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Breaking the Contraceptive Barrier: Techniques for Effective Contraceptive Consultations

(Published September 2008)

Introduction

As a health care provider, do you ever feel that you are not making the impact you want in helping women avoid unintended pregnancies? If so, that’s not surprising, given that in the United States, one in two women between the ages of 15 and 44 have unintentionally become pregnant,3 fifty-two percent of these women used no contraceptive method during the month in which they became pregnant.4,5 Just over 40 percent of women who have an unintended pregnancy used contraceptive methods inconsistently or incorrectly. The remaining 5 percent of unintended pregnancies can be attributed to failure of a contraceptive method.5-7

"I’ve often wondered what it would be like if we taught young people swimming the same way we teach sexuality. If we told them that swimming was an important adult activity, one they will all have to be skilled at when they grow up, but we never talked to them about it. We never showed them the pool. We just allowed them to stand outside the closed doors and listen to all the splashing. Occasionally, they might catch a glimpse of partially clothed people going in and out of the door to the pool and maybe they’d find a hidden book on the art of swimming, but when they asked a question about how swimming felt or what it was about, they would be greeted with blank or embarrassed looks. Suddenly, when they turn 18 we would fling open the doors to the swimming pool and they would jump in. Miraculously, some might learn to tread water, but many would drown."
- Elizabeth Roberts1,2
Many factors influence a woman’s use of contraceptives— and many barriers stand in the way. This publication will help identify barriers to access and effective use of contraception and provide practical ideas for helping women break through them.

The first step is recognizing the barriers, some of which are:

  • Personal beliefs (including historical, cultural, or religious beliefs) that can prevent use of contraception and a realistic view of risk of pregnancy
  • Partner’s beliefs and behaviors that can influence contraceptive use
  • Lack of knowledge and incorrect use of contraceptive methods
  • The media’s heavy emphasis on sex and minimal information about contraception
  • Inadequate sexual education curricula, with a current emphasis on abstinence-only programs, rather than comprehensive programs that include contraception and prevention of sexually transmitted infections (STIs)
  • Health care system barriers, such as delayed start of contraception, misinformation, insurance, and costs

Once you recognize the barriers, you can develop patientcentered strategies to address them.8 This case study-based publication will help you recognize contraceptive barriers and provide strategies for breaking through them and optimizing care for each patient. It will help you understand the reasons a woman visits a health care provider and the information she needs. It reinforces the importance of listening to each woman’s concerns about contraceptive methods and encouraging her use of methods that she trusts. The case studies highlight collaborative processes for developing solutions to her issues and addressing her concerns. The key is to take a humanistic approach to care and to see each woman as a whole person, with her own emotional needs, medical problems, and life issues. Being maximally effective in helping your patients select and use contraception requires much more than supplying them with a prescription. Armed with the strategies discussed in this publication, you can add new dimensions to your continuing relationships with women and deliver care that emphasizes prevention, reduces risks, and promotes health.

References

  1. Roberts E. Teens, sexuality and sex: our mixed messages. Television & Children. 1983;6:9-12.
  2. Strasburger VC. Adolescents, sex and the media: Ooooo, baby, baby. A Q&A. Adolesc Med Clin. 2005;16:269-88.
  3. Henshaw SK. Unintended pregnancy in the United States. Fam Plann Perspect. 1998;30:24-9, 46.
  4. Trussell J. Reducing unintended pregnancy in the United States. Editorial. Contraception. 2008;77:1-5.
  5. Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health. 2006;38(2):90-6.
  6. Trussell J. Contraceptive Efficacy. In: Hatcher RA, Trussell J, Nelson AL, Cates W Jr, Stewart FH, and Kowal D, editors. Contraceptive Technology. 19th rev. 3rd. ed. New York: Ardent Media Inc; 2007.
  7. Kost K, Singh S, Vaughan B, Trussell J, Bankole A. Estimates of contraceptive failure from the 2002 National Survey of Family Growth. Contraception. 2008;77:10-21.
  8. Little P, Everitt H, Williamson I, Warner G, Moore H, Gould C, et al. Preferences of patients for patient centered approach to consultation in primary care: observational study. BMJ. 2001;322:1-7.