Provider Bias in Long-Acting Reversible Contraception (LARC) Promotion and Removal: Perceptions of Young Adults

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Jenny A. Higgins, PhD, MPH, Renee D. Kramer, MPH, and Kristin M. Ryder, MA, MPH, CHES

AJPH - American Journal of Public Health

September 15, 2016

A user-centered approach to LARC could serve to increase people’s access to LARC methods if they wish to use them, could improve their ability to have LARC devices removed if they so choose, and could help them feel respected and cared for by their providers. System- and provider-level changes can help facilitate access to unbiased and non-coercive information through patient-centered contraceptive counseling.

Long-acting reversible contraception (LARC) is effective and acceptable. However, concern exists about potential provider bias in LARC promotion. No study has documented contraceptive users' attitudes toward or experiences with provider influence and bias regarding LARC. We collected qualitative data in 2014 to address this gap. Participants were 50 young adult women with any history of contraceptive use (including LARC) in Dane County, Wisconsin. Women often described providers as a trusted source of contraceptive information. However, several women reported that their preferences regarding contraceptive selection or removal were not honored. Furthermore, many participants believed that providers recommend LARC disproportionately to socially marginalized women. We encourage contraceptive counseling and removal protocols that directly address historical reproductive injustices and that honor patients' wishes.

……Reproductive justice supporters have described a variety of ways LARC methods might be promoted or practiced in socially unjust ways, particularly among poor women of color….

……Although outright coercion may be unlikely, subtler biases shape the ways in which race and class influence women’s contraceptive decision-making and patient–provider interactions….

……Some women reported feeling disrespected or patronized during provider–patient interactions regarding contraception……

…….Patients should also be offered thorough information about potential side effects so that they are empowered to better manage these effects if they occur…..In addition, practitioners should emphasize to contraceptive patients that they will support them whenever they decide to discontinue an LARC method….

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AJPH - American Journal of Public Health

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