Multiple Choice Questions Regarding Contraceptive Methods and Family Planning,reproductive Health
Am J Nurs. Writer manuscript; available in PMC 2020 Oct 4.
Published in last edited form as:
PMCID: PMC7533104
NIHMSID: NIHMS1628733
An Evidence-Based Update on Contraception
A detailed review of hormonal and nonhormonal methods.
Laura Due east. Britton, PhD, RN, Amy Alspaugh, MSN, RN, CNM, Madelyne Z. Greene, PhD, RN, and Monica R. McLemore, PhD, MPH, RN, FAAN
Abstruse
Contraception is widely used in the Us, and nurses in all settings may encounter patients who are using or want to apply contraceptives. Nurses may be called on to anticipate how family planning intersects with other health care services and provide patients with information based on the about current evidence. This article describes key characteristics of nonpermanent contraceptive methods, including machinery of action, correct use, failure rates with perfect and typical use, contraindications, benefits, side effects, discontinuation procedures, and innovations in the field. We also hash out how contraceptive intendance is related to nursing ethics and health inequities.
Keywords: birth control, contraception, family planning, reproductive wellness
Contraception is widely used in the Us, with an estimated 88.two% of all women ages 15 to 44 years using at least one form of contraception during their lifetime.ane Amidst women who could get significant but don't wish to practise so, 90% utilize some grade of contraception.two Thus, nurses in various settings are likely to meet patients who are using contraception while presenting for a vast range of wellness care needs. Nurses will accept many opportunities to support such patients by coordinating contraceptive apply with other treatments, such as by identifying medications that interact with contraceptives or are teratogenic. Some patients, coming together with a nurse on an unrelated matter, may even seize the moment to ask questions about contraception.
Patients are best prepared to make informed decisions almost contraceptive use when they have evidence-based information; nurses can better support patients' reproductive goals by cultivating their ain knowledge base. This commodity will prepare nurses at diverse practice levels and practise settings to meet the needs of patients who are current or potential contraceptive users. Information technology describes the major categories of nonpermanent contraceptive methods and provides evidence-based updates. Nosotros also talk over inequities in contraceptive intendance that nurses can accost using their current clinical knowledge and a reproductive justice approach.
Contraception in context.
In its position argument on reproductive wellness, the American Nurses Association (ANA) has asserted that clients have the correct to brand reproductive health decisions "based on full information and without coercion," and that nursing professionals must be prepared to hash out "all relevant information about health choices that are legal."3 Similarly, the American University of Nursing has issued policy recommendations that support "access to safe, quality sexual and reproductive health care and reproductive health care providers."4 Adjustment with these policies ways that, across settings and in accord with their scope of practice, nurses should exist prepared to provide contraceptive counseling, services, and referrals.
Moreover, adopting a reproductive justice approach to intendance delivery can potentially better the quality and disinterestedness of reproductive health intendance and outcomes significantly.v Reproductive justice is a human rights framework that aligns with the ANA'south Code of Ethics for Nurses with Interpretive Statements,half-dozen, seven and functions simultaneously every bit a theory, a practise, and a strategy. For more than details, see Reproductive Justice.five, 7 Understanding contraception and contraceptive intendance in the context of both nursing ethics and reproductive justice will help nurses exist best prepared for providing optimal care.
CONTRACEPTIVE METHODS: Key CONSIDERATIONS
3 main considerations commonly ascend in discussions of contraceptive methods: method safety and contraindications, failure rates, and return to fertility.
An important source for data about method prophylactic comes from the Centers for Illness Control and Prevention (CDC): the U.Due south. Medical Eligibility Criteria for Contraceptive Use (U.Southward. MEC),eight which categorizes the safe of contraceptive methods in accordance with the specific health concerns of patients (see Table i viii). In this article we'll highlight the mutual contraindications and drug interactions categorized as U.S. MEC 4: "A status that represents an unacceptable health risk if the contraceptive method is used."8 Nosotros recommend that readers familiarize themselves with the U.S. MEC, which includes a comprehensive list of such conditions; it's available complimentary online (www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6503.pdf) and as an app.
Tabular array 1.
