Methods of contraception

One of the most sensitive and intimate decisions made by an individual or by a couple is that of fertility control. This decision is often based on deeply held religious or philosophical convictions. Thus, the clinician must approach the patient’s fertility needs with particular sensitivity, empathy, maturity, and nonjudgmental behavior.

However, it must be recognized that there is a considerable need for contraception. The number of births rose 3% between 1999 and 2000. While the birth rate among teenagers fell to a historic low, the fertility rate rose 3% to 67.6 per 1000 women aged 15-44 years. Birth rates increased for all age groups over the age of 20. The number of births among unmarried, older women was also the highest ever reported, with a 3% increase compared to 1999. These numbers reflect the tendency for women to delay childbearing until their 30s or 40s, perhaps when their careers are well established. Thus, health care professionals who provide contraception need to meet the needs of women with diverse social and economic circumstances.

Individual Indications for Birth Control
Contraception is practiced by most couples for personal reasons. Many couples use contraception to space their children or to limit the size of their family. Others desire to avoid childbearing because of the effects of preexisting illness on the pregnancy, such as severe diabetes, or heart disease, such as severe aortic stenosis. For all of these types of decisions, clinicians must provide accurate information about the benefits and risks of both pregnancy and contraception. However, medical conditions that may substantially increase the risk of using some form of birth control usually increase the risks associated with pregnancy to an even greater extent. As a matter of public policy some countries, especially those that are less developed, promote contraception in an effort to curb undesired population growth.

Legal Aspects of Contraception
Contraceptives are prescribed, demonstrated, and sold in most states of the U.S. without restriction.

Despite high rates of unprotected intercourse and unintended pregnancy, the pros and cons of providing contraceptive information and materials to teenagers have been vigorously debated. A regulation proposed in 1982 for federally funded family planning programs in the U.S. would have required personnel at family planning facilities to notify the parent or guardian of any person under the age of 18 years at least 10 working days before the clinic would be able to provide a prescription contraceptive to the teenager. This proposal was declared unconstitutional by the courts. Furthermore, in 1977, the United States Supreme Court ruled that minors have a constitutional right of access to contraceptives. Most states either have legislation that permits access to contraception for persons under 18 or have not addressed the issue legislatively. Most physicians agree that teenagers should be given contraceptive advice and prescriptions within the confines of appropriate legal restraints. However, they must be careful to avoid imposing their own religious or moral views on their patients.

Health care providers must provide all persons requesting contraception with detailed information about the use of the method or methods, benefits, risks, and side effects so that an informed choice can be made relative to a particular method. Not only is the provision of this information of ethical and legal importance, but such counseling is also likely to ensure that the method will be used appropriately with overall improved compliance. Documentation of the discussion with the patient and her understanding of what has been said is of legal importance.

In particular, when using methods that require instrumentation or some type of surgical approach and that also may require intervention by a health care professional for discontinuation (eg, IUD, injectable or implantable progestin, or sterilization), use of signed consent forms that outline the information discussed and the patient’s understanding is important. Such a form serves as evidence, if needed, that counseling about use of a particular birth control method was given; that the patient appeared competent to understand what was said to her; and that she consented to receive contraceptive management in the manner specified.

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Provided by ArmMed Media
Revision date: July 8, 2011
Last revised: by Janet A. Staessen, MD, PhD