Provider support for IUDs can lead to coercive practices
Long-acting reversible contraceptives like IUDs and implants have been heavily promoted in recent years to reduce unintended pregnancies. However, this push for highly effective methods has received pushback for the way it ignores people’s preferences. Provider preferences for certain methods can result in coercive practices that undermine reproductive autonomy and trust in providers.
In 2015, ANSIRH researchers clinicians community health centers in the San Francisco Bay Area about their experiences providing IUDs, the barriers they faced, their contraceptive-related training needs, their contraceptive counseling practices, and how their concerns or their patients’ concerns about contraceptive coercion affected those practices.
Their findings show that, while clinicians said that they valued patient-centered contraceptive counseling approaches, the practices they described were not always consistent with that view. In particular, many clinicians engaged in what could be considered coercive practices by trying to dissuade patients from IUD removals within a year of placement and downplaying or offering to treat side effects instead. Encouraging people to continue to use a method that they want removed can diminish trust in the provider and patient satisfaction with the method. More importantly, such coercive dynamics run counter to medical ethics and principles of reproductive justice, which emphasize that providers should respect a patient’s bodily autonomy and decision making.
Researchers found that all clinicians interviewed reported wanting to provide comprehensive information to patients, without prioritizing any particular method. Several clinicians noted that their counseling was guided by ensuring that patients felt empowered to make contraceptive decisions without pressure. However, several also reported guiding young patients toward higher-efficacy methods and away from lower-efficacy ones, such as withdrawal.
Interviews with patients suggest that when people feel pressured to adopt a method, they are less likely to return for follow-up reproductive care. Some providers may benefit from training that increases their awareness of how their biases in favor of high-efficacy methods may inadvertently result in coercive practices. A patient-centered approach to clinician training would need to not only focus on improving access to all contraceptive methods. It would also take into account the history of reproductive injustice experienced by communities of color, value people’s reproductive choices above any public health goal to prevent unintended pregnancy, and specifically include the importance of honoring patient requests for removals.