Step 2. Personalize contraceptive discussions

Personalize contraceptive discussions by asking about individuals’ contraceptive preferences, based on their needs, desires, and prior experiences.

Patients are more satisfied with visits where providers ask about and personalize contraceptive discussions to meet their individual needs.55, 61, 86 Ask open-ended questions to elicit people’s preferences; for instance: 

• "Can you tell me something (or some things) that are important to you in your contraception?" and
• "What else are you looking for?" or
•  "Is there anything else you’re hoping to get out of your contraception?" or
• "Is there anything you don’t want (or want to avoid) in a method?" 

Open-ended questions enable the patient to explore and express what matters to them and enable the provider to tailor relevant information. For patients who may benefit from follow-up prompts, consider questions that help patients think about method characteristics that are important to them. For example, providers can ask patients about previous side effects that were undesired and what side effects a patient wishes to avoid in the future. Providers can also probe about preferences, such as about menstrual changes. After visits in which this type of counseling is practiced, patients report feeling that they received information in alignment with their needs56, 81 and they made an informed decision.91 This type of communication can also reduce bias and mistreatment.88, 89, 90 The PHI CARE counseling framework described in Exhibit 9 is an illustrative model providers can use to remember the main elements of person-centered contraceptive conversations.

People also have specific preferences for when and how conversations about contraception should occur. For example, patients who seek specialty care for health conditions may prefer to consult with their specialist before selecting contraceptives. For patients with serious medical conditions for whom pregnancy may confer significantly increased risk, for instance, a provider might say, "This medical condition" or "This medication carries a risk to a developing pregnancy" or "I don’t want to make any assumptions, but given this, would you like to talk about ways to safely prevent pregnancy or plan for a pregnancy?" 

Providers should be mindful of the timing and approach when offering contraceptive counseling to patients who are peri- and postpartum, and those who have just had an abortion or miscarriage, as well as patients seeking care for issues unrelated to pregnancy prevention, as patients can perceive mistimed contraceptive counseling as coercive. During non-contraceptive visits, if a provider determines that a conversation about reproductive desires or pregnancy prevention may be useful, it is appropriate to offer care while honoring autonomy.

Exhibit 9. Illustrative Framework: PHI CARE