To Help Prevent Unintended Pregnancy, Coach the Clinician

Eleanor Bimla Schwarz, MD, MS reviewing Harper CC et al. Lancet 2015 Jun 16.

Subdermal and intrauterine contraception are more frequently offered by trained clinicians.

Subdermal and intrauterine contraceptives offer high levels of user satisfaction, yet these highly effective reversible methods are used by fewer than 8% of U.S. women. To evaluate whether clinician training in placement of such contraceptives affects counseling and clients' choices, researchers conducted a randomized trial involving 1500 women recruited from 40 Planned Parenthood clinics in 15 states. Clinicians at intervention clinics received a half-day of training designed to improve method-specific contraceptive counseling and placement skills.

In 1 year of follow-up, significantly more women seen at intervention clinics than control clinics reported receiving counseling about highly effective reversible contraception (71% vs. 39%) and choosing such methods (28% vs. 17%), with no between-group differences in contraceptive autonomy (i.e., choosing their method independent of undue influence from their clinician). Pregnancy rates associated with family planning visits at intervention clinic were half those at control clinics (7.9 vs 15.4 per 100 woman-years).

Citation(s):

Harper CC et al. Reductions in pregnancy rates in the USA with long-acting reversible contraception: A cluster randomised trial. Lancet 2015 Jun 16; [e-pub].