Preventing Pregnancy
If the client is seeking to prevent pregnancy, and wishes to discuss contraception options
Preventing Pregnancy
Once a client has indicated their goal of not becoming pregnant, providers should engage the client in contraceptive education and counseling to determine what method may work best for their situation and life goals. If necessary, providers should conduct a physical exam and provide the decided upon contraceptive method if applicable.
Contraceptive Counseling and Education
Collaborate With the Client to Select a Method of Choice
When a client indicates they want to prevent pregnancy and would like to discuss contraceptive options, providers should consider using a Shared Decision-Making (SDM) approach. This approach helps the provider understand what is important to their client in a contraceptive method and assist the client in choosing the method that will best serve their needs, situation, and health.
Contraceptive Characteristics
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Effectiveness
Discuss the effectiveness of a method by explaining the rate of typical effectiveness within the first year of use.
When explaining effectiveness try to use natural frequencies like “Fewer than 1 in 100 women get pregnant on IUD” or “9 in 100 women get pregnant on pill/patch/ring” versus using percentages, like “this is 95% effective”
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Frequency of Using Method
“There are methods you take once a day, once a week, once a month, or even less frequently. Is that something that makes a big difference to you?”
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Different Ways of Taking Methods
Discuss how to use methods correctly to help a client decide between a method that is user dependent, like the pill, or a LARC that is not user dependent.
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Return to Fertility
Address any client concerns about their ability to become pregnant once they discontinue contraceptive use.
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(Specific) Side Effects
Discuss potential side effects that may or may not go away with time and any warning signs for rare adverse reactions to methods. This is also a good time to clarify any misconceptions a client may have about a method.
Ask client about previous experiences and/or what they may have heard from their friend’s experiences, for example:
“Have you experienced any side effects from birth control?”
Be sure to respond to concerns in a respectful manner.
“That’s too bad your friend had that experience. I haven’t heard of that before, and I can tell you it doesn’t happen frequently.”
According to the CDC and the U.S. Office of Population Affairs’ Providing Quality Family Planning Recommendations (QFP) side effects are a primary reason for method discontinuation. Providers should discuss ways the client might deal with potential side effects to increase satisfaction with the method and improve continuation.
In particular, when counseling on long acting reversible contraception (LARC), providers should communicate the potential side effects for changes in menstruation, bleeding, and cramping. Sharing this information with the client may help to alleviate client concerns after placement.
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Benefits
Discuss benefits some contraceptive methods may have. For example, some methods can help reduce heavy bleeding or acne, which is a positive for some individuals.
Counsel the Client on Protection from STIs and a Back-up Plan
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Discuss STI/HIV Protection
The CDC and the U.S. Office of Population Affairs’ Providing Quality Family Planning Recommendations (QFP) notes that clients should be informed that contraceptive methods other than condoms offer no protection against STIs, including HIV. Condoms can protect against pregnancy and STI/HIV transmission as well as a condom plus a contraceptive method.
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Share Information on Emergency Contraception (EC) and Make Available (if possible)
The American College of Obstetricians and Gynecologists (ACOG) notes that clients should be educated about the availability of emergency contraception in advance of need. Sharing information about EC is especially important for clients who may not choose a method or who are choosing a method that is user dependent, such as pills.
Research shows that EC can be safely provided in advance of when it may be needed and that women receiving an advance supply were more likely to take EC, and to do so more promptly, after unprotected sex. If advanced provision is not possible, share how the client may acquire EC at their health clinic or over the counter at a pharmacy.
Other Considerations for the Contraceptive Counseling Conversation
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Social-Behavioral Factors
Discuss the advantages and disadvantages of the methods chosen and assess for the client’s feelings about the method. Assess the client’s confidence in being able to use the method correctly (i.e. take a pill daily, change a patch weekly, use a condom with each act of intercourse).
For methods that are administered regularly by a provider, like the Depo-Provera shot, discuss potential barriers, like transportation and timing.
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Birth Control Sabotage and Reproductive Coercion
Current or past history of intimate partner violence and sexual violence can impede the correct and consistent use of a method. Providers should consider that clients experiencing partner violence may need a method they can conceal from their partner. Futures Without Violence’s Addressing Intimate Partner Violence, Reproduction and Sexual Coercion: A Guide for Obstetric, Gynecologic and Reproductive Health Care Settings can assist providers in responding to clients facing these situations.
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Mental Health and Substance Use Behaviors
Certain mental health and substance use behaviors may interfere with someone’s motivation or ability to use a method correctly and consistently. Assess for mental health and substance use and refer to appropriate care.
Provide the Contraceptive Method Same-day (if possible)
QFP Guidelines state that a broad range of FDA approved methods should be available onsite for dispensing and that contraception should be offered the same-day as counseling and education. ACOG also recommends that clients initiating combined hormonal contraceptives start the day of their visit and that LARC methods be provided the same day as requested if pregnancy can be reasonably excluded.
The Reproductive Health Access Project offers a useful Quick Start Algorithm to assist providers in navigating same day contraception initiation. The RHNTC’s Same-Visit Contraception: A Toolkit for Family Planning Providers, Increasing Access to Contraception Toolkit, and Contraceptive Access Change Package are comprehensive resources for clinics wanting to successfully and sustainably provide same day contraception, including LARC.
As previously noted, there is no medical or safety benefit to requiring routine pelvic examination or cervical cytology before initiating hormonal contraception. Providers should not let these exams or tests prohibit same day access to contraception.
For methods not stocked, referrals should be made for clients desiring a method not available onsite. In this case, a back-up method should be offered, which also includes condoms and EC, to ensure the client has protection until they are able to start their method of choice.
Checking Bias
Avoid denying access to certain methods due to outdated guidance or personal preferences.
Adolescents and individuals who have not had a pregnancy are good candidates for IUDs and Implants. ACOG advises that IUDs “should be offered routinely as safe and effective contraceptive options” for individuals with a uterus who have not given birth.
Additionally, ACOG and the American Academy of Pediatrics endorse the use of long acting reversible contraception (LARC), including IUDs for teens. Practices discouraging people from IUDs because they are nulliparous are outdated and misinformed. According to ACOG, even though IUD complications are uncommon, some providers still hold beliefs that nulliparous clients will have pain and difficulty with insertion and develop Pelvic Inflammatory Disease and therefore discourage IUD usage.
The U.S. Medical Eligibility Criteria notes that the advantages of a nulliparous person using an IUD generally outweighs the risk. Providers should ensure their practices are in alignment with ACOG recommended practice guidelines to ensure no client is denied their chosen contraceptive method simply because they have not given birth.
The content on this page was last reviewed and updated in October 2023.
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