Informed Decision Making about Contraception

Adapted from “New Dimensions in Women’s Health” by Linda Lewis Alexander & Judith H. LaRosa

An array of effective birth control methods is available to women today. The decision-making challenger is to determine which method or combination of methods best meets each woman’s unique needs. Safety and reliability are the first concern. Other factors such as health status, lifestyle, financial considerations, and patterns in sexual activity also determine which method is best suited. Many women will decide to change to a different method as factors change. Communication is an essential component of contraceptive decision making. It is important that couples talk about feelings, needs, and fears.

Determining Personal Needs

Sexual urges and sexual activity are normal events for men and women, but for women, a very real possible consequence of heterosexual intercourse is pregnancy. For both technological and sociological reasons, there has been a traditional tendency for women to assume the major responsibility for contraception. This has been both unfair and unreasonable for women. Although most of the current contraceptives require primary use by women, there are a number of ways couples can share the responsibility for contraception. Open and honest communication, sensitivity to each other’s needs and feelings, and awareness of each method’s strengths and weaknesses are essential components for effective decision making.

Specific strategies to informed consumer contraceptive decision making include the following:

  1. Review needs. It is important to consider when or if pregnancy may be desired. If never, perhaps sterilization is a more logical option. If pregnancy is desired in a few years, the more effective methods such as the pill may be preferable. If pregnancy is desired later on this year, one of the barrier methods may be a better choice. If a woman does not want to become pregnant and an abortion is out of the question, she may wish to consider a combination of two good birth control methods, such as foam and condoms, or pills and condoms, or a diaphragm and condoms. Frequency of intercourse is another major consideration to review. If intercourse occurs frequently, barrier methods may prove to be inconvenient. Number of partners should be considered. If a woman has more than one partner, or her partner has another partner, she has a greater risk for infection. In this case, a condom with spermicide in addition to birth control pills would provide the best protection against both sexually transmitted diseases and pregnancy. Emotional, behavioural, and psychological needs must also be considered. Even though a method may appear perfectly logical from a medical point of view, if it is distasteful or undesirable, the chances are that compliance with that method would be poor. The degree of partner cooperation is another important consideration. Barrier methods are more likely to be successful if there is partner cooperation and support. If spontaneity is an important consideration, barrier methods that require time-out for insertion may not be desirable and represent additional risk for pregnancy. Perhaps one of the most important considerations is an evaluation of partner feelings and support. Ideally the contraceptive choice is a joint decision made by a couple with open honest discussion of all the considerations and issues. With less than an ideal situation, the woman would be unwise to depend on her partner for contraception decision making or use.
  2. Consider medical factors. Medical factors such as risk factors for cardiovascular disease, smoking status, and circulatory disorders must be carefully reviewed before deciding on birth control pills.
  3. Review failure rates. It is important to compare typical failure rates with best observed failure rates for the method selected. The difference can provide insight into what the relative margin of error is in that method. For example, foam has a best reported failure rate of 3 to 5 percent with an average failure rate of 18 percent. Clearly these differences indicate that typical users are different form the study population that achieved the best reported rates. At best, however, failure rates can provide only a general idea of how successful other couples have been with a selected method in the past.
  4. Put risks and benefits of the methods in perspective. It is important to weight all the dimensions and issues of the relationship carefully with the advantages and disadvantages of each method. The risks and benefits of each method need to be carefully assessed for each method in terms of the individuals involved and the relationship. Some couples find that they can use a numerical rating scheme to determine the best contraceptive that meets their unique needs.

Periodic re-evaluation of decision. At regular intervals, contracepting couples need to reevaluate the level of effectiveness and their individual level of satisfaction with the selected method. Reevaluation requires review of each of these steps and consideration of any new contraceptive developments, possible medical contraindications, and a current assessment of their needs, feelings, and family planning goals.