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It’s an experience people often share when they visit a clinic or hospital: You go in to see a doctor, but you’re not altogether sure they’re seeing you.

For women and nonbinary people, this can be especially true when seeking family planning and birth control counseling.

This isn’t because doctors are bad or nefarious, according to Jennifer Villavicencio, an OB/GYN and the lead for equity transformation at the American College of Obstetricians and Gynecologists.

“Oftentimes, we think about treatments and medications from a numbers perspective: How do you get the best medication for the treatment you’re looking for?” Villavicencio said. But in doing so, she added, doctors can overlook their patients’ own expertise.

New guidance for obstetricians and gynecologists aims to change that.

<a href="https://www.acog.org/news/news-releases/2022/01/new-acog-guidance-contraceptive-counseling-emphasizes-patient-centered-framework" target="_blank">The new guidelines</a>, issued by the American College of Obstetricians and Gynecologists on Jan. 20, advises clinicians to apply a “patient-centered, reproductive justice framework” when they counsel patients about contraception.

“Counseling is an opportunity to solicit an individual’s values, preferences, and insight into what matters most to them as it relates to contraception,” reads the new guidance.

To achieve this, ACOG recommends that providers pay special attention to people of color and other marginalized communities who may have experienced “historical and ongoing reproductive mistreatment”; be cognizant of their bias, “unconscious or otherwise,” and work to minimize its effect on their counseling and care practice; prioritize patients’ values, preferences and lived experiences; and reach decisions about care in partnership with the patient.

How would you change your OB/GYN visits? This tweet got 3,000 responses.

During contraceptive counseling sessions, providers lay out birth control options available to a patient, providing insight and recommendations on the efficacy of different treatments. From there, the physician may write a prescription for medication or help set up a specific procedure.

The guidance reminds providers that this final decision should be a shared one, Villavicencio said.

This approach directly draws from the reproductive justice movement, which combines reproductive rights issues with social justice. The term “<a href="https://time.com/5735432/reproductive-justice-groups/#:~:text=The%20reproductive%2Djustice%20movement%20came,to%20head%20off%20Republican%20criticism." target="_blank">reproductive</a><a href="https://time.com/5735432/reproductive-justice-groups/#:~:text=The%20reproductive%2Djustice%20movement%20came,to%20head%20off%20Republican%20criticism." target="_blank"> justice</a>” stems from Black women activists in the 1990s who were concerned that reproductive health-care leaders were not doing enough to address issues that disproportionately affected Black women, such as <a href="https://www.thelily.com/do-you-experience-a-heavy-flow-and-pain-during-your-period-it-could-be-a-sign-of-a-common-condition/" target="_blank">fibroid screenings</a> or the impact that income and housing has on<a href="https://rewirenewsgroup.com/article/2020/07/30/why-losing-your-housing-is-one-of-the-greatest-threats-to-reproductive-health/" target="_blank"> reproductive decisions</a>.

The guidance also comes at a time when patients have become more vocal about their experiences seeking reproductive health care, especially when their values and priorities clash with those of their providers.

“There is an expertise that providers have. They’ve gone through years and years and decades of training to gain the knowledge in medicine. That expertise is important,” said Villavicencio, who helped write the guidance.

But, she added: “It’s equivalent and no more important than the lived experiences and the expertise of individuals who come seeking contraception. The expertise they have in their own lives.”

The new guidelines remind medical professionals that a patient has multiple concerns or priorities beyond the efficacy of birth control, said Kavita Arora, an OB/GYN who chairs ACOG’s Committee on Ethics and also co-wrote the statement.

Arora noted that contraception and reproductive life planning are “inherently personal.”

While doctors may prioritize a treatment that has the highest efficacy in preventing pregnancy, patients may have other priorities for their care, she pointed out.

“There are so many other attributes that [patients] weigh, whether it’s hormones, length of effectiveness, invasiveness, pain, whether it’s easy to remove or stop without seeing a doctor,” Arora said. “It’s complex, it’s nuanced and it fluctuates over time.”

For example, while intrauterine devices (IUDs) are a highly effective form of birth control, some patients may be concerned about the invasiveness of the technology, or prefer a method of birth control that is easier to start and stop.

In these cases, it’s not about persuading the patient to take the doctor’s preferred option but to arrive at a decision together about what would work best for the patient, Villavicencio said. She added that this decision-making process is as important when discontinuing birth control as starting it.

The lesser-known history of birth control

In recent years, advocacy groups and patients have been more vocal about the reproductive care they receive and its shortcomings.

For example, patients with endometriosis, a disorder in which the tissues that normally line the inside of the uterus grow outside of it, have increasingly shared stories about how they were <a href="https://www.thelily.com/choosing-between-children-and-a-lifetime-of-pain-a-endometriosis-case-in-the-uk-is-sparking-outrage/" target="_blank">denied treatment by their doctors</a> — some said their providers appeared to prioritize their patients’ ability to have children over treating their pain.

