“Did I Choose a Birth Control Method Yet?”: Health Care and Women’s Contraceptive Decision-Making

Abstract

In the United States, unintended pregnancy is medicalized, having been labeled a health problem and “treated” with contraception. Scholars find women’s access to contraception is simultaneously facilitated and constrained by health care system actors and its structure. Yet, beyond naming these barriers, less research centers women’s experiences making contraceptive decisions as they encounter such barriers. Through in-depth, semi-structured interviews with 86 diverse, self-identified women, this study explores how the medicalization of unintended pregnancy has influenced women’s contraceptive access and decision-making. We highlight the breadth of such influence across multiple contraceptive types and health care contexts; namely, we find the two most salient forces shaping women’s contraceptive decisions to be their insurance coverage and providers’ contraceptive counseling. Within these two categories, we offer crucial nuance to demonstrate how these oft-cited barriers implicitly and explicitly influence women’s decisions. Paradoxically, it is the health care system, itself, that both offers yet constrains women’s contraceptive decisions.

Oh Baby! A Content Analysis of Contraception Pins on Pinterest

“…Prior research suggests that side effects from OC pills can be significant and concerns about side effects may be dismissed by clinicians despite the importance of full knowledge for informed contraceptive decision-making by the patient (Stevens, 2018). Patient–provider health communication has been found to be vital to contraceptive decisions yet can act as a barrier when the provider is dismissive or undermines the patient’s own knowledge or past contraceptive decisions (Berndt & Bell, 2021; Manzer & Bell, 2022). In these instances, patients may be left feeling unsatisfied with their consultation leading to some women changing doctors or not returning to the health care setting (Berndt & Bell, 2021; Gomez & Wapman, 2017; Manzer & Bell, 2022).…”

“…Patient–provider health communication has been found to be vital to contraceptive decisions yet can act as a barrier when the provider is dismissive or undermines the patient’s own knowledge or past contraceptive decisions (Berndt & Bell, 2021; Manzer & Bell, 2022). In these instances, patients may be left feeling unsatisfied with their consultation leading to some women changing doctors or not returning to the health care setting (Berndt & Bell, 2021; Gomez & Wapman, 2017; Manzer & Bell, 2022). Poor experiences may also reflect why women may be switching to FAM because, unlike OC pills or IUDs, no engagement with medical professionals is needed to adopt FAM usage.…”

“…Some women attempt self-removal due to side effects and lack of access to providers (Amico et al, 2020). Poor patient–provider interactions may also contribute to women being deterred from hormonal contraceptives, as providers have been documented dismissing or disbelieving patient concerns (Amico et al, 2017; Berndt & Bell, 2021; Manzer & Bell, 2022; Stevens, 2018). Failing to consider women’s embodied experiences with contraceptives or to treat the patient–provider relationships as an equal partnership may also delay or deter women from seeking needed reproductive health care (Berndt & Bell, 2021).…”

Sensemaking About Contraceptive Methods Across Online Platforms

“…In addition to providing a means of family planning, birth control methods can also be used to treat and manage many medical conditions, including acne, endometriosis, cancer risks, gender dysphoria, and irregular and painful menstruation (Schindler 2013;Nahata, Chelvakumar, and Leibowitz 2017). However, birth control methods are not one-size fits all, and the choices of whether to use birth control and which method to select are complicated by personal beliefs, cost and accessibility, and a wide array of side effects that are difficult to predict and identify (Manzer and Bell 2022;Yoost 2014;Polis et al 2016).…”

Exploring Black Women’s Pathways to Motherhood Within a Reproductive Justice Framework

“…Discrimination in healthcare and obstetric violence undermine Black women’s quality of care (Bridges, 2011). For instance, although family planning initiatives are intended to promote maternal autonomy through education and preconception health services (Manzer & Bell, 2021; Nandagiri, 2021), evidence suggests that some clinics target young, unmarried, Black women to prevent “unwanted” pregnancies (Manzer & Bell, 2022). Given the growing recognition, that Black women’s maternal health is a public health issue, scholars are drawing more attention to health equity efforts that can improve family planning services and maternal care for Black women (BMMA Research Working Group, 2020; Chinn et al, 2021; Taylor, 2020).…”