Coercive contraceptive practices have a long history in the United States, beginning in the era of slavery and extending to forced sterilizations as recent as 2010. Forced contraception has targeted primarily low-income, incarcerated, disabled, Indigenous, Black, and Latinx people.

Knowing this horrific history, how can we adjust our contraceptive counseling to avoid any semblance bias of coercion? Qualitative studies provide some guidance. A study of 30 postpartum patients in a Chicago health center found that 53% reported negative contraceptive counseling experiences. Most involved poor communication, failure to explore multiple options, resistance to young patients’ choosing tubal ligation, and “pushy” clinicians who imposed a single birth control choice. A study of 31 Boston patients who had had a recent abortion found that 42% experienced unwelcome pressure during contraception counseling. Many of these patients mentioned pressure to use IUDs or implants.

The international family planning movement has moved from population control toward a voluntary, rights-based approach that prioritizes patients’ autonomy. High-quality contraceptive counseling requires:

• asking open ended questions
• active listening
• presenting multiple options
• using written materials
• honoring patient’s preferences

We must demonstrate that we respect our patients as individuals and value their reproductive autonomy.

Featured Resources 

Your Birth Control Choices Fact Sheet

LARC Statement of Principles

Sources 

Brandi K, Woodhams E, White KO, Mehta PK. An exploration of perceived contraceptive coercion at the time of abortion. Contraception. 2018;97(4):329-334. doi: 10.1016/j.contraception.2017.12.009.

Hardee K, Harris S, Rodriguez M, et al. Achieving the goal of the London Summit on Family Planning by adhering to voluntary, rights-based family planning: what can we learn from past experiences with coercion? Int Perspect Sex Reprod Health. 2014;40(4):2016-214. doi: 10.1363/4020614.

Senderowicz L. Contraceptive autonomy: conceptions and measurements of a novel family planning indicator. Stud Fam Plann. 2020;51(2):161-176. doi: 10.1111/sifp.12114. 

Yee LM, Simon MA. Perceptions of coercion, discrimination and other negative experiences in postpartum contraceptive counseling for low-income minority women. J Health Care Poor Underserved. 2011;22(4):1387-1400. doi: 10.1353/hpu.2011.0144.

Pharma-free

The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.