Leveraging the Client-Provider Interaction to Address Contraceptive Discontinuation: A Scoping Review of the Evidence That Links Them


Contraception and Abortion

This article was written by Kendal Danna, Alexandra Angel, Jamee Kuznicki, Laetitia Lemoine, Klaira Lerma and Amanda Kalamar and published in Global Health: Science and Practice.


Despite considerable investment and effort, unmet need for contraception remains an obstacle to improved family planning outcomes. One influencing factor is the frequency of contraceptive discontinuation among users who desire to prevent pregnancy, often due to method-related concerns and side effects. Contraceptive users have the right to be supported during counseling to voluntarily choose methods that align with their individual needs and preferences. Contraceptive counseling, as a key component of quality of care, is particularly important for providers to reduce unmet need among their clients. This scoping review examined the state of the evidence on contraceptive counseling and its impact on discontinuation. The review first examines the association between quality of care and contraceptive discontinuation, then looks to what the current body of evidence suggests are women’s contraceptive counseling priorities, and lastly, explores whether specific counseling tools and approaches have been evaluated with discontinuation as an outcome. The results identified general principles and priorities for good counseling including person-centeredness, client-tailored information exchange, clear and concise information on side effects and bleeding changes, reducing providers’ implicit and explicit biases, and trust and respect between the client and provider. The review of the literature also found that evidence to support the use of specific counseling tools and approaches to reduce contraceptive discontinuation is insufficient; research should be designed to determine which specific elements of the client-provider interaction can be improved to significantly impact contraceptive discontinuation. This evidence could inform how the global community of practice might improve and leverage specific counseling approaches and tools to address the most common predictors of discontinuation.

Key Messages

  • Reasons for discontinuation, while complex, include contraceptive counseling as an element that could be optimized to better support clients to choose methods that will enable voluntary continuation.
  • Information exchange during counseling—in particular how providers do or do not prepare clients for side effects—is associated with contraceptive discontinuation.
  • There is a need for evidence-based understanding of associations between common counseling approaches/tools and discontinuation. This lack of evidence incurs risk of using techniques that do not effectively lead to client satisfaction.


You can read the full research article here: https://www.ghspjournal.org/content/early/2021/11/08/GHSP-D-21-00235.full

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