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

As a part of person-centered contraceptive counseling, when a client indicates they are seeking to prevent pregnancy and want to discuss contraceptive options, providers should considering 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.

Steps two through five of the SDM approach are crucial to ensuring clients receive the best method for them. We skip Step One: Build Rapport and Establish Trust with the Client because this step should be applied to all reproductive life goals discussions, including pregnancy planning and with clients who may be unclear with regards to their pregnancy intention.

SDM Step Two: Elicit and inquire about the client’s contraceptive preferences, without assuming that efficacy is of primary importance. When doing so use direct questions, for example: “What is important to you about your method?” 

During this step consider the following contraceptive characteristics that may be of importance to the client:

Contraceptive Characteristics

Effectiveness 
Discuss method effectiveness by explaining the rate of typical effectiveness within the first year of use. When explain effectiveness try to use natural frequencies like “Less 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”.
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?” 
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.
Return to fertility 
Address any client concerns about their ability to become pregnant once they discontinue contraceptive use.
(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 definitely 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 and 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.
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.

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