U.South. Medical Eligibility Criteria for Contraceptive Employ (U.S. MEC): Categorization of Safety for Specific Wellness Weather condition8
| Category | Condition | Prophylactic Recommendation |
|---|---|---|
| U.S. MEC 1 | A condition for which there is no restriction for the apply of the contraceptive method. | Tin can use the method. |
| U.S. MEC 2 | A condition for which the advantages of the contraceptive method generally outweigh the theoretical or proven risks. | Can apply the method. |
| U.S. MEC three | A condition for which the theoretical or proven risks of the contraceptive method by and large outweigh its advantages. | Should not use the method unless no other method is appropriate and acceptable. |
| U.Southward.MEC4 | A condition for which the contraceptive method poses an unacceptable health risk. | Should not use the method. |
Failure rates correspond a way to assess the efficacy of various contraceptive methods. For a given method, the failure rate is the per centum of users who accept an unintended pregnancy during the first year of use; a lower failure rate indicates college efficacy. For context, consider that up to 85% of women who take unprotected intercourse will experience an unintended pregnancy within a year.9 Failure rates for perfect and typical utilise of a given contraceptive method are also distinguished. Perfect apply reflects method use when instructions are followed exactly and consistently; typical use reflects real-life utilise, when the method may not be used consistently or perfectly.
Many people have questions about the timing of return to fertility subsequently stopping contraceptive use. The render to fertility is relatively rapid after abeyance of near all hormonal and nonhormonal methods, with the exception of depot medroxyprogesterone acetate (DMPA). For instance, in one study among women who discontinued combined hormonal contraception, pregnancy rates were 57% at 3 months and 81% at 12 months subsequently cessation.10 Conversely, ovulation may not resume for xv to 49 weeks after one's last DMPA injection, according to one systematic review.10
Method safety, efficacy, and render to fertility are not the but considerations that influence contraceptive choice. Information technology's of import for nurses and other providers to understand that individuals will value unlike features of various contraceptive methods. Personal preferences (such as for a hormonal or nonhormonal method, ease and comfort with style of use, partner acceptance, effects on the sexual experience, strength of want to avoid pregnancy, and religious or spiritual beliefs and practices), medical considerations (such equally whether the method protects against sexually transmitted infections [STIs], potential side effects), and structural factors (such as immediate and ongoing costs, ability to begin or stop use without needing access to health care)—all of these elements play a role.11–14 Seeing the whole pic will better equip nurses to help patients choose a method virtually aligned with their preferences and needs.
In this commodity, we describe the about common nonpermanent contraceptive methods; summarize their efficacy, mechanisms of action, uses, common adverse furnishings, and contraindications; and review the modes of administration of each type. Emergency contraception lies across the scope of this article and is not addressed.
HORMONAL CONTRACEPTIVES
Combined hormonal contraceptives
(CHCs) are among the most ordinarily prescribed and well-researched types of medication in use.ane, fifteen Synthetic estrogen and progestin revolutionized modern family planning when this combination first came on the market place in pill form in 1960. Today CHCs can be delivered through a pill, patch, or vaginal band with similar failure rates: less than 1% with perfect use and 7% to 9% with typical use.9, xvi, 17
In CHCs, both progestins and estrogen inhibit the hypothalamic–pituitary–ovarian centrality, which controls the reproductive cycle (meet Figure 1).18 Progestins foreclose pregnancy past inhibiting the luteinizing hormone (LH) surge, thus suppressing ovulation, thickening the cervical fungus, lowering fallopian tube motility, and causing the endometrium to go atrophic.18 Estrogens prevent pregnancy past suppressing follicle-stimulating hormone (FSH) production, which prevents the evolution of a dominant follicle.18 Progestin is responsible for the majority of both contraceptive action and side furnishings; the add-on of estrogen helps foreclose irregular or unscheduled bleeding.nine
The Hormonal Regulation of Ovulation
At left: the hypothalamus secretes gonadotropin-releasing hormone (GnRH), which stimulates the pituitary gland to secrete the gonadotropins luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH and FSH stimulate the growth and maturation of the ovarian follicles. The mature follicle secretes estrogen, inhibiting the hypothalamus from further GnRH production (until the next reproductive cycle). At right: after ovulation, blood levels of LH and FSH autumn, and the ruptured follicle, at present a corpus luteum, secretes estrogen and progesterone to prepare the uterine lining for fertilization and implantation. Adjusted with permission from Encyclopædia Britannica, © 2013 by Encyclopædia Britannica, Inc.
Traditionally, users take CHCs for three weeks, and then placebo pills or goose egg for i week. The hormone-free calendar week prompts "withdrawal bleeding," caused by withdrawal from active CHC ingredients, that mimics the menstrual cycle and may provide balls that the user isn't pregnant.18 Nurses can educate their patients that withdrawal bleeding is not actual menses and isn't clinically necessary.18, 19
Common side effects of CHCs include lighter, shorter periods (xl% to 50% reduction in menstrual menstruum); irregular bleeding (quantum bleeding or spotting); amenorrhea; nausea; breast tenderness; emotional lability; headaches; and reduced premenstrual syndrome symptoms (such equally bloating, cramping, and acne).18 CHCs are besides associated with reduced risk of ovarian, endometrial, and colon cancer, and are essential in treating polycystic ovarian syndrome.xviii Equally with other methods, it's difficult to predict which individuals will experience which side effects and how severe these volition be. Certain side effects, particularly amenorrhea, may be considered benign by some people but unacceptable past others.20 These may be referred to as "noncontraceptive benefits" of these methods.
CHC contraindications (U.South. MEC four–category conditions) include being age 35 years or older and smoking 15 or more cigarettes per day; existence less than 21 days postpartum; having a systolic blood pressure of 160 mmHg or greater, or a diastolic blood pressure of 100 mmHg or greater; having had major surgery with prolonged immobilization; experiencing migraine with aura; and being at elevated risk for recurrent deep vein thrombosis or pulmonary embolism.8
CHCs are still effective when taken meantime with many medications, including well-nigh ordinarily used antibiotics. Merely concurrent use of certain medications—including rifampin (Rifadin) or rifabutin (Mycobutin) therapy, the antiretroviral drug fosamprenavir (Lexiva), and certain anticonvulsants—can reduce CHC effectiveness.8 In such cases, use of a nonhormonal fill-in contraceptive method is recommended.
CHC pills.
Numerous CHC pills are currently bachelor on the market. Typically, pills comprise a ombination of 10 to 35 mcg ethinyl estradiol and one of the 4 generations of progestins. Dissimilar formulations accept different side effect profiles, so patients may demand to endeavor some other formulation if an undesirable side effect occurs.
Pills should be taken at nigh the same time every day to maintain ovulation suppression. This frequent dosing is one of the major drawbacks of pill utilize, and missing a pill is mutual, regardless of historic period.sixteen In general, nurses should counsel patients that a missed pill should be taken as soon as it is remembered. Ovulation suppression is not guaranteed if more than 48 hours accept elapsed since the concluding pill was taken. Missing a single pill will have piffling effect on effectiveness, but if 2 pills are missed, the most recent pill should be taken as soon as possible, and a backup method (such as condoms) should be used for seven days.xviii
Pills tin exist initiated at any time. A "Sunday start" has been popular in the past because it typically ensures that the withdrawal drain does not occur on weekend days. Recently, a "quick start,"starting the pill on the twenty-four hour period of visit, has go more popular considering, at least initially, it'south associated with better adherence, and there is no increase in the incidence of irregular haemorrhage.21
Extended and continuous apply are increasingly popular dosing regimens. Extended apply involves using the CHC for longer than the typical month-long cycle, thereby giving the user an extended time betwixt withdrawal bleeds. This can be accomplished by taking pills specifically designed for such regimens or by simply skipping the placebo pills in a 28-twenty-four hour period pill pack (though users will run out of pills more than speedily). Continuous use involves taking CHCs without interruption for an indefinite fourth dimension. Extended and continuous use regimens have been associated with improved ovulation suppression, increased medication adherence, high user acceptability, decreases in scheduled bleeding, and less breakthrough haemorrhage over time.19, 22 Moreover, decreasing or eliminating periods can be preferable for patients who have period-related mood changes, headaches, painful cramping, heavy catamenia, or other estrogen-related changes. While extended and continuous use regimens take primarily been studied regarding CHC pills, in that location is evidence of similar efficacy amid CHC patch and vaginal ring users.23
CHC transdermal patch.
The CHC transdermal patch (Xulane), a thin square nearly two inches beyond, contains 150 mcg norelgestromin and 35 mcg ethinyl estradiol (run into Figure 2). It can be placed on the breadbasket, upper arm, buttock, or back, and must exist completely attached to the skin to be constructive. The patch is replaced every week for three weeks; during the fourth week no patch is worn and a withdrawal bleed occurs. Weekly application is appealing for those who don't want the brunt of daily pill taking. In 2014, the patch became bachelor as a generic production.
