• Posted May 24, 2022

With Abortion Access Under Threat, Doctors Focus on 'Contraceptive Counseling'

Women are more apt to use birth control when doctors treat it like a routine preventive health service, a new research review shows.

The analysis of 38 past studies found that women were more likely to use contraception when doctors were proactive about counseling them on the options, and in many cases providing the contraceptive.

The studies took place in various health care settings -- from family practices, to school health centers, to opioid treatment programs. And experts said the findings underscore an important point: Women should be able to receive contraceptive care from any primary care provider, not just their obstetrician-gynecologist.

That's now more critical than ever, said Dr. Christine Laine, as it appears likely Roe v. Wade will be overturned, curtailing abortion services for many U.S. women.

Laine is editor-in-chief of the Annals of Internal Medicine, which published the analysis and an accompanying editorial May 24.

She said that ideally, primary care providers should "have the facility to discuss contraception options, just like we do with diabetes treatment options."

But, Laine added, that is not always the reality. She said that compared with other routine preventive services -- such as cancer screenings and blood pressure and cholesterol checks -- contraceptive care does not get as much attention.

That's despite the fact that an estimated 43% of U.S. pregnancies are unintended.

"That figure is pretty astounding," Laine said, "in a country as affluent as the U.S., where plenty of safe options for contraception are available."

Laine noted that unintended pregnancies are not necessarily unwanted. But for a variety of reasons, she said, it's best for women to be able to plan pregnancy -- to get any chronic health conditions under good control, and to start prenatal care as soon as possible, for example.

Dr. Heidi Nelson, the lead researcher on the analysis, agreed.

"Every patient deserves the highest quality of care," said Nelson, a professor at Kaiser Permanente Bernard J. Tyson School of Medicine in Pasadena, Calif.

And for women of childbearing age, she said, that should include ready access to contraceptive care.

"We really need to broaden the range of providers who offer it," Nelson said.

For the analysis, her team looked at 38 clinical trials that tested the effects of doing more than the "usual" to provide women with contraception.

"These interventions were proactive," Nelson said. "Instead of patients having to ask, they were provided with contraceptive care."

In some trials, that meant providers and patients discussing the range of options, and either giving women the contraceptive on site or providing a referral. Some trials involved giving women emergency contraception, rather than information only. Emergency contraception -- or "morning after" pills -- are taken after sex, to stop a pregnancy before it starts.

Some other trials, at hospitals and family planning clinics, offered women contraception soon after childbirth or an abortion -- providing a contraceptive implant, for example, to women who wanted it.

The trials' details all differed to a degree, but the results were similar, Nelson said: "Doing more than the usual seems to work."

On average, providing women with emergency contraception doubled their use of it in the next six months, the analysis found. Meanwhile, counseling increased contraceptive use by 39%, and post-childbirth and post-abortion contraceptive care boosted that figure by 15% to 19%.

Often, Laine said, women themselves believe they have to see an ob-gyn for information on birth control. But she said they should feel free to broach the subject with any health care provider.

It's true that not all providers will offer all contraceptive services. Some will not be trained in how to insert an intrauterine device, for example, Laine said. But, she added, they should be able to refer women to a provider who can.

And if more and more women ask primary care providers about contraception, that message will get through, according to Laine.

Nelson agreed.

"Until we have contraceptive care routinely offered as a preventive health care service, patients need to be proactive in seeking it," she said.

And, Nelson added, it is covered under the Affordable Care Act (commonly known as "Obamacare"). The federal law required insurers to cover prescription contraception, with no out-of-pocket costs to patients.

More information

The U.S. Office on Women's Health has more on birth control options.

SOURCES: Heidi Nelson, MD, MPH, professor, health systems science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif.; Christine Laine, MD, MPH, editor-in-chief, Annals of Internal Medicine; Annals of Internal Medicine, May 24, 2022, online