Reproductive health providers might believe they provide unbiased contraceptive counseling, but research shows that this is not always the case.
For example, a recent study revealed that providers who said they embraced patient-centered care had used negotiating, withholding information, and delaying tactics to prevent patients from removing an intrauterine device (IUD) early.1
“In order to be really patient-centered and to provide culturally humble, patient-centered care, we have to remove ourselves from the outcome,” says Connie Folse, MPH, CHES, training and education manager for Beyond the Pill at the Bixby Center for Global Reproductive Health at the University of California, San Francisco. “We have to trust that patients are going to make the best decision for themselves, and our job is to facilitate that decision by providing factual information. It’s easier said than done.”
That is where training in neutral, nonbiased contraceptive counseling can be helpful. (For more information, see story on nonbiased contraceptive counseling techniques in this issue.)
“These trainings help walk people through and examine their own values and their communication that is subtle,” Folse says. “Training helps people liberate themselves from the need to get patients to arrive at a particular outcome.”
When providers are invested in achieving a particular outcome, such as preventing an unintended/unwanted pregnancy, they will discourage patients from discontinuing long-acting reversible contraception (LARC).
“We need to give the person neutral balance and a sounding board around contraceptive methods,” Folse says. “We fill in the gaps of knowledge and information in a way that’s free of an agenda and our preferences.”
Once a reproductive health provider learns about and employs cultural humility and unbiased counseling techniques, it can be liberating. “We get a lot of positive feedback around this idea of a sense of a weight being lifted off their shoulders when they recognize they don’t need to push the client in any particular direction,” Folse explains.
When providers accept that they do not have to be attached to a particular outcome for a patient, it is freeing and prevents burnout. “It allows them to meet the patient where the patient is,” Folse adds. “I think this is even more important now because the drive is going to be that much stronger to attract people toward highly effective methods. [These] methods are great in many respects for many people, and they’re not so great for many other people.”
The reproductive health world’s attitudes toward LARC have shifted from a magic wand and cure for poverty to the current belief they are a cure for abortion, Folse notes. The belief might be that LARC will save women from unintended pregnancies in areas without access to legal and safe abortion.
“The danger is it almost certainly will lead to counseling that’s directive in nature, rather than patient-centered,” Folse explains. “It’s really hard to trust that our patients will make the decision that’s best for them and that our patient has the answer.”
But to believe otherwise is paternalism. “We want to facilitate a process by which a patient makes their own decision, based on their own values and their own understanding of the circumstances around them, the challenges they may face, and what resources will and will not be at their disposal,” Folse says. “We have to trust the patient is going to make that decision and be able to sort of manage the outcome, and we remove ourselves a bit from it.”
Contraceptive counseling is not about saving the world. It is about providing evidence-based information to patients in a neutral way.
“We’re not trying to change people’s values. That’s really hard to do, and not something you can achieve in a training program,” Folse says. “We’re trying to get people to see how the biases they cannot help having can impact patient care negatively, and we show how to take steps to mitigate the impact of those biases.”
REFERENCE
- Harper CC, Rao L, Muñoz I, et al. Agency in contraceptive decision-making in patient care: A psychometric measure. J Gen Intern Med 2022 Sep 7. doi: 10.1007/s11606-022-07774-0. [Online ahead of print].
Reproductive health providers might believe they provide unbiased contraceptive counseling, but research shows that this is not always the case. A recent study revealed that providers who said they embraced patient-centered care had used negotiating, withholding information, and delaying tactics to prevent patients from removing an IUD early.
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