Changing the Conversation: Contraception

Think of a typical medical student or resident: mid to late twenties, a dedicated student with ambitious career plans, likely to be highly-motivated to avoid pregnancy until the opportune, pre-determined moment. These are not universal characteristics, and yet, as family planning practitioners and educators, concerns about contraceptive efficacy often dominate the care we give to patients.

Our teaching should help develop empathy in future clinicians to help them see that their own attitudes about pregnancy may not be aligned with their patients. As patient-centered practitioners, their first priority should be meeting the needs of each individual in their exam room, not working on population-level public health goals.

At the North American Forum on Family Planning last month, we were excited to see two plenary sessions highlighting opportunities to reframe the way we think about patient’s attitudes toward pregnancy and choices within the context of preference-sensitive health care decisions. Here is part 1, check back next week for part 2.

In the panel entitled “Advancing the understanding of unintended pregnancy: Broadening our perspective to improve research and practice”, panelists explored the idea of pregnancy intendedness. The panel urged family planning experts and practitioners to take a step back from its focus on unintended pregnancy because pregnancy planning is not universal across the population. While it may be common among people with high levels of education and career ambition—like the physicians, clinicians, and health professionals dedicated to providing family planning care—it is decidedly foreign to many demographic groups. For many people, planning and time-based intentions seem irrelevant or unrealistic.

Many people are ambivalent about pregnancy; they neither desire pregnancy nor work hard to avoid it. Further, some enjoy the element of chance that many family planning practitioners have been trained to avoid at all costs both in their personal reproductive lives and for their patients. Ultimately, the data presented points to a need for a new framework for family planning that considers: 1) patients’ individual conceptualizations of pregnancy, 2) desire for effective contraception including acceptability of risk of pregnancy, and 3) whether an unexpected pregnancy would ultimately be a positive or negative outcome.

Within this context, the panelists urged practitioners to consider our movement’s drive to expand the use of LARC devices that may not meet the nuanced reproductive goals of many people. Instead, we should consider how we can help prevent unacceptable pregnancies while simultaneously supporting patients experiencing unexpected but welcome pregnancies to healthy outcomes.

Next week we will dig into the related session: “Prioritizing preferences in reproductive healthcare: the role of shared decision making.”