Should EDs Offer Contraceptives, Related Family Planning Education?
September 1, 2022 3 minutes read
By Dorothy Brooks
With many states implementing or planning to implement stringent new restrictions on access to abortion, some clinicians are urging their colleagues to take strong steps to ensure the contraceptive needs of women are met.
The authors of a recently published editorial called on hospitalists to offer contraceptive counseling to all women of childbearing age, regardless of the reason for hospitalization.1 However, even more women could be reached with contraceptive counseling if the issue was raised during encounters in the ED.
Is such an approach realistic, considering the time-sensitive nature of responding to emergency needs? How would patients receive this idea? Caitlin Bernard, MD, MS, an assistant professor of clinical obstetrics and gynecology at Indiana University-Purdue University Indianapolis, studied the latter issue recently.
In a cross-sectional survey, Bernard and colleagues surveyed women about their interest in receiving contraceptives and/or information about contraceptives in the ED. The survey took place at two large academic EDs between June 2018 and September 2019. There were 505 participants between ages 18 and 50 years.
Investigators found 55.2% said they would be interested in receiving information about contraceptives and actual contraceptives in the ED if such services were available. Further, among patients indicating they did not want to conceive in the next year, 32.6% indicated they were not using anything to prevent pregnancy.2
Despite these findings, Bernard says it is important to ensure administrators are not overly coercive in their approach. “I want to caution people against assuming that everybody wants to use birth control or wants to talk about using birth control ... when that is not necessarily the patient’s priority or desire at that point,” she explains.
Bernard adds providing birth control pills to every woman of childbearing age who presents to the ED would not be advisable. “It would not give them more than one month of contraceptive coverage. The long-term value of that is not particularly helpful,” she argues. “Also, many people are not good candidates or don’t necessarily want to use birth control pills. You would need to offer all of the comprehensive contraceptive counseling and provision that would be appropriate for a patient.”
However, considering a significant proportion of the study participants indicated they would be interested in learning about birth control, Bernard notes EDs could provide patients with a pamphlet or a QR code they could scan to find resources in the community. Some EDs also might facilitate an appointment or provide a warm handoff to an OB/GYN who can offer the full range of contraceptive options.
Lily Bayat, MD, MPH, an OB/GYN at Robert Wood Johnson University Hospital in New Brunswick, NJ, believes EDs can play a role in helping prevent unintended pregnancy. “At any point in a patient’s journey, if we can help her get contraception — if that is what she wants — then that will be helpful. It can have long-term [impact] in reducing maternal morbidity and mortality,” she says.
Further, Bayat notes it is not only physicians who can provide contraceptive counseling. “At many Planned Parenthood sites, they don’t have doctors and nurses doing the birth control counseling. They have counselors who they have trained for this purpose. They go through the patient’s medical history to make sure the patient doesn’t have any contraindications to birth control,” she explains.
Bayat notes medical students or other personnel could be trained to provide such counseling in the ED. However, she cautions actually providing patients with some contraceptive options would require procedures an OB/GYN or family medicine provider would need to perform unless an emergency provider was trained in this area.
REFERENCES
1. Barrett E, Chambers-Kersh L. Urgent call to action: Engaging hospitalists in family planning. Ann Intern Med 2022; Jun 28. doi: 10.7326/M22-1450. [Online ahead of print].
2. Alexander AB, Chernoby K, VanderVinne N, et al. Acceptability of contraceptive services in the emergency department: A cross-sectional survey. West J Emerg Med 2021;22:769-774.
With many states implementing or planning to implement stringent new restrictions on access to abortion, some clinicians are urging their colleagues to take strong steps to ensure the contraceptive needs of women are met.
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