By Melinda Young
There are many approved and safe options for effective contraception available in the United States, but access is not guaranteed because of availability, costs, and other factors affecting supply, according to research.1-3 The important thing is to ensure patient autonomy in selecting a method that works best for them — even when contraception options are limited. Clinicians also can help patients obtain their desired method of birth control.
“Contraceptive technologies, broadly defined, offer the opportunity for people to make decisions and be proactive in managing whether or not they have kids and grow their families,” says Christine Dehlendorf, MD, MAS, professor and vice chair for research, family and community medicine and director of Person-Centered Reproductive Health Program in the departments of family and community medicine, obstetrics, gynecology, and reproductive sciences and epidemiology and biostatistics at the University of California, San Francisco.
“When we think about contraceptive technologies, we have to think about how it’s a benefit to society, individuals, and families,” Dehlendorf says. “But it has to be implemented and understood with attention to the fact it also provides the opportunity for control, especially given we are a society with profound inequities and bias about people’s reproduction.”
One persistent challenge for clinicians is their personal bias, she notes. “While there is a lot of verbal support for patient-centeredness and respect for patient autonomy, there continues to be a lot of bias for IUDs [intrauterine devices] and implants that is problematic,” Dehlendorf says. “People [continue to] have negative experiences with counseling in that they feel pressured to use IUDs and implants.”
Clinicians — wherever they practice — can reduce the impact of bias and help patients understand their options and how to access them by taking several steps, including the following:
Know and describe in plain language various options’ efficacy, benefits, and drawbacks: Plain language is important to identifying patients’ preferences and understanding. In the 22nd edition of Contraceptive Technology, published in 2025, there are suggestions for how to ask patients about their contraceptive preferences and concerns in plain language. For example, one question could be, “Can you tell me something that is important to you about your birth control?”4
Clinicians can use plain language when answering patients’ questions, as well. For instance, a patient’s question about how long it would take them to return to fecundity after stopping a contraceptive method could be answered in this way: “Once you stop using [birth control], your ability to get pregnant goes back to whatever is normal for you, right away.”4 Or, if a patient asks how long a particular method will work to prevent pregnancy, the answer could be, “This method is good for up to X amount of time.”4
The latest edition of the book also contains detailed clinical information about the newest contraceptives and guidelines for practitioners.
Patients who discontinue a particular contraceptive method often do so because of side effects, research shows.5 This makes it especially important to let patients know about potential side effects and what they should do if they experience one.
Also, when people start a new method, they may find it uncomfortable, such as changes in hormonal methods and menstrual bleeding. Some methods, including hormonal IUDs, may reduce or stop menstrual bleeding. Some patients may prefer the copper IUD, which allows menstrual bleeding to continue, although the bleeding may be heavier than their regular cycle.5
Support patient autonomy in contraceptive counseling: “This means supporting people’s autonomy in the environment they’re in,” Dehlendorf says. “It’s not that we know it’s better or we think we know what’s better; we support patients to understand and think about the context of lack of abortion care and reproductive services.”
The patient’s access to reproductive health services and some forms of contraception has to be integrated into their contraceptive counseling, she adds. “It means we don’t decide we know what people should decide for their contraception,” Dehlendorf says. “We support people in these environments but do not impinge on their autonomy further by making assessments that we know better than them.”
It is natural for clinicians to worry about patients lacking some family planning options, but they should not assume their advice on pregnancy prevention is more important than the patient’s concerns and decisions, she adds. “We should not think we know better than them about what their contextual circumstances should mean for them,” Dehlendorf says.
“We should support them for whatever their contextual circumstances are,” she explains. “It’s not our job that people should prevent pregnancy in any circumstance because to do that is a violation in itself of reproductive autonomy.”
Seek information to help patients with access: Healthcare resources are stretched, so clinicians may have little time to spend with patients seeking reproductive healthcare; however, educating them about their bodies is important, Dehlendorf notes.6
“We can and should be providing patients with support around their reproductive health and knowledge of their bodies,” she says. “I’ve taken care of some people who are confused about vaginal discharge that is normal after puberty, but no one told them, and they thought something was wrong.”
It also is challenging to help patients access methods that are not kept in stock and could be prohibitively expensive and/or require repeat visits to the clinic.
Suggestions for improving access to contraceptives include:
- Ask a patient if they live near a Planned Parenthood or other Title X family planning clinic, since these facilities often provide contraception at low cost to patients.
- Some states have programs that provide contraception at no cost to patients.
