielding better health outcomes.

Photo by Maskot via Getty Images.

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