New guidance issued by the American College of Obstetricians and Gynecologists advises clinicians to “apply a patient-centered, reproductive justice framework to contraceptive counseling”, as it can play an integral role in an individual's health and wellness.
The guidance was released on Jan.20 to “help patients achieve their reproductive goals”, according to a new committee statement from the American College of Obstetricians and Gynecologists (ACOG).
"Counseling is an opportunity to solicit an individual's values, preferences, and insight into what matters most to them as it relates to contraception," reads the new guidance, produced jointly by ACOG's Committee on Health Care for Underserved Women, Contraceptive Equity Expert Work Group, and Committee on Ethics.
Providers are advised to acknowledge historical and ongoing reproductive mistreatment of people of color and other marginalized individuals. The statement calls for providers to recognize that “counselor bias, unconscious or otherwise”, affects care.
The ACOG calls to prioritize patients' values, preferences, and lived experiences in the selection or discontinuation of a contraceptive method, and adhere to the recommended ethical approach of shared decision-making.
"Listening to our patients and understanding their values, preferences, and lived experiences will help us ensure that—if contraception is desired—each of our patients can select the right contraception for them," said Melissa Kottke, MD, MPH, MBA, FACOG, co-writer of the statement, and a former ACOG committee member on Health Care for Underserved Women. "That means looking past our own opinions about contraception and working to overcome our biases about our patients' needs—and it applies equally to contraceptive selection and discontinuation."
According to Kavita Arora, MD, MBE, MS, FACOG, who chairs ACOG's Committee on Ethics and co-writer of the statement, there must be a "shared decision-making approach to contraceptive counseling".
“By promoting honest, transparent, and open conversations, shared decision-making is more likely to help our patients be satisfied with their contraceptive choices," Arora said.
The patient-centered approach stems from a reproductive justice framework created in 1994 by Black women activists to explain that all people have a fundamental right to bodily autonomy. Throughout U.S. history, contraceptive experimentation without informed consent, government-sponsored forced sterilization, and other reproductive mistreatment have, and continue to target people of color, people with low incomes, incarcerated individuals, and people with mental illness.
California Gov. Gavin Newsom recently announced a program that will compensate survivors of state-sponsored sterilization as a part of the 2021-2022 state budget package.
"As lifelong learners, it is the privilege and responsibility of obstetrician-gynecologists to learn from the past to better support patients regarding their contraceptive choices with respect and dignity," said Jen Villavicencio, MD, MPP, FACOG, lead for equity transformation at ACOG and a co-author of the statement.
According to Arora, the new guidelines remind medical professionals that a patient has multiple concerns or priorities beyond the efficacy of birth control, noting that contraception and reproductive life planning are "inherently personal." Though doctors may prioritize a treatment that has the highest efficacy in preventing pregnancy than the patient's priorities.
Intrauterine devices (IUDs) are an example of a highly effective form of birth control, though some patients raised concern regarding how invasive the device can be, or prefer a method of birth control that is easier to start and stop, according to the statement.
"Decisions about birth control are not static, and our patients' preferences change over time, just as their lives change," said Lisa Goldthwaite, MD, MPH, FACOG, and Co-author of the statement. "Implementing a patient-centered framework for contraceptive counseling will help clinicians support their patients in a way that reflects their evolving priorities throughout the years."