- When a pregnant patient is enrolled in Medicaid, it is a good time to plan for long-term reversible contraception or for permanent contraception, since those procedures could be provided at no additional cost shortly after they give birth. Medicaid requires a 30-day waiting period for permanent contraception, so this should be discussed early in the pregnancy.6
- The Women’s Reproductive Rights Assistance Project (WRRAP) helps women who are financially unable to pay for emergency contraception or safe, legal abortions.7
- Planned Parenthood provides information on how someone can afford birth control and suggests patients talk with their staff to find payment options if they are uninsured.8
Improve contraceptive counseling and communication with patients: It is up to clinicians to help patients find additional resources online that are accurate, high-quality, and evidence-based. For example, Dehlendorf recommends the AMAZE series for patients. It has more than 150 videos about sexual and reproductive health that physicians could recommend to patients.6
A recent look at the AMAZE website shows links to videos on these topics, among others:
- A Yearly Checkup: Before, During & After a Doctor’s Visit;
- Abortion with Pills: What Is It?;
- Accessing Sexual Health Care for Minors;
- Active Listening: How to Communicate Effectively;
- All About Getting Your Period;
- Anatomy of Female Bodies;
- Are You Ready to Have Sex?; and
- Birth Control Basics: Condoms, The Pill & Patch.6
Clinicians could find additional educational materials, and there are more in the pipeline of development: “We developed a tool in our team called, ‘What I need to know,’” Dehlendorf adds. “It has teen input along with adolescent knowledge of their bodies and healthcare rights, and it helps people access healthcare.” The project is seeking funding for implementation before it is rolled out, she says.
Contraceptive counseling is better if clinicians are well-informed about the history of reproductive coercion in the United States, including events in the recent past, Dehlendorf says.9-11
There were states that forced sterilization on women in the 1900s. Even as recently as 2006-2010, there were incarcerated women in Atlanta and California who were forcibly sterilized, she adds.9-11 “A doctor decided that it was for the best in his assessment for these people to not reproduce anymore, and basically, he would operate on them without telling them he would sterilize them,” Dehlendorf says.11
This pattern of taking away women’s bodily autonomy makes it especially important that today’s clinicians make sure patients have the final word on their contraceptive decisions, she adds.
“I’m a family doctor,” Dehlendorf says. “I think these are difficult times to provide sexual and reproductive healthcare to our community, and it is also a time where it’s all the more important that we stay true to our values and build trust with our communities to make sure they come back to see us.”
Providers need to protect patients’ reproductive autonomy, she adds. “Our role is to not change people’s decisions but rather to remember that our professional responsibility is to protect people’s ability to make decisions about their own lives,” Dehlendorf says.
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Harper CC, Brown K, Arora KS. Contraceptive access in the US post-Dobbs. JAMA Int Med. 2024;184(11):1279-1280.
2. Rodriguez MI, Heath THA, Daly A, et al. Twelve-month contraceptive supply policies and Medicaid contraceptive dispensing. JAMA Health Forum. 2024;5(8):e242755.
3. Sleiman J. Policy vs. practice: Hurdles in expanding birth control access. Public Health Post. Feb. 5, 2025. https://publichealthpost.org/sexual-reproductive-health/policy-vs-practice-hurdles-in-expanding-birth-control-access/
4. Cason P, Cwiak C, Edelman A, et al. Contraceptive Technology. 2025; 22nd Revised Edition. Jones & Bartlett:94-96.
5. Cason P, Cwiak C, Edelman A, et al. Contraceptive Technology. 2025; 22nd Revised Edition. Jones & Bartlett:160-161.
6. AMAZE. Video descriptions. https://amaze.org/video-descriptions/
7. Women’s Reproductive Rights Assistance Project (WRRAP). https://wrrap.org/
8. Attia, Planned Parenthood. What if I can’t afford birth control? Planned Parenthood. April 24, 2025. https://www.plannedparenthood.org/blog/what-if-i-cant-afford-birth-control
9. Agtuca J, Turner K. Past and current United States policies of forced sterilization. National National Indigenous Women’s Resource Center. https://www.niwrc.org/restoration-magazine/november-2020/past-and-current-united-states-policies-forced-sterilization
10. Chappell B. California’s prison sterilizations reportedly echo eugenics era. NPR. July 9, 2013. https://www.npr.org/sections/thetwo-way/2013/07/09/200444613/californias-prison-sterilizations-reportedly-echoes-eugenics-era
11. Hall D. ICE sterilizations in Georgia evoke tragic chapters in South’s history. Facing South. Nov. 19, 2020. https://www.facingsouth.org/2020/11/ice-sterilizations-georgia-evoke-tragic-chapters-souths-history
The important thing is to ensure patient autonomy in selecting a method that works best for them — even when contraception options are limited. Clinicians also can help patients obtain their desired method of birth control.
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