Patient Preferences or Provider Pressure? The Relationship Between Coercive Contraceptive Care and Preferred...

Background/Objectives: Coercion in contraceptive care occurs when healthcare providers unduly influence patients to use or not use birth control. Contraceptive coercion is antithetical to quality patient-centered care. However, it is unclear how experiencing contraceptive coercion relates to patients' lives and contraceptive outcomes. In this study, we examined associations between contraceptive coercion and a patient-centered outcome: preferred contraceptive use. Methods: In 2023, we used the Prolific panel to recruit reproductive-aged people in the USA who were assigned female at birth. Our analytic sample included surveyed participants who had ever talked to a healthcare provider about contraception (N = 1197). We conducted chi-square and regression analyses to investigate associations between contraceptive coercion and preferred contraceptive use. We added context by mapping the current and preferred contraceptive method(s) for participants who experienced coercion and were not using their preferred method(s). Results: After adjusting for potential confounders, participants who reported downward coercion (pressure to not use birth control) at their last contraceptive counseling were less likely to be using their preferred contraceptive method(s). The odds of using preferred contraception did not differ significantly based on whether participants experienced upward contraceptive coercion (pressure to use birth control). Patterns in unmet contraceptive preference for patients experiencing coercion include use of the pill when it is not the desired method and unmet desire for permanent contraception. Conclusions: In this study, patients who perceived pressure from a provider to not use birth control were less likely to be using their preferred contraceptive method(s). Promoting reproductive autonomy requires comprehensive, patient-centered, and unbiased contraceptive care.