While contraindications for CHCs apply to all commitment methods, there are some additional concerns with the patch. Findings from early enquiry suggested in that location was an increased risk of venous thromboembolism (VTE) with the patch compared to CHC pills, but afterwards inquiry has yielded conflicting results.24, 25 The U.S. Nutrient and Drug Assistants (FDA) recommends that the aforementioned guidelines regarding VTE exist applied to both methods: CHC pills and the patch should be avoided in patients at high take chances for clots, such every bit those who have a history of or electric current VTE or surgery requiring immobilization.24, 26 The patch also causes peel irritation in about xx% of users, though but nearly 3% discontinue the method for this reason.17
CHC vaginal ring.
The ring (NuvaRing) is a clear, flexible ring about two inches in diameter that is placed in the vagina for 21 days and removed for 7 days to allow for withdrawal haemorrhage; it's replaced monthly (see Figure 3). Information technology releases 15 mcg/day of ethinyl estradiol and 120 mcg/24-hour interval of etonogestrel. Users can simply place the ring in the vaginal canal themselves. As with the patch, the less frequent applications can be appealing and can lead to increased adherence.17 The ring's internal placement ensures the steady delivery of hormones, which allows for lower serum concentrations than occur with either the patch or pills. As a result, the band by and large has milder side furnishings than are seen with other CHC delivery methods.17 Some users may experience increased vaginal irritation and discharge.17 There is also some testify of reduced vaginal dryness, which may appeal to perimenopausal women and others who tend to feel such dryness.
Ring users may have concerns about their risk for pregnancy if the band is removed intentionally or accidentally. The ring can be removed for up to three hours without diminishing its contraceptive effect. This gives users the choice of removing information technology during sex if they prefer. The manufacturer recommends rinsing the device in cool or lukewarm water prior to reinsertion.27 If the band is out for more than iii hours, users should take extra steps to protect against pregnancy. As with whatsoever device, users should consult the package insert for more than specific instructions.
Progestin-just methods
include pills, injections, implants, and intrauterine devices (IUDs). Without concomitant estrogen, progestin-only methods pose less risk of VTE than CHCs.28 While the safe of the CHC pill, patch, and ring are addressed collectively in the U.South. MEC, the progestin-only methods are given separate prophylactic profiles. Like CHCs, progestin-just methods require a prescription.
Progestin-only pills (POPs).
POPs are generally made with first-generation progestins, and dosage amounts are substantially lower than those constitute in whatsoever CHC. Like CHCs, POPs should be taken at the same time of day. They are used continuously, with no hormone-gratuitous interval. Despite their pharmacokinetic differences, failure rates are often reported together: Hatcher and colleagues report that for both types of pills, the failure rate is less than 1% with perfect use and 7% with typical use.9 That said, POPs have a higher failure rate when not taken at the same time every day, because effective drug levels are maintained in the bloodstream for only 22 hours.nine Nurses should circumspection patients that they must be vigilant about adhering to the dosing schedule. The most mutual side effects of POPs are unscheduled bleeding and spotting, likely due to the shorter daily window of efficacy and the absence of estrogen.xviii
POPs are considered prophylactic in many clinical scenarios wherein CHCs are contraindicated (as noted in a higher place). Every bit with CHCs, patients should utilize a nonhormonal backup method when taking certain medications, including rifampin or rifabutin therapy, the antiretroviral drug fosamprenavir, and sure anticonvulsants.8
DMPA injection.
DMPA (Depo-Provera) is bachelor as a 150 mg/mL intramuscular injection or a 104 mg/mL subcutaneous injection given every 12 to xiii weeks.18, 29 Injections must be administered by a provider. The failure rate is less than 1% with perfect use and iv% with typical use.9 In addition to the aforementioned progestin mechanisms of activeness, DMPA also affects the hypothalamic–pituitary–ovarian axis at the hypothalamus, inhibiting ovulation through suppression of gonadotropin-releasing hormone.18
Irregular periods are a mutual side event. One systematic review found that, after a year of regular employ, only 12% of DMPA users had regular periods and 46% had amenorrhea.30 Although personal preferences vary, amenorrhea may exist seen as beneficial by patients with anemia, endometriosis, fibroids, dysmenorrhea, or menorrhagia.nine Other potential side furnishings include weight gain, impaired glucose metabolism, bone mineral density loss, headache, and mood changes (specifically depression).18 Because DMPA is i of the more detached methods available, it may entreatment to people wishing to keep their contraception private.
