Patient Perspectives on Clinician Support When Pursuing Permanent Contraception in the United States

Abstract

Background: Given the history of coercion in the provision of sterilization, it is important that patients who desire permanent contraception receive patient-centered care that respects their preferences. Recent literature examining the provision of postpartum permanent contraception has not explored whether patients who desire permanent contraception feel supported by their clinical teams.

Methods: We interviewed patients from four medical centers around the United States with a documented desire for postpartum permanent contraception. We audio-recorded, transcribed, and analyzed interviews using rapid qualitative methods and thematic content analysis.

Results: Of the 81 patients interviewed, most (n = 64) felt supported by their clinician throughout their prenatal care and delivery hospitalization. Seventeen patients shared stories of feeling unsupported. Patients recalled feeling dismissed when they initiated conversations about permanent contraception. Additionally, they felt they had received incomplete counseling on permanent contraception and felt discouraged from getting the procedure during prenatal care encounters. During delivery hospitalization, patients discussed not being informed about barriers to permanent contraception as they surfaced, facing lack of prioritization of the procedure by clinicians, recognizing communications errors among the clinical team, and feeling pressured to undergo or not undergo permanent contraception.

Conclusion: Most patients felt supported by their clinicians throughout permanent contraception decision-making and provision. Patients who did not feel supported reported a spectrum of experiences ranging from rushed appointments, perceived clinician bias in counseling, and communications barriers to the provision of permanent contraception after delivery. Patient-centered care that prioritizes patient experiences, values, and desires is necessary to ensure that all people can achieve their reproductive goals.

Keywords: coercion; permanent contraception; postpartum contraception; sterilization.