Shared Medical Decision Making
Supporting Patient Autonomy
The U.S. has a history of coercive provision of contraception and forced sterilization. Due to this history, marginalized communities may mistrust clinicians and the broader health care system. Any counseling about postpartum contraception, especially sterilization or LARC, should be sensitive to this history. LARC can give women a decreased sense of control over their contraception, as a clinician is required for both device initiation and removal.
Health care provider bias can contribute to coercion, and health care providers are encouraged to self-reflect on their own biases and how to provide patient-centered care that supports autonomous decision-making.
The LARC Statement of Principles says, “We believe that people can and do make good decisions about the risks and benefits of drugs and medical devices when they have good information and supportive health care. We strongly support the inclusion of long-acting reversible contraceptive methods (LARCs) as part of a well-balanced mix of options, including barrier methods, oral contraceptives, and other alternatives. We reject efforts to direct women toward any particular method and caution providers and public health officials against making assumptions based on race, ethnicity, age, ability, economic status, sexual orientation, or gender identity and expression. People should be given complete information and be supported in making the best decision for their health and other unique circumstances.”
More information about the statement can be found on the NWHN’s page about LARC.
ACOG also supports the use of a reproductive justice framework for contraceptive counseling, which is essential to providing equitable health care, accessing and having coverage for contraceptive methods, and resisting potential coercion by health care providers.
Citation: Dehlendorf C, Levy K, Kelley A, Grumbach K, Steinauer J. Women’s preferences for contraceptive counseling and decision making. Contraception 2013;88:250-6.