Contraception

The Women’s Preventive Services Initiative (WPSI) recommends that adolescent and adult women have access to the full range of contraceptives and contraceptive care to prevent unintended pregnancies and improve health outcomes. Contraceptive care includes screening, education, counseling, and provision of contraceptives (including in the immediate postpartum period). Contraceptive care also includes follow-up care (eg, management, evaluation, and changes, including the removal, continuation, and discontinuation of contraceptives).

The WPSI recommends that the full range of U.S. Food and Drug Administration (FDA)-approved, -granted, or -cleared contraceptives, effective family planning practices, and sterilization procedures be available as part of contraceptive care. The full range of contraceptives currently includes those listed in the FDA’s Birth Control Guide: 1) sterilization surgery for women, 2) implantable rods, 3) copper intrauterine devices, 4) intrauterine devices with progestin (all durations and doses), 5) injectable contraceptives, 6) oral contraceptives (combined pill), 7) oral contraceptives (progestin only), 8) oral contraceptives (extended or continuous use), 9) the contraceptive patch, 10) vaginal contraceptive rings, 11) diaphragms, 12) contraceptive sponges, 13) cervical caps, 14) condoms, 15) spermicides, 16) emergency contraception (levonorgestrel), and 17) emergency contraception (ulipristal acetate); and any additional contraceptives approved, granted, or cleared by the FDA.

The WPSI recommends access to and provision of the full range of FDA-approved, – granted, or -cleared contraceptives. Individualized effective family planning practices and related services are also recommended as part of contraceptive preventive services.

Contraceptive counseling should be between an individual and clinician or appropriately trained professional, emphasizing patient-centered decision making and allowing for discussion of the benefits, risks, and preferences of the full range of contraceptive options. Although less effective as a standalone approach, it is reasonable to provide counseling in fertility awareness–based methods, including the lactation amenorrhea method, for individuals for whom other methods are not acceptable. While beyond the scope of the WPSI, male sterilization is extremely effective and should be included in discussions about contraception. The WPSI strongly supports equitable access to permanent contraception for all individuals.

The WPSI recommends providing alternative contraceptives when a particular drug or device is not tolerated or is inappropriate as determined by the individual and the clinician. This includes initiation, discontinuation, and timely removal of contraceptives. More than one visit may be necessary to identify appropriate contraceptive methods, manage contraceptive side effects, achieve effective contraception, and optimize use as determined through shared decision making. Research indicates that delayed initiation or disruption of contraceptive use increases the risk of unintended pregnancy; therefore, removal of preapproval requirements for contraceptive care, including in the immediate postpartum period, is recommended. The WPSI recommends that emergency contraception, including advanced provision, should be broadly available and provided to all women who may benefit.

Clinicians should consider the cultural and linguistic needs and priorities of each individual, and counseling should be consistent, respectful, affirming, and nonstigmatizing.

• Additional studies of the effectiveness of different types of information sources and their delivery on contraception and family planning decisions that build on successful interventions in the existing body of research.
• Studies evaluating the patient experience of contraceptive care including evaluation of biases based on patient and clinician beliefs and demographics; effects of using a reproductive justice framework in patient decision making; and the relationship between the interpersonal quality of family planning counseling and contraceptive use.
• Research on innovative ways to expand access to contraceptives, including studying the safety and efficacy of reducing or eliminating prescription requirements for certain methods.
• Studies to determine the most effective frequency and methods of follow-up to facilitate contraceptive continuation over time.