Providers are a crucial link in supporting patients in achieving reproductive well-being by offering patient-centered contraceptive counseling. Integrating contraceptive counseling at the time of abortion can be challenging due to feasibility and logistic factors, such as cost, insurance, and health center workflows, as well as acceptability and potential concerns about contraceptive coercion. Offering, but not requiring, counseling at the time of abortion promotes autonomy but also ensures that patients feel respected, informed, and empowered in making decisions about their reproductive futures.
A patient-centered approach begins with the understanding that each individual has unique circumstances, needs, and goals. Counseling prioritizes active listening, empathy, and collaboration to align contraceptive care with the patient’s values and preferences. Centering the patient in contraceptive counseling at any time is key to reproductive well-being, including at the time someone is seeking an abortion.
Available but not required
Building trust and rapport is the foundation of effective contraceptive counseling. Abortion care can be a deeply personal experience, and patients may arrive with varied emotions, cultural influences, or past health care experiences. Some people want to talk about or start birth control at the time of their abortion, and others don’t—it’s okay either way. The key to contraceptive counseling at the time of abortion care is to offer, but not require, contraceptive counseling or method selection at the time of the abortion without an expectation of starting a method or having an explicit “plan” for pregnancy prevention in the future. Requiring abortion seekers to have contraceptive counseling is coercive and erodes trust in the provider-patient relationship.
Leave the door open
Patients may decide not to start contraception immediately or at all. Providers should respect their autonomy and reassure them that they can revisit the conversation in the future. For example, “It sounds like you’re not ready to decide on a method right now, and that’s completely okay. If you have questions later, we’re here to help.”
Counseling doesn’t always mean starting a method today
For people who are interested in contraceptive counseling, using a patient-centered approach can help patients understand what matters most to them about their method. For people who are not interested in starting a method soon after their abortion, providers can provide additional resources with accurate and unbiased information on birth control, like Bedsider.org, so patients can review and learn about methods on their own after a visit.
Make all methods available
For people who want to start a contraceptive method, most methods can safely initiated on the day of their abortion. Providers should make available, either through provision or referral, all methods the patients are interested in hearing about. Logistical, financial, or systemic barriers to accessing contraception at the time of abortion can limit access to the full range. If a provider is not able to offer the full range of methods at their site (or on the day of the abortion), they can build a referral network in their area of providers who provide other methods, including IUDs, sterilization, and others. When not able to offer a method on-site at the time of abortion, providers can offer another method, a.k.a. “bridge” method, until patients are able to obtain their desired method.
Make follow-up visits an option
Contraceptive counseling doesn’t have to end with the initial conversation. Providers can keep the door open by offering a follow-up visit to talk more about contraception, let patients know how to make a follow-up appointment if they would like, and offer resources, including educational materials.
Bottom line
Offering contraceptive counseling in abortion care is an opportunity to support patients in achieving reproductive well-being. By taking a patient-centered approach to offering counseling and providing it, providers can ensure that everyone receives the respectful, empowering care they deserve.
