The importance of patient-centered contraceptive care: Linking provider contraceptive coercion to patient psychological distress and mental well-being

Abstract

Objective

Provider-based contraceptive coercion, or pressure from a healthcare provider to use or not to use birth control, undermines patient-centered care. We investigated the relationship between contraceptive coercion and mental health, which is previously unstudied.

Methods

In 2023, we used Prolific to survey reproductive-aged people in the United States who were assigned female at birth. We conducted t-tests and linear regression to assess relationships between upward (pressure to use birth control) and downward contraceptive coercion (pressure to not use birth control) and psychological distress and mental well-being among participants who had ever received contraceptive counseling (N = 1,154).

Results

In bivariate analyses, we found a significant association between contraceptive coercion and psychological distress (upward coercion: M = 8.31 vs. 9.82, t = -3.023, p = 0.003; downward coercion: M = 8.44 vs. 10.78, t = -2.634, p = 0.009) and between contraceptive coercion and emotional (upward coercion: M = 7.60 vs. 7.04, t = 2.613, p = 0.009; downward coercion: M = 7.56 vs. 6.52, t = 2.744, p = 0.006) and psychological well-being (upward coercion: M = 15.05 vs. 14.03, t = 2.339, p = 0.019; downward coercion: M = 15.00 vs. 12.66, t = 3.018, p = 0.003). When controlling for the effects of sociodemographic factors, both upward (B = 1.06, SE = 0.50, p = 0.034) and downward coercion (B = 1.94, SE = 0.88, p = 0.027) remained positively associated with psychological distress. Although downward coercion remained negatively associated with emotional (B = -0.78, SE = 0.37, p = 0.035) and psychological well-being (B = -1.89, SE = 0.75, p = 0.012), upward coercion did not.

Conclusion

People who perceived coercion in their contraceptive care reported higher levels of psychological distress and worse mental well-being, underscoring the importance of safeguarding patients’ autonomy during contraceptive counseling to support reproductive decision-making and positive mental health outcomes.