DMPA has few contraindications and virtually no drug interactions. Additional benefits include decreased risk of endometrial cancer and pelvic inflammatory illness, reduced incidence of epileptic seizures, and reduced frequency of sickle cell crises.9, 29
Implants.
Implants and IUDs containing progestin, as well as IUDs without hormones, are collectively referred to every bit long-acting reversible contraception (LARC). LARC insertions and removals are within the telescopic of practice of avant-garde do clinicians, including NPs and certified nurse midwives. In one case inserted, LARCs involve little user effort to maintain contraceptive efficacy.
The single-rod implant (Implanon, Nexplanon), which is most the size of a matchstick, is inserted in the upper arm and can remain in place for up to three years (see Effigy 4). The implant contains 68 mg of etonogestrel that is released incrementally at slowly diminishing rates, from sixty to 70 mcg/twenty-four hour period initially to 25 to 30 mcg/day by the end of the third year.31 Failure rates with both typical and perfect use are below i%.ix The most commonly reported reasons for discontinuation include irregular bleeding (10%), emotional lability (two%), and weight gain (2%).32 The implant method can appeal to people who desire a long-term, reversible, highly effective method only are uncomfortable with having devices in the vagina or uterus or with insertion procedures at those sites.18 The implant is safety for the vast majority of people, though at that place are contraindications for some specific weather, such as active breast cancer.8
IUDs with progestin (as well called intrauterine systems [IUSs]).
With both typical and perfect use, IUDs have failure rates below i%.nine Those with progestin modify the cervical mucus such that sperm cannot pass through the cervix to access the upper reproductive tract.
4 levonorgestrel (LNG) IUDs are available on the U.S. market, with similar effectiveness but varying doses, elapsing, and side effects.33 The naming convention uses a number to betoken the average number of micrograms of LNG released per day. The LNG-IUS 20 (Mirena) and LNG-IUS 12 (Kyleena) tin be used up to five years. The LNG-IUS twenty (Liletta, designed as a lower-price version of Mirena) can be used upward to four years, and the LNG-IUS 8 (Skyla) up to iii years. The LNG-IUS 12 and LNG-IUS eight are smaller in size, which makes insertion easier. Amenorrhea occurs in twenty% of LNG-IUS twenty users afterwards one twelvemonth, in 12% of LNG-IUS 12 users after 1 year, and in 12% of LNG-IUS 8 users later iii years.
Contraindications to IUD use include electric current purulent cervicitis, chlamydia infection, gonorrhea infection, or pelvic inflammatory disease at the time of insertion.21 If pelvic inflammatory disease develops after insertion, a grade of antibiotics may be prescribed, and removal may be warranted.
Despite their safety and efficacy, IUD utilise in the Us is lower than in other parts of the industrialized globe.34 IUDs take a fraught history, the legacy of which may impact patient and provider attitudes (see Are IUDs Safety? viii, 9, 35–forty). This is slowly starting to change, and recent substantial declines in unintended pregnancies are attributed, in function, to an increase in the utilize of LARCs.41
NONHORMONAL METHODS
Nonhormonal methods include the copper IUD, barrier methods with and without spermicides, and behavioral methods. Nonhormonal methods mostly accept fewer risks and side furnishings considering, by definition, they don't involve exposure to exogenous or synthetic hormones. Every bit with hormonal methods, the effectiveness, condom, and ease of apply of various nonhormonal methods are important user considerations and volition strongly influence private choices.
Copper IUD.
The about effective reversible nonhormonal method is the copper IUD (Paragard), which has a failure charge per unit below 1% with both typical and perfect employ; the device can be used for up to 10 years, and must be inserted by a skilled provider.9, 42 Copper ions are spermicidal. The copper IUD does not affect ovulation or timing of the menstrual cycle, just it is associated with heavier menstrual bleeding and cramping.43 In a three-year Australian study among 211 users, of the 59 women who discontinued utilize though still requiring contraception, 28 did and then considering of heavy haemorrhage.44 This side effect may be felt more acutely by users switching from a hormonal method that lessened their normal menses; anticipatory guidance from nurses can help ready such users for this possibility.
