Case vignette

Counseling a new patient seeking contraception.

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Counseling a new patient seeking contraception.

Counseling on contraception can be a sensitive subject for some patients and requires active listening, appropriate medical decision making, and robust patient education. Ultimately, the decision to start, change, or continue a contraceptive method should be up to the patient, with the provider acting as a source of culturally relevant, evidenced-based information and support. 

When Jessica enters her appointment the provider notices she looks a bit uncomfortable.

Rather than jumping straight into asking about her medical history, the provider decides to start the visit by building rapport. After the provider introduces themself, they spend time asking Jessica about what brought her to a new city and creating space for Jessica to ask any questions. 

Once this foundation is set, the provider asks the following question. “Is there anything you are hoping to get out of your appointment today?”

Jessica answers by discussing her desire to start on a new birth control and hesitancy for “anything hormonal.” 

The provider asks what her concerns are about hormones, and if there are any other important considerations she has for picking birth control. The provider gives some examples (e.g., menstrual control) and asks some follow-up questions including medical history, partner(s) gender identity, anatomy, and sexual activity. The provider is careful to only ask questions relevant to providing the care needed for today's visit. 

The provider also inquires about what Jessica has heard about different contraceptive options from friends or family. After asking the necessary questions, and giving Jessica information on all relevant contraceptive options, the provider asks if she would like to start one today or have more time to consider her options. 

Jessica decides she would like more time to consider the right fit for her. The provider gives Jessica resources on the few options she was most interested in, and advises condom use in the interim as Jessica indicates having penile-vaginal sex with a cisgender male partner.

Things to consider.


Setting a strong foundation by building rapport is critical for all patients, especially when considering the sensitive nature of conversations about sexual and reproductive health. Asking a patient what they need out of the visit allows you to budget your time effectively and let them know up front if some concerns will need to be addressed in a follow-up appointment. 


In most visits about contraceptives, the patient should be doing the majority of the talking. Make sure your personal preferences on contraception aren’t impacting how you counsel the patient. 

Question to think about:

LARCs are recommended to Black patients more than white patients. Knowing that, would this impact your contraceptive counseling to Jessica? If so, how?