The Fine Line Between Informing and Coercing: Community Health Center Clinicians’ Approaches to Counseling Young People About IUDs
While community health centers (CHCs) are meeting increased demand for contraceptives, little is known about contraceptive counseling in these settings. Understanding how clinicians counsel about IUDs in CHCs, including whether they address or disregard young people's preferences and concerns during counseling, could improve contraceptive care.
As part of a training program, 20 clinicians from 11 San Francisco Bay Area CHC sites who counsel young people about contraception were interviewed by telephone in 2015 regarding their IUD counseling approaches. An iterative grounded theory approach was used to analyze interview transcripts and identify salient themes related to clinicians’ contraceptive counseling, IUD removal practices and efforts to address patient concerns regarding side effects.
Most clinicians offered comprehensive contraceptive counseling and method choice. While several clinicians viewed counseling as an opportunity to empower their patients to make contraceptive decisions without pressure, they also described a tension between guiding young people toward higher‐efficacy methods and respecting patients’ choices. Many clinicians engaged in what could be considered coercive practices by trying to dissuade patients from removals within a year of placement and offering to treat or downplay side effects.
Providers try to promote their young patients’ autonomous decision making, but their support for high‐efficacy methods can result in coercive practices. More training is needed to ensure that providers employ patient‐centered counseling approaches, including honoring patient requests for removals.
M. Antonia Biggs and Lori Freedman are associate professor, and Shelly Kaller is research project director—all at Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco. At the time of the study, Lucia Tome was a medical student at Perelman School of Medicine, University of Pennsylvania, Philadelphia. Aisha Mays is clinical faculty at Department of Family and Community Medicine, University of California, San Francisco. Cynthia C. Harper is professor at Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco.