Supporting Contraceptive Decision-Making Among Young Women

For young women, unintended pregnancies are a concern, and how physicians can assist patients in their decision-making to find the right contraceptive plan for them.

Unintended pregnancies remain a significant concern among young women despite the availability of diverse contraceptive options. These pregnancies are often linked to increased health risks, social challenges, and economic instability, such as disrupted education and job instability. While family planning is recognized as a fundamental human right, many young women still face barriers to accessing modern contraceptives.

Although the same options are available to them as to older women, only 60% of women aged 15 to 19 use modern contraceptives, compared to 75% of women over 30. These disparities highlight the importance of targeted support for young women navigating contraceptive choices.

Contraceptive Challenges

Young women face specific challenges in selecting a contraceptive method, including concerns about side effects and the pain associated with long-acting reversible contraceptives (LARC) like intrauterine devices (IUDs). Additionally, cognitive, emotional, and behavioral factors unique to adolescents influence their decision-making process. Barriers such as limited knowledge, cultural stigmas, and healthcare professionals’ attitudes can further restrict access to contraception. Misconceptions about contraceptives—such as fears of infertility, weight gain, and cancer—complicate decision-making, increasing the likelihood of unintended pregnancies.

To address these challenges, international efforts promote the use of safe, effective contraceptive methods like LARC. However, it is crucial to respect the reproductive rights of young women and avoid coercion. Empowering them to make informed decisions enhances their understanding of risks, benefits, and personal preferences. Decision support interventions, such as patient decision aids and educational materials, can play a critical role in helping young women make quality decisions aligned with their values and needs.

A recent umbrella review published online in BMC Women’s Health summarized the decisional needs and effective support interventions for young women considering contraceptive options. It identified four main decisional needs: access to accurate information, respect for personal values, availability of support resources, and acknowledgment of personal characteristics like embarrassment or religious beliefs. Reviews indicated that young women value clarity on contraceptive safety, effects on fertility, and side effects. Young women also desire non-judgmental support and privacy in their decision-making processes. Social context, including peer, family, and community influences, significantly affects their choices.

Interventions Physicians Can Make

Interventions supporting decision-making, including patient decision aids and educational materials, have shown positive outcomes. Studies from the United States found that these tools improved young women’s knowledge of contraceptive options and facilitated more informed discussions with healthcare professionals. However, patient decision aids did not significantly enhance participation in decision-making, and the benefits varied across different study designs and settings.

The review suggests that while existing interventions can improve knowledge, additional approaches like decision coaching or question prompts could further support shared decision-making. Moreover, interventions should be non-directive, offering balanced information that respects young women’s autonomy and encourages them to select the best option for their needs.

Understanding these decisional needs is crucial to fostering a patient-centered approach for physicians. Effective implementation of decision aids requires training, organizational support, and a commitment to integrating these tools into clinical practice.

Empowering Young Women

The researchers noted that policymakers can facilitate broader use by endorsing decision aids, supporting quality improvement efforts, and offering incentives to encourage their application.

Addressing these elements can significantly enhance young women’s ability to make informed, empowered choices about their reproductive health, reducing unintended pregnancies and supporting better health outcomes.