Patients in the United States have many methods of contraception to choose from based on their own preferences. However, with the advent of LARC, the narrative of contraception counseling has changed from generalized counseling based on preferences to more focused recommendations. Complicating this shift in contraceptive counseling is the medical field’s history of coercive provider practices regarding contraception in vulnerable populations.
We explored patient experiences of contraceptive coercion by healthcare providers at time of abortion by conducting a qualitative study of English-speaking women seeking abortion services at a hospital-based clinic. We used the Integrated Behavioral Model and Reproductive Autonomy Scale to inform our semi-structured interview guide. We enrolled participants until thematic saturation was achieved. Two coders used modified grounded theory to analyze transcribed interviews with Nvivo 11.0 (Κ=0.81).
From June 2016 to March 2017, we interviewed 31 women. Participants were predominantly young (mean age 27 years, ± 5.31), non-Hispanic Black (52%), and Medicaid-insured (68%). Several participants reported feeling “pressured” into choosing some form of contraception. Some participants voiced that providers seemed to prefer LARC methods or were “pushing” a specific method. A few participants perceived pressure to choose any method due to providers’ preference to prevent repeat abortions. Participants who were offered a range of methods through the use of decision aids and who were given time to deliberate demonstrated more autonomy.
The reproductive autonomy model provides a useful framework to explore experiences of contraceptive coercion by providers at the time of abortion. Participants perceived coercion in the form of provider preference for specific methods or initiation of a method. Use of decision aids to offer a range of methods and time for participant deliberation supported participant self-efficacy and communication ability. Abortion stigma may mediate potentially coercive interactions between patients and providers.