New ACOG Guidance on Contraceptive Counseling Emphasizes a Patient-Centered Framework

Washington, DC – Contraception can play an integral role in an individual's health and wellness. Clinicians who apply a patient-centered, reproductive justice framework to contraceptive counseling can help patients achieve their reproductive goals, according to a new committee statement from the American College of Obstetricians and Gynecologists (ACOG).

"Counseling is an opportunity to solicit an individual's values, preferences, and insight into what matters most to them as it relates to contraception," according to the new statement, which was produced jointly by ACOG's Committee on Health Care for Underserved Women, Contraceptive Equity Expert Work Group, and Committee on Ethics.

The committee statement includes the following recommendations for clinicians to achieve patient-centered contraceptive counseling:

• Acknowledge historical and ongoing reproductive mistreatment of people of color and other marginalized individuals
• Recognize that counselor bias, unconscious or otherwise, can affect care and work to minimize the effect of bias on counseling and care provision
• Prioritize patients' values, preferences, and lived experiences in the selection or discontinuation of a contraceptive method
• Adhere to the recommended ethical approach of shared decision-making

"Listening to our patients and understanding their values, preferences, and lived experiences will help us ensure that—if contraception is desired—each of our patients is able to select the right contraception for them," said Melissa Kottke, MD, MPH, MBA, FACOG, a named author of the committee statement and a former member of ACOG's Committee on Health Care for Underserved Women. "That means looking past our own opinions about contraception and working to overcome our biases about our patients' needs—and it applies equally to contraceptive selection and discontinuation."

"The shared decision-making approach to contraceptive counseling means each patient's expertise in their own lives and bodies is on equal footing with the clinician's expertise," said Kavita Arora, MD, MBE, MS, FACOG, chair of ACOG's Committee on Ethics and a named author of the statement. "By promoting honest, transparent, and open conversations, shared decision-making is more likely to help our patients be satisfied with their contraceptive choices."

"Decisions about birth control are not static, and our patients' preferences change over time, just as their lives change," said Lisa Goldthwaite, MD, MPH, FACOG, a named author of the statement. "Implementing a patient-centered framework for contraceptive counseling will help clinicians support their patients in a way that reflects their evolving priorities throughout the years."

"There is a long, painful historical record of the devaluing of the reproductive needs of many patient populations, including people of color, people with low incomes, people who are incarcerated, and people with mental health conditions. As lifelong learners, it is the privilege and responsibility of obstetrician–gynecologists to learn from the past in order to better support patients regarding their contraceptive choices with respect and dignity," said Jen Villavicencio, MD, MPP, FACOG, lead for equity transformation at ACOG and a named author of the statement.

Patient-Centered Contraceptive Counseling is the first committee statement released under ACOG's Clinical Content Transformation Initiative. Committee statements are evidence-informed, consensus-based documents that may include recommendations directed to different audiences, including clinicians, organizations, government agencies, and legislative bodies and are intended to provide guidance about the context and delivery of clinical care.