Journal of Adolescent Health 54 (2014) 367e368
www.jahonline.org Editorial
Contraceptive Counseling: Does It Make a Difference?
Approximately half of all pregnancies in the United States are unintended, with adolescents and young adult women being at highest risk [1]. Ninety-five percent of all unintended pregnancies occur in 35% of U.S. women who are not using contraception consistently or at all [2]. Prevention of unintended pregnancy requires a multifaceted approach including sexual health education and contraceptive counseling, reducing health disparities, and improving access to effective contraception. The Centers for Disease Control and Prevention recommends that all women be “counseled about the full range and effectiveness of contraceptive options for which they are medically eligible” [1]. However, this does not ensure understanding or adherence. Counseling adolescents to achieve true understanding of a given contraceptive method and to promote adherence can be challenging [3]. There are often confidentiality and access concerns. Knowledge about reproductive physiology and anatomy varies widely among adolescents and young adult women [4]. A teen’s ability to properly use a contraceptive consistently over time and manage minor side effects is also variable. While some adolescents seemingly know which contraceptive they want, this is often driven by misconceptions about certain contraceptives. Providers have the responsibility to dispel myths and guide their patients with evidence-based information. Providers must be careful that bias regarding the efficacy and acceptability of certain forms of contraception does not inappropriately steer them away from or toward certain options [5]. In this issue of the Journal of Adolescent Health, Merki-Feld and Gruber [6] report on the experience of over 1,000 15- to 20-yearold Swiss women considering a combined hormonal contraceptive (CHC), a subgroup from the 11-European country Contraceptive Health Research of Informed Choice Experience (CHOICE) study. A detailed leaflet provided consistent information across study sites with almost all counseling performed by gynecologists (93%). While provider opinion regarding optimal contraceptive options for a given subject was collected, this information was not directly communicated to the participant. Interestingly, if the provider had a preference, women without a preference for a CHC method before counseling typically opted for the provider preferred method, yet 91.2% of participants felt that counseling was “very fair” and “balanced.” Efficacy, menstrual cycle control, ease of use, lower likelihood to forget use, and peer use of a given agent were important considerations for these women.
Interestingly, after counseling, 47%e68% of subjects claimed to “not know” or to have “no opinion” regarding the statement “The method has many side effects.” After counseling, the fraction of women intending to use the Evra patch increased from 3.3% to 5.8% and for the NuvaRing from 7.5% to 21.8%, whereas similar percentages of women intended to use a combined hormonal pill before and after counseling (62.1%e67.9%). In the larger Swiss CHOICE study (2,629 women, 15e40 years, 65%
www.jahonline.org Editorial
Contraceptive Counseling: Does It Make a Difference?
Approximately half of all pregnancies in the United States are unintended, with adolescents and young adult women being at highest risk [1]. Ninety-five percent of all unintended pregnancies occur in 35% of U.S. women who are not using contraception consistently or at all [2]. Prevention of unintended pregnancy requires a multifaceted approach including sexual health education and contraceptive counseling, reducing health disparities, and improving access to effective contraception. The Centers for Disease Control and Prevention recommends that all women be “counseled about the full range and effectiveness of contraceptive options for which they are medically eligible” [1]. However, this does not ensure understanding or adherence. Counseling adolescents to achieve true understanding of a given contraceptive method and to promote adherence can be challenging [3]. There are often confidentiality and access concerns. Knowledge about reproductive physiology and anatomy varies widely among adolescents and young adult women [4]. A teen’s ability to properly use a contraceptive consistently over time and manage minor side effects is also variable. While some adolescents seemingly know which contraceptive they want, this is often driven by misconceptions about certain contraceptives. Providers have the responsibility to dispel myths and guide their patients with evidence-based information. Providers must be careful that bias regarding the efficacy and acceptability of certain forms of contraception does not inappropriately steer them away from or toward certain options [5]. In this issue of the Journal of Adolescent Health, Merki-Feld and Gruber [6] report on the experience of over 1,000 15- to 20-yearold Swiss women considering a combined hormonal contraceptive (CHC), a subgroup from the 11-European country Contraceptive Health Research of Informed Choice Experience (CHOICE) study. A detailed leaflet provided consistent information across study sites with almost all counseling performed by gynecologists (93%). While provider opinion regarding optimal contraceptive options for a given subject was collected, this information was not directly communicated to the participant. Interestingly, if the provider had a preference, women without a preference for a CHC method before counseling typically opted for the provider preferred method, yet 91.2% of participants felt that counseling was “very fair” and “balanced.” Efficacy, menstrual cycle control, ease of use, lower likelihood to forget use, and peer use of a given agent were important considerations for these women.
Interestingly, after counseling, 47%e68% of subjects claimed to “not know” or to have “no opinion” regarding the statement “The method has many side effects.” After counseling, the fraction of women intending to use the Evra patch increased from 3.3% to 5.8% and for the NuvaRing from 7.5% to 21.8%, whereas similar percentages of women intended to use a combined hormonal pill before and after counseling (62.1%e67.9%). In the larger Swiss CHOICE study (2,629 women, 15e40 years, 65%
