Contraceptive Dogma and Reproductive Health Access in the US

It’s been nearly a year since I submitted the final draft of my master’s thesis. I reflected on the process today and decided to release the final draft. At the time it was an immense source of stress on top of a busy clinical year in the middle of a pandemic. Looking back on it, I’m thankful for the opportunity and the learning experience that it was. I’m also hopeful that my work can help influence others for good. I’m thankful to Professor Applegate for her guidance in the process and my family for their much needed mental and emotional support.

I chose to write my thesis paper on misinformation and dogma in contraception because of my experiences in clinical rotations and talking to patients and friends about their experiences related to obtaining contraception from providers. I initially intended to do original research and send out surveys to clinicians across the country to gauge the extent of misinformation and dogmas among providers. Unfortunately, 2020 had other plans for me in the form of COVID-19. The review board was no longer meeting/approving research and I couldn’t conduct surveys without their approval. With the deadline looming I chose to opt for a literature review. The results were shocking. The extent of misinformation and dogmas among providers in the US is staggering. The effect on access, especially among the medically underserved community is heartbreaking. My hope is that this research can in some way help dispel these myths and contribute to better reproductive health access in the US. Please take the time to read and share this paper especially if you are a healthcare provider involved in primary care or reproductive health.

— David Nichols, MS-PAS, PA-C


Background: Reproductive health is a basic human right. Access to reproductive health includes access to effective and affordable contraception, and an informed choice in methods. Despite the need for access and choice in contraception, many women in the US lack access or are dissatisfied with their current method. Previous studies have described different medical barriers that act to restrict access. Dogmatic beliefs and practices among healthcare providers regarding the use of various contraceptive methods are thought to affect the counseling and provisioning of a variety of highly effective contraceptive methods.

Methods: A search was conducted in PubMed, MEDLINE, and Google Scholar for combinations of key terms: “contraception”, “provider bias”, “medical barriers”, “combined hormonal contraceptive”, “oral contraceptive”, “intrauterine device”, “emergency contraception”, “sterilization”, “tubal ligation”, “vasectomy”. Results were screened for relevance, focusing on studies in the US or similar developed nations since 1990.

Conclusions: Dogmatic beliefs and practices were found to be common among providers. These dogmas are based on an inaccurate perception of the mechanisms and risks associated with contraceptive methods, outdated information, and personal beliefs. These dogmas result in inadequate patient counseling, inappropriate contraindications, unnecessary exams and tests, and refusal to provide contraception. Contraceptive dogmas restrict access to highly effective contraception and put patients at risk for unintended pregnancy.

Nichols and Applegate, 2020

Full text available on ResearchGate.

DOI: 10.13140/RG.2.2.13988.60803

Poster Presentation

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