‘You Will Have These Ones!’: Six Women’s Experiences of Being Pressured to Make a Contraceptive Choice That Did Not Feel Right

Abstract

This study aims to contribute to an understanding of women's experiences of contraceptive counselling, and of being pressured to make a contraceptive choice that did not feel right. Six women in Sweden participated in semi-structured interviews, which were analysed through interpretative phenomenological analysis. The results were organised into three themes: (1) The normalisation process, i.e., the ways in which the women experienced using the contraceptive were being promoted as a natural part of womanhood; (2) Drawing the shortest straw, i.e., the women's experiences of encountering insensitive caregivers; and (3) Feeling like a guinea pig, i.e., the women's sense of not being allowed to control the situation and make their own choices. In conclusion, the experience of not being respected in the healthcare system could lead to consequences not only for women's sense of self-efficacy with regard to contraceptives, but also for their willingness to engage in renewed counselling. The caregivers' communicative skills are, therefore, of prime importance.

Claims in the clinic: A qualitative group interview study on healthcare communication about unestablished side effects of the copper IUD

“…Morison et al [ 33 ] note that expert-directed decision-making in contraceptive care, in which patient knowledge or concerns are not considered, may lead to covert patient resistance through discontinuation of contraceptive use. Poor PCC in contraceptive care can also damage the patient-provider relationship [ 34 , 104 , 105 ] and increase distrust in healthcare [ 26 , 106 ]. In other contexts too, such as among patients with contested diseases [ 107 ], distrust in medicine and withdrawal from care-seeking have been related to experiences of feeling deprioritized or badly treated by caregivers [ 6 , 39 , 40 , 108 ].…”

“…Worth noting here, firstly, is that limitations in PCC [79] have been observed in research on contraceptive care, where caregivers have been noted to downplay, dismiss or neglect to discuss (concerns about) potential side effects of contraceptives including copper IUDs [24,[26][27][28][29][30][31][32][33]35]. In a study of contraceptive care in Sweden [34], some women reported having felt patronized and bereft of agency, as their worries were dismissed and their experiences invalidated by caregivers. The researchers observed that due to the existing provider/patient power hierarchy, the affirmation of differing views or actions demanded strong self-efficacy on the part of the patient (cf [109]).…”

“…Such efforts have included attendance to side effects and coercive practices associated with contraceptives [19][20][21][22], on occasion contributing to litigation or product recall due to previously unknown risks [20,21,23]. Research has furthermore pointed to patients finding it difficult to express their concerns about side effects of contraceptives to, and receive sufficient information about them from, caregivers [24][25][26], and to healthcare providers downplaying or dismissing such side effects or women's concerns about them [27][28][29][30][31][32][33], in countries including Sweden [34,35]. This is while side effects of contraceptives for women have been deemed more tolerable than those of contraceptives for men, even as women suffered more severe health outcomes [36], and the embodied experiences of women have historically been taken as unreliable sources of knowledge in medical contexts [37].…”

“…Relatedly, tensions may arise in clinical meetings between caregivers and patients contesting established medical knowledge. This is of importance not least in to contraceptive counselling, where provider-patient interaction can strongly affect contraceptive choices [ 34 , 44 ] and potentially create barriers to contraceptive use [ 27 ].…”

“…A paucity of research on how caregivers relate to patient concerns or dissatisfaction with contraceptives has also been noted [ 31 , 32 , 76 ], including when reported side effects have no (established) scientific basis [ 32 ]. This is despite the relevance of patient-provider interaction for contraceptive choice [ 34 , 44 ] and use [ 27 ], as well as for PCC.…”