Step 3. Determine which contraception aligns with the patients’ values and preferences
Collaboratively determine which contraceptive method (if any) aligns with the patients’ values and preferences.
Once a patient has identified what matters to them, providers can discuss the methods that align with those preferences and that are medically safe. It is important to recognize that there are diverse preferences and priorities that can guide a patient’s method selection. In some cases, the counseling in Step 2 may reveal that patients’ preferences for methods conflict. For instance, patients might want to use a method that will ensure regular monthly bleeding (that is, pill, patch, or ring) but also want a method that they do not need to think about often (that is, shot, implant, or IUD). When this situation occurs, providers can help patients prioritize preferences relative to each other. Exhibit 10 provides some sample language that can be used to describe various features of contraceptive methods with patients. Additionally, providers should consider using visual tools to help map preferences onto available contraceptive methods.
As part of this discussion, providers should assess for and integrate information about potential contraindications to certain methods, as required. Providers should refer to the U.S. Medical Eligibility Criteria for Contraceptive Use 2024 (U.S. MEC) in Appendix 2 for recommendations on safe use of contraception among patients who have certain medical conditions or who are taking certain medications that may interact with contraception.93 If a patient has a medical condition for which certain methods might be unsafe for use, offer to discuss the risks and alternative methods that might be safer, based on the U.S. MEC.
Shared decision making, as described in Section 3, can improve patient satisfaction and helps people make contraceptive decisions consistent with their preferences and medical context.61 Although the process of soliciting preferences and mapping them to the available methods is collaborative, the decision about which method to use should be made by the patient. When patients indicate they are ready to initiate a method or methods, providers can ask open-ended summary questions such as "Given what we talked about and what is important to you about your method, what do you think would be the best choice for you at this time?"4 Some patients may explicitly ask for guidance from the provider; in that case, providers can rely on their knowledge of the patient’s preferences and medical history to suggest a method that is likely to be a good fit.
Exhibit 10. Sample Contraceptive Counseling Language
Proactive and candid description of possible side effects:
"Some people who use this IUD have heavier or crampier or longer periods than they did before they got the IUD. What would that be like for you?"
Non-contraceptive health benefits:
“I can see why you would want to find a method that also can help with your painful periods. These methods here (show on visual decision aid) can all do that."
Discreetness of a method/privacy:
“Since you’ve said privacy is important to you, and you can’t use anything that changes your period, would you like to talk about the IUD (hand them a sample IUD)? This needs no supplies, and you will still get your period.”
Effect on future fertility:
"Your ability to get pregnant goes back to whatever is normal for you once you stop using the patch."
Control over discontinuation:
"You mentioned that you want to use something you can stop any time. Barrier methods like condoms and some of the hormonal methods like the pill, patch, and ring can be stopped any time, and the hormones in those methods leave your body quickly."
Source: Adapted from PHI CARE,92a provider tool for operationalizing patient-centered contraceptive counseling