“Contraception counseling and provision are vital components of comprehensive health care,” write authors of an In the Clinic review of contraception. “An unplanned pregnancy can be particularly challenging for patients with chronic illness. Internal medicine physicians are uniquely positioned to assess pregnancy readiness and provide contraception, as they often intersect with pregnancy-capable patients at the moment of a new diagnosis or when providing ongoing care for a chronic medical condition. A shared decision-making counseling approach engages patients, ensures patient-centered care, and supports their choice of a contraceptive method that aligns with their reproductive plans and medical needs.”
The authors describe potentially challenging ethical situations when clinicians are discussing long-acting reversible contraception (LARC) with patients: “When a clinician’s values and lived experiences differ from those of their patients, clinicians risk imposing their values preferentially and engaging in coercive care. Clinician concern about potential contraceptive failure must not eclipse an individual’s right to contraceptive preference (including no method at all). Prior efforts to promote contraceptive use, particularly LARC methods, as solutions to poverty, adolescent pregnancy, or inequities in unintended pregnancy rates resulted in the coercion and oppression of groups that were already marginalized by society and the health care system, effectively limiting contraceptive options for these populations. Clinicians should recognize each patient’s cultural, racial, religious, socioeconomic, language, and educational backgrounds and avoid harmful and imbalanced power dynamics. Thus, patient-centered and shared decision-making approaches to contraceptive counseling are particularly important.”
Editorial: “The In the Clinic review provides an elegant outline of the key steps any clinician, regardless of their specialty, can take to initiate important conversations about pregnancy intention and to help patients interested in contraception understand which methods are effective and safe in the context of their medical comorbidities,” an editorialist writes. “All clinicians who care for patients of reproductive potential should become comfortable discussing pregnancy intent, preconception risk assessment, and contraceptive counseling. Such conversations should not be restricted to primary care, gynecology, or even Women’s Heart Health programs, as many people of reproductive potential never present to such settings. As pregnancy-associated mortality increases and abortion access decreases in the United States, all encounters with patients of reproductive potential present opportunities to help them realize their pregnancy goals and avoid unintended pregnancy. Preconception and contraceptive counseling has never been more important—this is our lane.”