People have also pushed back on <a href="https://www.thelily.com/how-would-you-change-your-obgyn-visits-this-tweet-got-3000-responses/" target=_blank>other aspects of gynecological care</a>, such as “archaic” tools and offices that are not inclusive of trans patients.

The guidance is relevant for anyone seeking reproductive care and especially so for providers who care for historically marginalized individuals, Villavicencio said.

“We unfortunately have a pretty egregious history of coercive [contraception] and co-opting individual’s reproduction,” Villavicencio said.

“It’s really important to acknowledge that history when you’re engaging with patients,” she said, “because oftentimes there’s a lot of cultural beliefs and things that have been taught to them because of the history. And it is unfortunately a well-earned reputation in medicine.”

According to ACOG, coercive contraception includes inappropriately incentivizing use of contraception, prioritizing specific, long-acting or permanent methods at the expense of the individual’s personal preferences, or creating barriers that prevent a patient from discontinuing contraception.

The stakes have often been highest among people who seek or receive sterilization procedures.

There have been prominent examples of this throughout American history, much of it rooted in racism and eugenics. Beginning in the 1930s, <a href="https://www.hercampus.com/school/inter-sg/forced-sterilization-puerto-rico/" target=_blank>doctors in Puerto Rico pushed women into sterilizations</a>, offering no other methods of birth control; the practice was so pervasive, some researchers estimate, that by the late 1960s, more than one-third of women who had been married had been sterilized.

Forced sterilizations have also been a matter of policy, with state and federal governments targeting <a href="https://daily.jstor.org/the-little-known-history-of-the-forced-sterilization-of-native-american-women/">Native American women</a>, <a href="https://www.mississippifreepress.org/12782/the-troubling-past-of-forced-sterilization-of-black-women-and-girls-in-mississippi-and-the-south/">Black women</a> and <a href="https://www.thelily.com/as-disabled-women-our-lives-have-always-been-erased-but-in-a-pandemic-theyre-urgently-at-stake/" target="_blank">disabled women</a> throughout U.S. history.

A whistleblower alleges mass hysterectomies at an ICE detention center. The U.S. has a brutal history of forced sterilizations.

While those policies no longer stand, disparities in treatments persist: Some research has shown that doctors are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622766/#:~:text=Results.,%5D%20%3D%202.52%2C%204.90)." target=_blank>more likely</a> to give Black women hysterectomies than their White peers, even in cases when the patient isn’t seeking it and it is not medically necessary.

At the same time, some young people have complained that their doctors have <a href="https://www.redbookmag.com/body/a45886/the-parenting-choice-my-doctors-wont-let-me-make/" target="_blank">dismissed their wishes</a> to get sterilized. In one recent case, one woman was told she <a href="https://www.insider.com/a-woman-needed-husbands-consent-to-get-her-tubes-tied-2020-2" target="_blank">needed her husband’s permission</a> to get a tubal ligation — a procedure that ties off the fallopian tubes.

When counseling patients and couples about these procedures, physicians <a href="https://www.chicagotribune.com/lifestyles/ct-xpm-2014-05-13-ct-met-sterilization-denied-20140513-story.html" target=_blank>often express concern</a> that a person might regret their decision, especially if they’re young. But some research shows that concerns about regret could be overstated: One survey found about 7 percent of women <a href="https://www.webmd.com/women/news/20020619/few-regrets-after-sterilization" target=_blank>regretted tube ligation</a> within five years of their operations.

Arora said the latest ACOG guidance was informed by years of advocacy from reproductive justice organizations like <a href="https://www.sistersong.net/" target=_blank>SisterSong</a>, which amplifies the needs and perspectives of Indigenous women and women of color.

“It’s about liberation,” SisterSong executive director Monica Simpson told <a href="https://time.com/5735432/reproductive-justice-groups/#:~:text=The%20reproductive%2Djustice%20movement%20came,to%20head%20off%20Republican%20criticism." target=_blank>Time in a 2019 interview</a>, “and it’s about dismantling systems of oppression that make our lives hard in this country but also that make it impossible for us to have the access and the choices that we want to have.”

Arora said it’s important to acknowledge the history of gynecology — and learn from mistakes.

She will occasionally see patients who tell her she’s their second, third, fourth OB/GYN they had to see before a doctor would agree to perform a sterilization procedure on them.

She still uses evidence and science to counsel her patients about the risks of regretting this kind of treatment, but Arora also understands there’s not a “monolithic conception of regret.”

“That patient has autonomy over making her own medical decisions,” Arora said. “And honestly, upholding and uplifting her autonomy — that is much more meaningful and important to me.”

University of North Carolina at Wilmington, BFA, Creative Writing

University of Southern California, MS, Journalism

Anne Branigin is a staff reporter in Style covering breaking news and writing feature stories. Previously, she worked at the Root covering news, politics, health and social justice movements through the lens of race and gender.

Anne Branigin

New ACOG guidance on contraception is ‘patient-centered’