Shared Decision-Making: The Way Forward for Postpartum Contraceptive Counseling

Abstract

There are multi-level barriers that impact uptake of postpartum contraception and result in disparities, including clinical barriers such as provider bias. Fortunately, clinicians have direct control over their contraceptive counseling practices, and thus reducing structural barriers is actionable through high quality contraceptive counseling that equips patients with the knowledge and guidance they need to fulfill their reproductive desires. Yet, many commonly employed contraceptive counseling strategies, like One Key Question and WHO tiered contraceptive counseling, are not patient-driven, do not account for the important nuances of contraceptive choices, and are not focused specifically on the postpartum period. Given the history of eugenics and reproductive coercion in the US, supporting patient through their contraceptive decision-making process is especially vital. Additionally, contraceptive preferences vary based on patient-level factors and fluctuate over time and counseling should account for such differences. Shared contraceptive decision-making occurs when patients provide input on their values, desires, and preferences and clinicians share medical knowledge and evidence-based information without judgement. This approach is considered the most ethically sound form of counseling, as it maximizes patient autonomy. Shared decision-making also has clinical benefits, including increased patient satisfaction. In sum, shared contraceptive decision-making should be universally adopted to promote ethical, high-quality care and reproductive autonomy.

Shared decision‐making in scaling and root planing

“…Evidence-based practice, supported by best scientific literature and high professional standards, place professionals in a strong position to recommend best practices. [37][38][39][40][41] Historically, health care generally is moving away from a model where this is sufficient to determine the behaviour of both professionals and patients. This approach has been identified with paternalism: it is based exclusively on professional knowledge.…”

“…Shared decision‐making is one of several approaches that can be used to enhance oral care by optimizing the potential consistency between patients' and professionals' understanding of and acceptance of best approaches to care. Evidence‐based practice, supported by best scientific literature and high professional standards, place professionals in a strong position to recommend best practices 37–41 . Historically, health care generally is moving away from a model where this is sufficient to determine the behaviour of both professionals and patients.…”

Promoting Shared Decision-making in Maternal Health Care

“…This approach is considered the most ethically sound form of counseling, as it maximizes patient autonomy. Shared decision-making also has clinical benefits, including increased patient satisfaction [11].…”

Providing Inpatient Contraception Care Within a Reproductive Justice Framework

“…2,15 These include socioeconomic and sociodemographic factors such as wealth status, education level, and place of residence, but also restrictive regulations and insurance limitations that inhibit equitable access to contraception and contraceptive counseling. 7,16 Support is provided to institutions for planning and implementing inpatient contraception programs by the Postpartum Contraceptive Counseling Initiative (PCAI) established by ACOG. 17 PCAI offers resources to plan, implement, and sustain inpatient LARC programs and addresses many of the most common barriers to inpatient contraception, specifically LARC, including billing, reimbursement, clinician education, and institutional support.…”

“…16 In addition to accessibility, concerns have been raised regarding equitability and clinical contraceptive counseling practices. 6,7,9,15,18,19 This is of particular importance given the way pregnant-capable individuals are counseled regarding contraception, which can significantly impact their attitude, choice, and satisfaction with contraception use. Recent studies have shown that person-centered contraceptive care that places an emphasis on the needs and desires of the individual contributes to improved reproductive health outcomes.…”