Published open-access in Contraception
Abstract
Objectives
Contraceptive coercion during contraceptive counseling can limit pregnancy-capable individuals’ contraceptive autonomy over decision-making and use. We examined the contraceptive counseling experiences of adolescent and young adult women for evidence of contraceptive coercion.
Study design
This study involved individual interviews with a racially diverse sample of 46 adolescents and young adults, ages 16–24, assigned female at birth, and residing in one of five southern states. All participants self-identified as women. The study team conducted interviews between October 2023 and March 2024. We used codebook thematic analysis to examine participants’ accounts of healthcare interactions about contraception.
Results
Participants recalled how clinicians often presented the pill as their optimal contraceptive option and rarely discussed more than a few methods. Participants also recounted that clinicians discouraged them from using the copper intrauterine device (IUD) by emphasizing potential negative side effects, even when they expressed concerns about hormonal methods. Persistent self-advocacy was required among those who desired the copper IUD to obtain the method.
Conclusion
Our findings highlight how clinicians may circumscribe adolescent and young adult women’s contraceptive access and autonomy by how they discuss patients’ contraceptive options, especially when patients express interest in a non-hormonal prescription method. These interactions can inhibit patients’ ability to use their preferred contraceptive method.
Implications
Clinicians' preference for certain methods and bias against others may lead them to disregard patients’ contraceptive concerns and associated preferences, including a desire to switch methods or use the copper IUD. Such practices are inconsistent with a reproductive justice-informed, person-centered approach to contraceptive care.