Decisions about how many children to have (if any) or what type of contraception to use are complex. For patients who are not health care providers, the doctor-patient relationship remains a critical relationship by which these sometimes difficult decisions are navigated. As a practicing gynecologist for 13 years, I continue to be mystified at how many women report to me a nearly complete lack of counseling prior to being prescribed a contraceptive.
A health care provider’s (HCP) obligation is to explain the risks and benefits of various birth control methods in order to choose the one that is most acceptable to the patient in the context of that patient’s medical history, family history, personal risk factors such as smoking as well as issues of convenience and cost. There has been a recent move in the U.S. to make oral contraceptive pills (OCPs) over the counter, expediting counseling sessions with check-off lists and brief discussions with a pharmacist rather than a HCP. Knowing how busy pharmacists are filling prescriptions all day, I question the reality of these overworked professionals being able to adequately screen and counsel patients on top of their own duties.
Unfortunately, contraceptive counseling is frequently not extensive or thorough, and many patients feel that they did not truly give informed consent when it came to accepting a contraceptive method. Whether this is due to time constraints on the part of the HCP, an erroneous assumption that a patient would prefer a certain type of birth control, or simply an inadequate knowledge base, patients frequently report that they not made aware of how their birth control works such as taking a OCP at the same time every day. They may experience side effects that they do not relate to the contraceptive.
In some populations, especially low-income urban ones, certain types of birth control seem to be suggested more often than those recommended in the wealthier suburbs. More urban women are offered shots, implants or IUDs rather than oral contraceptives or fertility awareness methods. This is also true in developing countries where shots and implants are encouraged over pills (too easy to forget) and IUDs (require more skill to insert). Extensive counseling about methods, risks and benefits may be lacking due to poor training of community health workers (who are not doctors or nurses), language barriers, or lack of a locally available variety of birth control options.
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