Doctor knows best? Provider bias in the context of contraceptive counseling in the United States

Abstract

Objectives: The study examined how clinicians described their patients in relation to their practices of contraceptive counseling.

Study design: This qualitative study involved individual interviews with 15 clinicians working in obstetrics and gynecology in South Carolina about their approaches to contraceptive counseling. We analyzed the data using a combination of deductive and inductive approaches.

Results: Clinicians attributed challenges of working with diverse patient populations to patients' race/ethnicity, socioeconomic status, and age. Clinicians often interpreted patient concerns about or refusal to use effective contraceptive methods as a problem with patients themselves. When clinicians described patients in disparaging ways, they often focused on adolescent patients.

Conclusion: Bias informed by structural inequalities and power relations influences how clinicians perceive their patients and approach counseling them about contraception. Such practices may limit patients' informed decision-making and autonomy regarding initiating or continuing contraceptive use.

Implications: Greater attention to redressing structural inequalities and power relations that inform provider bias in the context of contraceptive counseling is needed to ensure patients receive person-centered healthcare free from prejudice and discrimination. Fostering structural competency among clinicians may improve provider-patient interactions and support patients' reproductive autonomy.

Keywords: Contraceptive counseling; Long-acting reversible contraception; Provider bias; Qualitative research; Reproductive justice; United States.