Almost 50 years ago, the Supreme Court ruled that safe and legal access to abortion was a woman’s constitutional right. Now that ruling, Roe v Wade, will likely be overturned by the current Supreme Court. At the same time, several states are in the process of enacting laws to limit access to abortions.
It is still not clear whether the ruling, when and if it comes, will clear the way for even more restrictions on birth control; but a meta-analysis of studies regarding contraceptive counseling published in the journal, Annals of Internal Medicine, suggests contraceptive counseling can make a difference.
Supporting a woman with her reproductive goals — primarily by providing contraceptive counseling and follow-up services when needed — can lessen her chance of an unwanted pregnancy, as the study and an editorial accompanying it explain. In addition to promoting safer sex, the editorial suggests such services should be a routine part of medical care in order to protect the sexual health of women.
The researchers looked at data from 38 randomized controlled trials of contraceptive counseling and provision interventions in 43 articles and involving over 25,000 participants to determine if contraceptive counseling was effective in reducing unintended pregnancy. The results were clear.
“]W]e should ask all patients…who are sexually active whether pregnancy is possible and desired and, when appropriate, counsel them about effective contraception.”
Several approaches were found to be more effective in promoting higher contraceptive use during the months following interventions for adolescents and women, compared to more common controls such as receiving educational materials without any accompanying counseling.
Among the effective interventions were:
- Contraceptive counseling that includes a discussion of all available methods for contraception including their success rates, ease of use and potential health risks
- Follow-up services to discuss satisfaction of contraceptive choice and, if needed, offer alternatives
- Emergency contraception in advance of pregnancy
- Offering contraceptive services immediately postpartum or at the time of an abortion
Counseling women about contraceptive use and providing contraceptives not only increased their use, the meta-analysis also showed, but did so without increasing the risk for sexually transmitted infections (STIs) or reducing condom use compared to a patient’s usual practice. However, none of the trials evaluated any additional potential harms such as anxiety, stigma and whether it resulted in reproductive coercion.
The editorial accompanying the study, by the editor-in-chief of Annals of Internal Medicine, Dr. Christine Laine, supports the value of contraceptive counseling, particularly at this time when the ability of American women to access abortion is increasingly limited. She maintains the meta-analysis’s findings are important for clinicians caring for women with unintended pregnancy — especially those who have have underlying medical conditions that put them at higher risk.
Internists may also need to be responsible for contraception counseling when offering healthcare to a patient who may become pregnant. “…[I]t is in the power of every physician to begin to make contraceptive counseling a routine part of preventive care by asking women of childbearing age a few key questions and facilitating effective contraception for those who do not desire pregnancy,” she points out. “In addition, if the goal is to reduce unintended pregnancies, we should ask all patients regardless of sex and gender who are sexually active whether pregnancy is possible and desired and, when appropriate, counsel them about effective contraception.”