Patient and healthcare provider talkingContraception decision-making is a critical aspect of reproductive health, impacting individuals’ reproductive autonomy, physical well-being, and overall quality of life. It plays a pivotal role in family planning, allowing individuals and couples to make informed choices about if and when they want to have children.

However, the results of a recent study conducted by HealthyWomen, an organization focused on women’s health, demonstrates a significant discrepancy between patient preferences and healthcare provider perceptions, particularly regarding the choice between hormonal and non-hormonal contraceptive methods. This incongruity can have profound implications for individuals’ access to effective contraception and their overall reproductive health.

Patient Preferences versus Provider Perceptions

This new survey was conducted in the fall of 2022, just several months after the Supreme Court overturned Roe v. Wade, and involved more than 5,000 women (aged 18 to 55) plus 506 healthcare professionals (HCPs) with expertise in gynecology (OB/GYNs, nurse practitioners, physician assistants, family practitioners).

The HealthyWomen survey explored a range of topics, including the perceived impact of the Supreme Court ruling on patient care: More than 20 percent of the patients surveyed indicated that they did change or planned to change their method of birth control, and more than 25 percent of HCPs said they changed the way they counseled their patients about contraception. The study also involved questions about hormonal and non-hormonal contraception methods, including costs, pregnancy, and general health. The study results were released by HealthyWomen in May 2023.

One of the more interesting and surprising stats emerging from this survey involved patient preference versus provider perceptions: The survey results showed that three in five women surveyed (60 percent) prefer birth control without hormones, while three in five HCPs surveyed (59 percent) recommend birth control with hormones when patients don’t have a preference.

Growing Concerns about Hormonal Contraception

In recent years, we have seen a growing trend in which women increasingly express a preference for non-hormonal contraceptive options, such as condoms, intrauterine devices (IUDs), or fertility awareness methods. Many women are concerned about the potential side effects and health risks associated with hormonal contraceptives. These can include mood changes, weight gain, and an increased risk for blood clots. Also, a significant portion of women value natural and noninvasive approaches to contraception, or want greater control to easily initiate or discontinue their contraception, both of which align with non-hormonal choices.

Conversely, healthcare providers often recommend the combined hormonal contraceptive pill as the default option, perhaps due to its familiarity, ease of prescription, and effectiveness. This mismatch between patient preferences and provider recommendations highlights the need for a more patient-centered approach to contraceptive decision-making.

Barriers to Patient-Centered Care

Several factors may contribute to this disconnect between patient preferences and provider perceptions in contraception decision-making:

  • Lack of Awareness: Patients may not be fully aware of all available contraceptive methods, their benefits, and potential side effects. Providers must take the time to educate patients about their options, including non-hormonal methods.
  • Prescribing Habits: Healthcare providers may have established prescribing habits that are influenced by their clinical training, existing clinical guidelines, and other factors that favor hormonal methods. Over-reliance on these habits can limit patient choice.
  • Misconceptions: Providers may hold misconceptions about the safety and effectiveness of non-hormonal methods, leading them to discourage or dismiss these options without proper consideration.
  • Communication Barriers: Limited time during appointments, communication gaps, and differing priorities may hinder effective discussions between patients and providers about contraception preferences. For example, hormonal contraceptives, particularly the pill, are relatively easy to prescribe and counsel patients about, compared to some non-hormonal methods. This also may lead providers to recommend them more frequently.
Significance of Aligning Patient Preferences

Addressing the misalignment between patient preferences and provider perceptions in contraception decision-making is crucial for several reasons:

  • Reproductive Autonomy: Respecting patient preferences empowers women to make choices that align with their values and health needs, promoting reproductive autonomy.
  • Health Outcomes: Choosing a contraceptive method that matches a woman’s preferences and health status can minimize side effects and improve adherence, leading to better overall health outcomes.
  • Reducing Disparities: Bridging the gap between patient and provider perspectives can help reduce healthcare disparities by ensuring that all individuals, regardless of their contraceptive preferences, receive equitable access to information and options.
  • Patient Satisfaction: A patient-centered approach increases patient satisfaction with healthcare services, strengthening the provider-patient relationship and fostering trust.
  • Shared Decision-Making: Encouraging shared decision-making between patients and providers is essential. This approach allows women to voice their preferences, concerns, and priorities while providers offer evidence-based guidance.
  • Research and Innovation: Continued research into the development of new contraceptive technologies, especially non-hormonal options, can expand the range of choices available to women.

Contraception decision-making is a complex and deeply personal process that should prioritize the alignment of patient preferences with evidence-based healthcare recommendations. Bridging the gap between a woman’s desire for non-hormonal options and provider perceptions is essential to ensure that women have access to the contraception methods that best suit their unique needs and preferences, ultimately optimizing a woman’s lifestyle and her health.

To learn more about the many factors involved in the contraception decision-making process, click here.

For specific information about hormonal versus non-hormonal contraception options, click here.

View a short video about contraception decision-making here.