The copper IUD may exist an appealing pick for those who are limited by contraindications to CHCs or progestin-merely methods. In addition to the aforementioned contraindications for progestin-containing IUDs, copper IUDs are contraindicated for women with copper allergies, uterine infections, or uterine cancer.8
Barrier methods (with or without spermicides)
include condoms and diaphragms used at the fourth dimension of intercourse. Efficacy is highly dependent on user behavior, and failure rates with typical and perfect utilise vary widely. For the male person condom, failure rates with typical and perfect use are xiii% and 2%, respectively; for the female condom, 21% and 5%, respectively; and for the diaphragm, 17% and 16%, respectively.9
Condoms are available over the counter. Those made from polyurethane or latex preclude the manual of STIs, including HIV infection. Nonlatex condoms fabricated of lambskin are available for individuals with latex sensitivity, but don't protect against STIs.
Diaphragms are inserted into the vaginal canal such that they block the cervical os and can be placed up to an hour before intercourse. They crave a prescription, and accept traditionally come in multiple sizes, thus requiring plumbing fixtures by a provider. Diaphragms are used with a spermicide to increase their effectiveness. In the United States, all commercially bachelor spermicides contain nononoyl-nine (Northward-9) and are sold over the counter. N-9 may cause irritation or allergic reactions, and increases the run a risk of urinary tract infections.8 The irritation can cause genital lesions, which may increase the gamble of HIV acquisition. For women with HIV, N-nine irritation is suspected of increasing viral shedding, which increases the likelihood of manual to partners. Thus, spermicide use is contraindicated in people at high hazard for contracting HIV and is non recommended for people who accept HIV.eight
Behavioral methods
include withdrawal, lactational amenorrhea (LAM), and fertility awareness-based methods (FABMs). Withdrawal (often chosen "pulling out") involves removal of the penis from the vaginal culvert during intercourse merely before ejaculation. The failure rates are 20% with typical use and 4% with perfect use.9 Withdrawal requires proficient communication and common agreement, besides equally acceptable physical command by the ejaculating partner. Inquiry indicates that only a very small proportion of individuals apply withdrawal equally their primary contraceptive method; but because it's also normally used in conjunction with other methods and might non be considered a "real" method, its utilize may be underreported.45 Withdrawal may be an pick for people who don't desire to use other contraceptive methods for religious or cultural reasons.
LAM relies on the natural suppression of the LH surge that occurs during sectional breastfeeding. Information technology's highly effective when infants are exclusively fed breast milk on demand, when infants are under six months of age, and when the woman has not yet resumed menses.18 If breastfeeding is nonexclusive or the infant is older than six months, efficacy drops.
FABMs involve avoiding unprotected intercourse during an estimated fertile window, which is determined through a multifariousness of strategies of varying effectiveness. There are limited data nearly failure rates for each approach46; just collectively, the FABMs announced to have failure rates of 15% with typical utilize and from 0.4% to five% with perfect utilize.9 These methods may involve tracking the menstrual wheel, basal trunk temperature, cervical mucus, or LH levels in order to calculate the likely fertile menses. Midcycle, the LH surge preceding ovulation is followed by an increment in progesterone, causing a small but measurable increment in basal body temperature. The timing of ovulation varies, even among women with similar cycle lengths.47 Some FABM users might not fully comprehend how the method works,48 and nurses can help them attain a meliorate understanding of their menstrual cycle.
