Recommendations for improving contraceptive service provision in the U.S

Objectives: Unintended pregnancy and contraceptive failure continue to be significant problems in the U.S. today. By comparing information obtained from women about their difficulties using methods successfully with information from providers about their services and perceptions of women's needs, we have developed recommendations for improving contraceptive service provision. Methods: We conducted nationally representative surveys of women and of contraceptive service providers. The women's sample was generated through random-digit-dialing and 1,978 eligible women were interviewed over the phone. The provider samples were drawn from lists of obstetrician/gynecologist and family practice physicians and publicly funded family planning clinics. Mailed questionnaires were collected from 382 private physicians and 805 clinics. Descriptive and multivariate analyses were conducted for each survey and the results compared across surveys. Results: Both women and providers report that inconsistent method use is common and that some women experience periods of contraceptive nonuse while remaining at risk for unintended pregnancy. Although women report that method dissatisfaction often precedes gaps in use, not all providers discussed these difficulties with patients. Other factors identified by women as contributing to difficulties—for example, motivation to prevent pregnancy, life changes, and method side effects—were discussed by some, but not all, providers during contraceptive visits. Conclusions: The findings suggest a number of strategies that have the potential to help women improve their ability to use contraception consistently and correctly. Specific recommendations are presented within each of the following categories: counseling and follow-up; clinical practices; information and education; access and funding; and technology and training.