The American College of Obstetricians and Gynecologists The American Congress of Obstetricians and Gynecologists 409 12th Street, SW • PO Box 96920 • Washington, DC 20090-6920 • Telephone 202-638-5577 Contraceptive Counseling Position Statement The American College of Obstetricians and Gynecologists and The American Congress of Obstetricians and Gynecologists Contraception and reproductive life planning are the responsibility of all physicians, not just obstetrician–gynecologists. All health care providers should be aware of the role that contraception can play in women’s health, especially when prescribing medication. Roughly half of all pregnancies in the United States are unintended; these unintended pregnancies can occur among any woman of child-bearing age, including women nearing menopause. At the same time, more than 45 percent of all Americans have a chronic disease, and almost all women may anticipate an unexpected illness that requires medication. One recent study1 found that fewer than 30 percent of females ages 14 to 25 being prescribed teratogenic medications also had documented contraceptive use. Because of this, health care providers involved in the care of women, should always be prepared to discuss contraception and reproductive life planning when treating women of child-bearing age. Specifically, when prescribing medications that carry an elevated risk of complications such as birth defects, physicians should routinely inquire about each patient’s current contraceptive use and, when appropriate, counsel patients regarding the availability of highly effective forms of contraception, including long-acting reversible contraceptives (LARC) and sterilization. Evidence-based guidelines regarding safe contraceptive use among women with a variety of medical conditions are available2 and have been endorsed by ACOG. Some common forms of birth control are less effective than LARC methods and sterilization. For example, according to the U.S. Centers for Disease Control and Prevention, oral contraceptives have a nine percent failure rate. In other words, with 1 Stancil SL, Miller M, Briggs H, Lynch D, Goggin K, Kearns G. Contraceptive provision to adolescent females prescribed teratogenic medications. Pediatrics 2016;137:1-8. PMID: 26676050. 2 Centers for Disease Control and Prevention. United States medical eligibility criteria (US MEC) for contraceptive use, 2010. Atlanta (GA): CDC; 2015. Available at: http://www.cdc.gov/reproductivehealth/unintendedpregnancy/usmec.htm. Retrieved January 20, 2016. Contraceptive Counseling Page 2 typical use of oral contraceptives, nine women out of one hundred would face an unintended pregnancy each year. For many women with coexisting medical conditions, relying on these less-effective forms of contraception can put their own health, and that of potential future pregnancies, at risk. Because so many pregnancies are unintended, it is essential to reliably prevent pregnancy among women with underlying conditions not currently desiring pregnancy. Pregnancy could occur at any time, is physically demanding, and can exacerbate existing conditions, potentially worsening outcomes. Obstetrician–gynecologists can provide expert consultation regarding contraception for women with coexisting medical conditions, when needed. Physicians treating women of reproductive age with acute or chronic medical conditions should be open to consultation with obstetrician–gynecologists if considering discontinuation of a patient’s contraceptive method prior to treatment, and should offer subsequent contraceptive counseling after treatment. Contraception is an important part of women’s health care throughout their child-bearing years, and it is through collaboration among health care providers that we can provide effective methods of contraception and other needed medications. ACOG has three Committee Opinions on contraception: Access to Contraception3 (Committee Opinion 615), Increasing Access to Contraceptive Implants and Intrauterine Devices to Reduce Unintended Pregnancy4 (Committee Opinion 642), and Reproductive Life Planning to Reduce Unintended Pregnancy5 (Committee Opinion 654). Approved by the Executive Board: January 2016 Revised: February 2016 ______________________ 3 Access to contraception. Committee Opinion No. 615. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;125:250–5. PMID: 25560140. 4 Increasing access to contraceptive implants and intrauterine devices to reduce unintended pregnancy. Committee Opinion No. 642. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;126:e44–8. PMID: 26393458. 5 Reproductive life planning to reduce unintended pregnancy. Committee Opinion No. 654. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;127:e66–9.

American Congress of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188 | Mailing Address: PO Box 70620, Washington, DC 20024-9998