Although FABMs take traditionally been a low-tech contraceptive method, several mobile apps that back up FABMs are now available. An app user inputs the relevant information, and the app uses an algorithm to generate fertility window predictions. Apps algorithms vary, as does the accuracy of their predictions.49, fifty Nurses should explain to patients that most health apps aren't regulated by the FDA, and very few accept been evaluated in peer-reviewed scientific studies.51 In one study, near twenty% of FABM apps contained erroneous medical information.50 Moreover, there is evidence that some app companies' advertising overstates their production's efficacy.52
For recent developments in contraception, run into Innovations in Hormonal and Nonhormonal Methods.53–62
DISPARITIES IN Admission AND USE
Because of economic hardship and institutionalized racism, homophobia, and transphobia, many people have compromised access to the full spectrum of contraceptive options. Studies indicate that such socioeconomic factors play a role in the higher rates of unintended and unwanted pregnancies observed amid Black and Latina women compared with white women in the United states, too as influencing user preferences.14, 63 Black and Latina women tend to report lower rates of overall contraceptive use and prescription contraceptive use, simply higher rates of safety apply and tubal ligation or sterilization.64, 65
Disparate patterns of contraceptive use and options are also related to bias and discrimination within the health care system. Barriers to high-quality contraceptive care may emerge in the forms of limited knowledge about contraceptive options, limited admission to health care more often than not, receiving biased care from providers, and reproductive compulsion. For example, in that location is evidence to suggest that providers are more likely to recommend IUDs to Black and Latina women with low socioeconomic status than to white women with such status.66 Explanations for this pattern include that some providers subconsciously see certain women (that is, women of color or depression socioeconomic status) as "not needing" more children, needing a lower-maintenance method, or needing more help to effectively foreclose pregnancy.67 But pressuring certain patients into using LARCs undermines their reproductive autonomy and risks standing historically coercive and racist U.Due south. contraception policies. As frontline providers, nurses can address these disparities past engaging in reflexive nursing practices and working to undo institutionalized racism.68
Members of sexual and gender minorities—including those who identify as lesbian, gay, bisexual, queer, transgender, or gender nonbinary—also require admission to contraceptive services. But they often have limited access to prophylactic, affirming wellness intendance of all types. Members of these minorities have pregnancy and childbearing histories, plans, and desires every bit diverse as those of any other population. Many nonheterosexual women have been significant and given birth, and many have a desire to practise and so.69 Others regularly accept sex that could atomic number 82 to pregnancy, and need and want reliable and consistent contraception.70, 71 Yet others may rarely or never have penile–vaginal intercourse, and use contraception mainly for its noncontraceptive benefits, such as menstrual regulation, or acne or endometriosis handling.72
Many transgender or nonbinary individuals who have a uterus and ovaries are capable of becoming significant through penile–vaginal intercourse.73 Testosterone therapy in transgender men is non a reliable contraceptive method, though this misconception is common.74 Admission to effective contraception may be particularly critical for transgender men or transmasculine people, since many desire menses suppression.75, 76 Clinical and anecdotal prove besides suggest that menstruation and pregnancy may trigger or enhance feelings of gender dysphoria or may put safety at risk by "outing" one as transgender or transmasculine.77, 78 Some members of these minorities may achieve amenorrhea and pregnancy prevention with sterilization. Others may desire to terminate menstruating but retain the possibility of becoming significant later in life. Nurses can permit such patients know that this may be possible with progestin-simply IUDs. Estrogen-containing contraceptives may cause amenorrhea but are contraindicated in people on masculinizing hormone therapy.
An essential component of patient-centered nursing practice is the delivery of individualized intendance; this includes avoiding assumptions nearly a patient's reproductive health priorities and needs based on membership in a particular group. Individuals from whatever marginalized or stigmatized group who accept experienced bias and bigotry in health care might have learned to await the same from future encounters. It's of import for nurses in all clinical settings to understand how such history can affect patients' current experiences and the nurse–patient relationship. By applying nursing skills such as taking thorough health histories, listening actively to patients' reproductive wellness priorities, and referring patients to appropriate wellness care services, nurses may be able to meliorate these relationships and clinical outcomes.
Determination
Information technology'southward vital that nurses in all settings and specialties stay current on the latest show regarding contraception. Showtime, this is essential to fulfilling the World Health Organisation'southward recommendation to provide comprehensive contraceptive patient didactics79 and the ANA's ethical mandate to support the reproductive self-determination of all patients.vi Second, nurses can provide amend patient-centered care if they can competently address patients' family planning concerns and questions with electric current and evidence-based cognition. We recognize that this is challenging, as new types of contraception, hormonal formulations, delivery systems, and indications for use are always being developed. For a listing of resources that volition help nurses stay up to engagement, see Resources for Nurses. Lastly, actively addressing the concerns of patients from stigmatized groups volition ultimately contribute to efforts to resolve disparities in contraceptive care and piece of work toward reproductive justice for all.▼
Footnotes
The authors and planners have disclosed no potential conflicts of interest, financial or otherwise.
A podcast with the authors is available at world wide web.ajnonline.com.
For four boosted continuing nursing education activities on the topic of contraception, go to world wide web.nursingcenter.com/ce.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533104/
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