Contraceptive counseling conversations: consider intentional questions

As a healthcare professional, you can help your patients make informed choices by consistently discussing all contraceptive options, including LARC options. By asking the right questions, you can support your patients in choosing a contraception that best fits their needs.^4,5

An essential aspect of contraceptive counseling that helps your patients decide which method to choose is prioritizing their values, preferences, and lived experiences.⁴

In the shared decision-making model, both you as the healthcare professional and your patient are recognized as having valued expertise.⁴

Here are a few ways you can initiate this conversation with your patients:

Ask open-ended questions about your patient’s priorities and values related to their pregnancy goals and desired contraceptive features⁴

Share details about the medical contraindications, risks, and benefits for each method⁴

Reflect knowledge back to your patient about their desired attributes and how individual contraceptive methods may or may not satisfy those priorities⁴

Allow your patient to consider all their contraceptive options and determine which of these best meets their needs before they choose a contraceptive method⁴

Resources and recommendations to help you stay up-to-date on counseling

Below are some resources you can use to help facilitate the contraceptive conversation

Shared Decision-Making Conversation Resource

This quick start guide provides sample questions that can be used for engaging patients in joint contraceptive decisions.

Download PDF

Questionnaire: Patient Perspectives on Birth Control

This 10-question resource can be used to help facilitate contraceptive counseling conversations with your patients.

Download PDF

Contraceptive counseling: What do medical societies recommend?

Now more than ever, discussing contraceptive options with your patients is an important topic. Many leading medical societies have outlined recommendations on best practices for counseling. Take a look below to learn more.

American College of Obstetricians and Gynecologists (ACOG)

In February 2022, ACOG issued a committee statement regarding patient-centered contraceptive counseling.⁴

ACOG recommends that ob/gyns intentionally incorporate the reproductive justice framework into contraceptive counseling⁴:

Acknowledge the historical and ongoing reproductive mistreatment of people of color and other marginalized individuals whose reproductive rights have been devalued
Recognize that counselor bias, unconscious or otherwise, can affect care, and work to minimize the effect of bias on counseling and care provision
Prioritize patients’ values, preferences, and lived experiences in the selection or discontinuation of a contraceptive method

Ob/gyns should adhere to the recommended ethical approach of shared decision-making through patient-centered contraceptive counseling.⁴

American Academy of Family Physicians (AAFP)

In their position paper on preconception care, the AAFP states, “Preconception care is primary care, and it should be a priority for primary care providers in all settings.” The AAFP considers preconception care as “individualized care for men and women that is focused on reducing patient and fetal morbidity and mortality, increasing the chances of conception when pregnancy is desired, and providing contraceptive counseling to help prevent unintended pregnancies.”⁶

The AAFP recommends that family physicians and primary care providers become leaders in preconception care as they are “ideally suited” for this task, having “an outstanding opportunity to address health issues (eg, preconception risk reduction and chronic disease management) with patients in multiple settings.”⁶

Selected AAFP Preconception Care Recommendation⁶:

Family physicians and primary care providers should⁶:

Understand unintended pregnancy (UIP) risk factors and realities
Recognize how reproductive planning can reduce UIP risk factors
Incorporate preconception health risk assessment during care visits that are not specifically focused contraceptive on women’s health issues
Present information on effective contraceptive options

American Academy of Pediatrics (AAP)

The AAP considers contraception a “pillar in reducing adolescent pregnancy rates” and recommends that pediatricians adopt practices that will help reduce postmenarchal adolescent unintended pregnancy.⁷

The AAP recommends⁷:

Postmenarchal adolescent contraceptive counseling should include a broad range of appropriate contraceptive options
Contraceptive options for postmenarchal adolescents should include long-acting reversible contraceptive methods, such as implants and IUDs

Want to find out more about one contraceptive option for your patients?

References & Abbreviations

LARC = long-acting reversible contraception; Ob/gyns = obstetricians and gynecologists; IUD = intrauterine device.

References: 1. Quick Stats: Percentage of women who have ever used emergency contraception among women aged 22–49 years who have ever had sexual intercourse, by education—National Survey of Family Growth, United States, 2017–2019. MMWR Morb Mortal Wkly Rep. 2021;70. doi: 10.15585/mmwr.mm7004a7 2. Faustmann T, Crocker J, Moeller C, Engler Y, Caetano C, Buhling KJ. How do women and health care professionals view hormonal long-acting reversible contraception? Results from an international survey. Eur J Contracept Reprod Health Care. 2019;24(6):422–429. 3. Lindberg LD, VandeVusse A, Mueller J, Kirstein M. Early impacts of the COVID-19 pandemic: findings from the 2020 Guttmacher survey of reproductive health experiences. Accessed September 26, 2023. https://www.guttmacher.org/sites/default/files/report_pdf/early-impacts-covid-19-pandemic-findings-2020-guttmacher-survey-reproductive-health.pdf 4. Committee on Health Care for Underserved Women and Committee on Ethics. ACOG Committee Statement Number 1: Patient-centered contraceptive counseling. Obstet Gynecol. 2022;139(2):350-353. doi:10.1097/AOG.0000000000004659 5. Gavin L, Moskosky S, Carter M, et al; Centers for Disease Control and Prevention (CDC). Providing quality family planning services: recommendations of CDC and the U.S. Office of Population Affairs. MMWR Recomm Rep. 2014 Apr 25;63(4):1-54. 6. American Academy of Family Physicians. Preconception Care (Position Paper). 2015. Accessed September 26, 2023. https://www.aafp.org/about/policies/all/preconception-care.html 7. Ott MA, Sucato GS. American Academy of Pediatrics Committee on Adolescence. Contraception for adolescents. Policy statement. Pediatrics. 2014;134(4):e1244–e1256.