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Breaking the Contraceptive Barrier: Techniques for Effective Contraceptive Consultations

(Published September 2008)

Partner Considerations

For many women, their partner presents a barrier to effective contraception. Situations range from partners having different views on contraception to situations involving intimate partner violence (IPV).1

Some women who are having abortions have told health care providers that their partner’s expectations and desires had prevented them from using a method consistently or at all.2 Men can play an important role in ensuring contraceptive success. This is particularly true when couples rely on condoms, withdrawal, or periodic abstinence. Partner consent, cooperation, and understanding are also important for ensuring success with other contraceptive methods.

Strategies for breaking barriers related to intimate partner violence7
  • Institute routine screening of all patients—this is the single greatest step health professionals can take in identifying victims of domestic abuse.
  • The American Medical Association recommends asking women, “Are you now or have you ever been in a relationship where you have been abused physically, emotionally, or sexually?”
  • If a woman acknowledges violence or abuse, follow up with questions such as:
    • Is it safe for you to go home?
    • Do you need immediate shelter?
    • Are your children safe?
    • Is there a friend, neighbor, family member, or acquaintance you can call?
    • Do you need crisis counseling right now?
    • Do you have a safety plan if you need to leave?
    • Are you aware of possible resources?
  • For information for patients and providers, contact the National Domestic Violence Hotline at www.ndvh.org or 1-800-799-SAFE (7233).
  • Intervene, support, document, and refer patients, as appropriate. Consider services of a case manager, legal resources, court advocacy programs, or victim services.
  • Assure the patient about your concerns for her health and welfare. Help her create an exit strategy or give her resources for developing an exit strategy, such as the National Domestic Violence Hotline.
  • Deliver messages such as “You do not deserve to be abused,” “What happened to you is against the law,” and “You are not alone. There is help available.”
  • Schedule follow-up appointment(s)—this is very important for providing the patient with support through the changes she may be undergoing in her life.

After years of inadequate sexual education for adolescents, there is now a large adult population with inadequate and often inaccurate information about sexuality and contraception. Many men and women don’t know where to learn about and discuss relationships, sexuality, and contraception. Health care providers can fill an important role in educating men, as well as women, about fertility, contraception, and access to reproductive health services.2

In more extreme cases, intimate partner violence contributes to unintended pregnancy. IPV affects about 1.5 million women in the United States each year. Nearly one in four women experiences IPV at some point during her life.3 Women in violent relationships may be forced or coerced into having sex. Often these women cannot control or negotiate the regular use of contraception.4 Recent studies show an association between women experiencing IPV and unintended pregnancy and abortion.5 It is estimated that more than 32,000 pregnancies in the United States each year result from rape.6

References:

  1. Garcia-Moreno C. Dilemmas and opportunities for an appropriate healthservice response to violence against women. Lancet. 2002;359:1509-14.
  2. Jones RK, Darroch JE, Henshaw SK. Contraceptive use among US women having abortions in 2000-2001. Perspect Sex Reprod Health. 2002;34(6):294-303.
  3. Tjaden P, Thoennes N. Full report of the prevalence, incidence, and consequences of violence against women. Findings from the National Violence Against Women Survey. Publication NCJ 183781. Washington, DC: US Department of Justice, Office of Justice Programs; 2000.
  4. Glasier A, Gülmezoglu AM, Schmid GP, Moreno CG, Van Look PF. Sexual and reproductive health: a matter of life and death. Lancet. 2006; 368:1595-607.
  5. Steinberg JR and Russo NF. Abortion and anxiety: What’s the relationship? Soc Sci Med. 2008 Jul;67(2):238-52.
  6. Holmes M, Resnick SH, Kilpatric DG, Best CL. Rape-related pregnancy: estimates and descriptive characteristics from a national sample of women. Am J Obstet Gynecol. 1996;175:320-4.
  7. Hadley SM. The orthopaedic response to family violence: linking the orthopaedic patient with community family violence resources. Orthopaed Nurs. 2002;21(5):19-23.