Clinician Perspectives on Adolescent Contraceptive Counseling Following Dobbs v. Jackson: Implications for Young People's Contraceptive Autonomy.

Abstract

Objective: The objective of this study is to understand whether clinicians who provide contraceptive counseling to adolescent patients perceive that the Dobbs decision has influenced their counseling.

Study design: We conducted in-depth interviews with a convenience sample of 16 clinicians who provide contraceptive counseling to adolescents at the American Academy of Pediatrics annual conference in October 2022. We used thematic content analysis and an iterative process of constant comparison to identify themes inductively. This analysis focused on participants' perception of if and how the Dobbs decision has or will influence their contraceptive counseling with adolescents.

Results: Most clinicians in our study reported that the Dobbs decision influenced their contraceptive counseling. This included promoting long-acting reversible methods more so than pre-Dobbs, and explicitly considering changing state-level abortion laws and restrictions. Many clinicians openly noted that their personal preferences influence their counseling, such as prioritizing pregnancy prevention and encouraging patients to use particular methods.

Conclusion: We found that most clinicians in our sample acknowledged that the Dobbs decision has influenced their contraceptive counseling practices with adolescents. Clinicians' responses demonstrate that, in many instances, the Dobbs decision motivated them to focus on method effectiveness, leading to tiered and directive contraceptive counseling. We recommend practice changes to support comprehensive contraceptive care provision, provider trainings in unbiased counseling, and developmentally tailored decision aids are needed to ensure that adolescent patients' autonomy is prioritized over a singular focus on pregnancy prevention.