On October 21, 2024, the Biden Administration’s Department of Health and Human Services proposed a
new Affordable Care Act rule requiring insurance companies to cover over-the-counter birth control at no cost to patients (The White House, 2024). This rule would broaden access to emergency contraception, a new nonprescription birth control pill, spermicides, and condoms. Today, under the Affordable Care Act, most private health plans are only required to cover prescription birth control pills without co-payments. The new rule will undergo a two-month public comment period. It may be revised based on feedback, then the final rule is published in the Federal Register, making it official law.
Should this new rule pass, it will undoubtedly raise more questions from patients who are seeking advice on their pregnancy prevention options. As healthcare providers, regardless of our personal opinions concerning contraception, we are obligated to provide our patients with appropriate information so they can make choices that best suit their circumstances. This is particularly important if you work in primary care, family planning, women’s health, community, or student health clinics.
Contraception counseling should be a shared decision-making process between the provider and the patient. Begin the conversation by asking, “Do you have a sense of what is important to you about your method of contraception?” Incorporating a patient-centered care approach allows the focus to remain on the patient, their autonomy, religious beliefs, and desired reproductive goals. Carefully consider the patient’s preferences, then discuss the available options based on the patient’s priorities.
Below is an overview of available contraceptive methods progressing from most effective to least effective in preventing pregnancy (Planned Parenthood, 2023.).
- Abstinence (100% effective)
- Permanent procedures (99% effective): the individual will no longer be able to become pregnant or impregnate a partner.
- Tubal ligation or occlusion
- Vasectomy
- Long-acting reversible methods (99% effective): inserted by a health care provider.
- Intrauterine devices (IUD):
- A small t-shaped metal device is inserted into the uterus.
- Non-hormonal (copper) and hormonal (progestin) devices are available.
- It may last 3 to 12 years.
- Hormone implants:
- A small rod is placed under the skin of the upper arm.
- It may last 3 to 5 years.
- Hormonal birth control: must be prescribed by a health care provider. Hormones such as progestin stop ovulation and thicken the cervical mucus, making it difficult for sperm to enter the uterus.
- Injections (96% effective)
- Progestin is injected in the arm or hip.
- Lasts 3 months.
- Pills (93% effective)
- Progestin-only or combined hormone pills
- Must be taken at the same time daily for maximum effectiveness.
- Patches (93% effective)
- Contains hormones and is placed directly onto the skin.
- Apply weekly.
- Vaginal rings (93% effective)
- A flexible ring containing hormones is inserted into the vagina.
- Change monthly.
- Barrier methods: prevent sperm from entering the uterus and reaching the egg.
- Condoms
- External male (87% effective) and internal female (79% effective)
- Made with latex, plastic (non-latex), or lambskin
- The only method that will prevent the spread of sexually transmitted infections during intercourse.
- Diaphragms (83 to 94% effective)
- A shallow, bendable cup placed inside the vagina to cover the cervix.
- Must be used with spermicide for better efficacy.
- Sponge (91% effective)
- A small, round sponge made from soft plastic placed inside the vagina to cover the cervix.
- Typically contains spermicide.
- Cervical Caps (86% effective)
- Small silicone cup placed inside the vagina to cover the cervix.
- Must be used with spermicide for better efficacy.
- Emergency Contraception (Hormonal & non-hormonal)
- It can be used up to five days after unprotected sex.
- Pill or IUD form
- Prevents pregnancy by preventing ovulation and cervical mucus thickening but does NOT cause an abortion.
- Spermicides (79 – 86% effective)
- Contains chemicals that slow sperm motility and block them from joining an egg.
- Foam, gel, film, or vaginal suppository is placed inside the vagina before intercourse.
- It should be used with diaphragms and cervical caps for these devices to be effective.
- Fertility Awareness-based Methods/Natural Family Planning (77 – 98% effective)
- Females track their monthly cycle from menstruation through ovulation to determine when they may be most or least likely to become pregnant.
- Methods include:
- Temperature Method
- Cervical Mucus Method
- Calendar Method
- Withdrawal/Pull-out Method (78% effective)
- Removal of the penis from the vagina before ejaculation
- More effective when used with another form of birth control (e.g., ring, pill, or condom).
Spend time learning and understanding each contraceptive method. When discussing these options with your patients, educate them on the following (Dehlendorf, 2024):
- How they are taken
- How often are they taken
- Efficacy
- Effects on menstrual bleeding (including regularity and flow)
- Other side effects
- Non-contraceptive benefits
- Protection from infection
- Privacy
- Effect on future fertility
Remember to emphasize that contraception is a personal decision, that no birth control works all the time, except for abstinence, and there are important pros and cons to consider. Always follow your institution’s professional guidelines and policies regarding procedures, nursing scope of practice, and patient education. Above all, clinicians should provide contraceptive counseling that is respectful, nonjudgmental, and supportive.
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