Contraception

Clinical Recommendations

The Women’s Preventive Services Initiative recommends that adolescent and adult women have access to the full range of female-controlled contraceptives to prevent unintended pregnancy and improve birth outcomes. Contraceptive care should include contraceptive counseling, initiation of contraceptive use, and follow-up care (eg, management, and evaluation as well as changes to and removal or discontinuation of the contraceptive method). The Women’s Preventive Services Initiative recommends that the full range of female-controlled U.S. Food and Drug Administration-approved contraceptive methods, effective family planning practices, and sterilization procedures be available as part of contraceptive care.

The full range of contraceptive methods for women currently identified by the U.S. Food and Drug Administration include: (1) sterilization surgery for women, (2) surgical sterilization via implant for women, (3) implantable rods, (4) copper intrauterine devices, (5) intrauterine devices with progestin (all durations and doses), (6) the shot or injection, (7) oral contraceptives (combined pill), 8) oral contraceptives (progestin only, and), (9) oral contraceptives (extended or continuous use), (10) the contraceptive patch, (11) vaginal contraceptive rings, (12) diaphragms, (13) contraceptive sponges, (14) cervical caps, (15) female condoms, (16) spermicides, and (17) emergency contraception (levonorgestrel), and (18) emergency contraception (ulipristal acetate), and additional methods as identified by the FDA. Additionally, instruction in fertility awareness-based methods, including the lactation amenorrhea method, although less effective, should be provided for women desiring an alternative method.

Implementation Considerations

The Women’s Preventive Services Initiative recommends as a preventive service, access to and provision of the full range of female-controlled U.S. Food and Drug Administration-identified contraceptive methods. This includes access to contraceptive counseling, initiation of contraceptive use, and follow-up care (eg, management, evaluation, as well as changes to and removal or discontinuation of the contraceptive method) by a health care provider or appropriately trained individual. Additionally, effective family planning practices, and patient-specific services or U.S. Food and Drug Administration-approved methods that may be required based on individual women’s needs are recommended as part of contraceptive preventive services.
The Women’s Preventive Services Initiative recommends accommodation of an alternative form of contraception when a particular drug or device (generic or brand name) is medically inappropriate for a patient as determined by the individual’s health care provider. Research indicates that delayed initiation or disruption of contraceptive use increases the risk of unintended pregnancy; therefore, the Women’s Preventive Services Initiative recommends timely authorization of contraceptives.
The Women’s Preventive Services Initiative also recommends as a preventive service counseling that emphasizes patient-centered decision-making and allows for discussion of the full range of contaceptive options.
For some women, more than one visit may be needed to achieve effective contraception. More than one visit may also be necessary to identify the appropriate contraceptive methods to optimize compliance and effectiveness as determined by a woman and her health care provider, based on shared decision making.

*These are the recommendations of the WPSI and not necessarily of any individual participating organization.