Patients Who Perceive Contraceptive Coercion Report Psychological Distress
June 1, 2025 5 minutes read
By Melinda Young
When patients perceive contraception coercion from their providers, they are less likely to eventually receive their preferred contraceptive method and also may report higher levels of psychological stress, new research shows.1,2 The purpose of the research is to better understand how contraceptive coercion manifests, which groups are more likely to experience coercion, and how contraceptive coercion affects people’s lives, says Laura E.T. Swan, PhD, LCSW, a senior research scientist at the Reproductive Equity Action Lab at the University of Wisconsin-Madison.
“We define contraceptive coercion as pressure from the healthcare provider to use or not use birth control,” she explains. “Upward coercion is to use birth control, and downward coercion is to not use birth control.” Coercion can be subtle, such as when a provider implies a preference for a certain method. More overtly, coercion occurs when the provider refuses to give a patient a birth control prescription or refuses to remove an intrauterine device (IUD), she adds.Upward coercion is more common, but downward coercion still happens, Swan notes.
Coercion is common: One in five participants in Swan’s research reported experiencing some kind of coercion in their last contraceptive counseling session. There were three times more reports of upward coercion than downward coercion, she says.1 The most common types of coercion involve pressure to use or not use birth control, pressure to use or not use an IUD, and refusals of permanent contraception, Swan says.
Those who experienced contraceptive coercion reported lower emotional wellbeing and lower psychological wellbeing when compared to those who did not experience coercion.1 Researchers found that experiencing any type of pressure from a healthcare provider to use or not use birth control is linked to feelings of nervousness, hopelessness, restlessness, depression, and worthlessness.1 In another study with online survey responses, one in six participants reported experiencing contraceptive coercion during their last contraceptive counseling.2
Those who experienced any contraceptive coercion at last counseling had significantly lower odds of using their preferred contraceptive. The findings also suggested that patients who had perceived downward pressure from their provider — being denied their desired contraception — were statistically significantly less likely to be using their preferred contraceptive method.2
“In analyses, when we only looked at contraceptive use and contraceptive coercion, we found a statistically significant relation for both upward and downward coercion,” Swan says. “Once we controlled for socioeconomic factors, the relationship was still there for downward coercion but not statistically significant for upward coercion.”
The bottom line is investigators need more research to understand that finding, she adds. “Is it that downward coercion impacts contraceptive use and people’s ability to use their preferred method, whereas upward coercion doesn’t? Or does the sociodemographic that we controlled for explain that relationship?”
Swan wants to study more about what type of coercion is happening and how it affects people’s lives. She speculates that coercion sometimes occurs when a person is already using a birth control pill and is interested in switching to another method. “They are perceiving that their provider is not giving them what they need to switch their method,” Swan says. “That’s one possible pathway of how coercion could happen.” Another pathway is when a person does not want to use any birth control method but feels pressured into it by a provider.
For a study that looked at the relationship between patients’ perceived contraceptive coercion and their mental health, investigators found a relationship between the two.1 “We found patients who felt pressured to use or not use birth control had worse psychological distress and wellbeing,” Swan says. “That connection between contraceptive coercion and mental health speaks to the damage it causes.” It also demonstrates the importance of protecting patient autonomy during contraceptive care, she adds.
“This one study is cross-sectional. We collected data at one point in time,” Swan explains. “It’s difficult to say that coercion causes mental health issues or that mental health issues cause people to experience coercion. What the study tells us is there is a relationship happening here between these two variables.”
Future research could explore how these variables are related and what clinicians can change in visits with patients to better safeguard their wellbeing. Societal changes and pressure could possibly have an impact on contraceptive coercion, as well. Clinicians working in areas of the country where some types of contraception are more difficult to obtain or where abortion is banned may think they are doing the right thing to provide some pressure for patients to use a particular method, such as long-acting reversible contraception (LARC).
But they need to keep in mind that the importance of patient-centered contraceptive care has not changed, even if laws affecting women’s reproductive healthcare have. “Patient-centered contraceptive care means we have to tailor care to the needs of each patient,” Swan says. “Providers should work to address their own biases about who should or should not be having children and using birth control.”
Biases are built into the systems around OB/GYNs, and this has been true for years. “Many providers were taught implicitly or explicitly under those systems that more effective methods like LARCs are better than other methods,” Swan says. “So, providers should work to dismantle those beliefs and the systems that promote those ideas.”
Eliminating bias also requires providers to pay attention to patients’ concerns about side effects and access barriers. “They should do what they can in that clinical encounter to help the patient achieve their contraceptive goals,” Swan says. “The right method is whatever method the patient prefers, even if it means using no method at all or a less effective method.”
OB/GYNs also can advocate for better state legislation and share information with their patients about contraceptives and obtaining ones where access is an issue. “It’s about working together — patient and provider — to help within existing systems to help them reach their reproductive and contraceptive goals in the best way possible,” she explains.
The research findings show how contraceptive coercion affects patients and why it is important to make sure all reproductive healthcare is not coercive. There are potential long-lasting impacts on people’s lives, Swan adds.
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Swan LET, Wasser O, Cannon LM. The importance of patient-centered contraceptive care: Linking provider contraceptive coercion to patient psychological distress and mental well-being. Sex Reprod Healthc. 2025;43:101073.
2. Swan LET, Cannon LM, Lands M, Zhao IH. Patient preferences or provider pressure? The relationship between coercive contraceptive care and preferred contraceptive use. Healthcare (Basel). 2025;13(2):145.
When patients perceive contraception coercion from their providers, they are less likely to eventually receive their preferred contraceptive method and also may report higher levels of psychological stress, new research shows.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content