A new tool to measure agency in contraceptive care

September 9, 2022

provider showing a model with an IUD to a patient
Contraceptive agency means the ability to decide about birth control without undue influence, judgment or coercion from healthcare providers. It’s especially important among patient in communities that have faced reproductive harms, including racism and contraceptive coercion in the healthcare system. Agency in making decisions about birth control is a key part of reproductive autonomy. Provider bias can show up in contraceptive care, limiting patients’ ability to make fully voluntary choices.

To address health equity goals, we need ways to capture patient experiences of bias or coercion. New Bixby research aims to fill a gap in measuring contraceptive agency in people’s interactions with a provider.

The researchers gave a Contraceptive Agency Scale survey to patients in nine California clinics. They rated their agreement with statements like “my provider helped me to choose a method of birth control that could work for me” and “my provider wanted to make by birth control decisions for me.”

The Contraceptive Agency Scale was an effective tool, and overall reflected that providers facilitated high agency during the contraceptive care visit. However, about 1 in 5 patients who took the survey had scores indicating lower agency. That low score showed the provider wanting the patient to use a specific method or even sometimes making decisions for the patient. Among people at publicly funded clinics, lower-socioeconomic patients had lower agency. The research also identified racial/ethnic disparities, with Asian/Native Hawaiian/Pacific Islander patients having relatively low scores.

Contraceptive care delivery needs to better meet the needs and preferences of all patients. These findings indicate that it’s important to address prioritizing each patient’s voice and preferences in their care plan. Reproductive autonomy and agency over birth control have been frequently neglected, especially among patients of color. The Contraceptive Agency Scale adds an important dimension by focusing on whether a patient feels pressure about using birth control in general, or a specific method, and whether they are making their own decisions.

This scale can be used to evaluate patient agency in contraceptive interventions to make sure autonomy is maintained in efforts to increase access. It can also be used to assess and reinforce agency in clinical services. Administering the scale periodically would be a low-cost way to get data to improve quality of services. It can also help inform programs and policies of health systems on a larger scale. Without a way to measure agency, people may put focus on other measures like contraceptive uptake that can potentially lead to eroding people’s agency.

There have been notable advances in sexual and reproductive health to highlight the importance of patient-centered care and people’s preferences. This study adds by creating a tool to help promote agency as an expected part of high-quality contraceptive care.