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Contraception: Counseling Principles
The Challenge
The challenge is to assist couples in identifying and using the most appropriate method of controlling fertility. Changing patterns of sexual expression, new technologies, increased consumerism, and heightened cost pressures all affect the choices made in the search for fertility control. The very nature of the topic gives contraception personal, religious, and political overtones that often lead to conflict, emotionality, and confusion.
Scope Of The Problem
In the United States, nearly half (45%) of all pregnancies are unplanned. Specifically, 27% of all pregnancies were “wanted later” and 18% of pregnancies were “unwanted.” Despite the fact that 90% of women at risk (fertile, sexually active, and neither pregnant nor seeking pregnancy) are using some form of contraception, nearly 5% of reproductive-age women have an unintended pregnancy each year. The 10% or so of women not using contraception account for more than half of these unintended pregnancies. The remaining unplanned pregnancies occur as either failure of the contraceptive method used or the improper or inconsistent use of the method. Roughly 40% of unintended pregnancies (excluding miscarriages) end in elective termination.
Objectives Of Counseling
There is no “ideal” contraceptive method. While efficacy and an acceptable risk of side effects are important in the choice of contraceptive methods, these are often not the factors upon which the final choice is made. Motivation to use or continue to use a contraceptive method is based on education, cultural background, cost, and individual needs, preferences, and prejudices. Factors such as availability, cost, coital dependence, personal acceptability, and the patient’s perception of the risk all have a role in the final choice of methods. Side effects, such as irregular or unpredictable vaginal bleeding, can often contribute more to the patient’s acceptance or continuance of a method than any other factor.
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