How can we help people to choose a method of contraception? The case for contraceptive decision aids.

©FSRH J Fam Plann Reprod Health Care 2009: 35(4) Background Contraceptive decision-making is a complex process. In an ideal world, individuals would choose the best method of contraception for them by systematically weighing up its ‘pros and cons’, based on the importance they attach to criteria such as efficacy, safety and ease of use, the extent to which the available contraceptive options are able to meet these criteria, and accurate and reliable information on both. In practice, this is rarely the case. Methods tend to be chosen according to personal beliefs and preconceptions, with concerns about side effects and health risks, for example, often overestimated.1 ‘Medical intervention’ can also affect people’s decision-making. For example, the attitudes and beliefs of health care workers can influence the contraceptive options clients are presented with. Few would disagree that women and men need a better understanding of the risks and benefits associated with different methods to make an informed choice. A choice well made is not only more likely to lead to correct and consistent use, but also to higher continuation rates. This has potential benefits for the individual, and also for public health more broadly. Analysing the impact of contraceptive discontinuation in 15 developing or transitional countries, Blanc and colleagues report that within a year of starting a new contraceptive method, 7–15% of women stopped using contraception for quality-related reasons.2 Preventing unplanned births consequent on discontinuation of contraception would have reduced the total fertility rate by an estimated 28–64%. The case for developing interventions to improve sustained and correct use of methods acceptable to women (and men) is therefore strong.