(Published June 2006)

Introduction

With the exception of a fictional name, the following case study reflects actual events. Alissa Smith is a 25-year-old woman with three children who does not currently desire additional children. She has tried a number of contraceptive methods that did not fit her needs and values: She developed nausea with the contraceptive patch, had difficulty remembering to take oral contraceptives (OCs) on a daily basis, and was not interested in intrauterine contraception or in methods requiring vaginal insertion. She eventually tried depot medroxyprogesterone acetate (DMPA) and had been satisfied with the method for three years.

The primary care clinic at which she received care changed its policy and stopped prescribing DMPA. Ms. Smith was told by her provider that it was “bad for bones” but was given no information about specific risks or benefits. She left the clinic without a plan for effective contraception. Within three months, Ms. Smith became pregnant and chose to undergo an early medical abortion.

After the abortion, a provider at another facility described the specific risks associated with DMPA, placing them in context with risks that were relevant to Ms. Smith’s situation. Ms. Smith weighed the risks and benefits associated with DMPA and decided to resume the hormonal contraceptive.

People cannot make truly informed health decisions when given general information about risks without context or perspective. In situations such as the one described in this case study, it is important for providers to help women weigh the risks of adverse events associated with a contraceptive against the risks associated with unintended pregnancy. When providers place specific risks and benefits in context, a woman can make a more informed choice about the contraceptive best suited for her health profile, lifestyle, and values.