Blog of the Society for Menstrual Cycle Research

The contraceptive doctor–patient disconnect

June 17th, 2014 by Saniya Lee Ghanoui

Guest Post by Jennifer Aldoretta

There seems to be a growing disconnect in recent years between physicians and their patients, and women are especially susceptible to this given our reliance on doctors for information about contraception. When compared to the questions many of us ask our doctors, the information we receive isn’t always up to snuff.

Patient autonomy, as defined by medical dictionaries, is “the right of patients to make decisions about their medical care without their healthcare provider trying to influence the decision.” Based on many conversations with other women, in addition to my own personal experiences, patient autonomy often does not exist for women seeking information about contraception. And this is a huge problem. Deadly (and rare) birth control side effects have become a hot-topic in the news as of late – which is likely contributing to this physician–patient disconnect – but the growing patient interest in control and autonomy means that this cannot simply be dismissed as a side effect of the media.

A recent study, published in the Journal of Contraception, asked both women and healthcare providers to rank the importance of 34 questions relating to contraceptive options. They found that the things that are most important to women are often not as important to their healthcare providers. For example, knowing exactly how a method works to prevent pregnancy was ranked by women as the most important piece of information, whereas how to use a method correctly topped the list for providers. Effectiveness, while still important, was ranked fifth by women, which is a stark inconsistency if you consider just how central a method’s effectiveness is in ads and in the media. The study also found that questions regarding potential side effects ranked in the top three for 26% of women, but only 16% of providers.

These stats may seem inconsequential – after all, physicians should be educating patients about proper use of contraceptive methods. But here’s the problem: the methods suggested by physicians don’t always align with a woman’s stated preferences. I’m certain I’m not the only woman who has been pressured to use a hormonal method (despite my voiced concerns) simply because these methods are considered to be easy and effective. While it seems like a logical solution for physicians to advocate for hormonal methods over methods with higher typical-use failure rates, this approach is ultimately a detriment to women.

A growing number of women seem to be turning to withdrawal, and while this isn’t inherently bad, it becomes bad when a patient isn’t educated on how to properly use it simply because her physician is hesitant to discuss “unreliable” methods. This means that women are turning to potentially unreliable internet sources (or, worse, misinformed friends) for this information. The same can be said for diaphragms, cervical caps, and fertility awareness-based methods. If we want to continue to drive down unintended pregnancy rates, dismissing patient concerns and eliminating patient autonomy isn’t the route we should take. Contraceptive methods aren’t one-size-fits-all, which should be obvious by the huge differences in side effects experienced from person to person. So why do so many contraceptive consultations continue to be carried out in this one-size-fits-all fashion?

Empowering women through family planning is more complex than simply prescribing the most effective methods. It must be coupled with engagement in an open dialogue, including acknowledgement of patient concerns and a respect for patient autonomy. Patients are increasingly demanding autonomy, and if healthcare providers wish to remain a respected part of a woman’s health, it’s time to set aside contraceptive biases and listen.

  

One Response to “The contraceptive doctor–patient disconnect”

  1. Many of the hormonal methods have high discontinuation rates – if a woman is swapped from the Pill to a LARC and no longer wants to use either – where does this leave her? I think this is when women are abandoned by their doctors. Non-hormonal methods can be highly effective if women are also shown how to use those properly, but seeing as they’re barely discussed I think even knowledge of proper use of male condoms can be limited. An IUD is not effective if you get it removed because you can’t stand the side effects.

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