Supporting Patient Autonomy

Supporting Patient Autonomy

The U.S. has a history of contraceptive coercion and forced sterilization perpetrated against economically marginalized individuals and persons of color. Due to this history, certain communities, particularly communities of color, may mistrust clinicians and the broader health care system. Any counseling about postpartum contraception, especially sterilization or LARC, should be sensitive to this history and follow a trauma-informed care framework. LARC may impact the patient’s autonomy by giving the patient a decreased sense of control over their contraception, as a clinician is required for both device insertion and removal.

ACOG supports the use of a reproductive justice framework for contraceptive counseling, which is essential to providing equitable access to healthcare and maintaining patient autonomy.

Health care provider bias can contribute to coercion and undermine the trust in the patient-provider relationship. Providers are encouraged to self-reflect and address their own biases to provide patient-centered care that supports autonomous decision making.

ACOG supports the LARC Statement of Principles by SisterSong and the National Women’s Health Network (NWHN).

The LARC Statement of Principles says, “We believe that people can and do make good decisions about the risks and benefits of drugs and medical devices when they have good information and supportive health care. We strongly support the inclusion of long-acting reversible contraceptive methods (LARCs) as part of a well-balanced mix of options, including barrier methods, oral contraceptives, and other alternatives. We reject efforts to direct women toward any particular method and caution providers and public health officials against making assumptions based on race, ethnicity, age, ability, economic status, sexual orientation, or gender identity and expression. People should be given complete information and be supported in making the best decision for their health and other unique circumstances.”

More information about the statement can be found on the NWHN’s page about LARC.

Citation: Dehlendorf C, Levy K, Kelley A, Grumbach K, Steinauer J. Women’s preferences for contraceptive counseling and decision making. Contraception 2013;88:250-6.