The power of persuasion: Normative accountability and clinicians’ practices of contraceptive counseling

Abstract

Efforts to reduce the incidence of unintended pregnancy by expanding access to and use of a new generation of long-acting reversible contraception (LARC) in recent years led to the wide-spread adoption of a tiered effectiveness (i.e., LARC-first) approach to contraceptive counseling in clinical practice. While reproductive justice scholar-advocates have critiqued this approach for how it may limit pregnancy-capable people's reproductive decision-making, less work in this area has examined efforts to prevent unintended pregnancy via contraceptive counseling as an interactional process shaped by social norms and inequities. Using individual interviews with clinicians working in obstetrics and gynecology that examined their approaches to contraceptive care delivery, this article draws on the sociological theory of interactional accountability to argue that clinicians hold their women patients accountable to social norms about pregnancy prevention in their attempts to persuade them to use LARC. Qualitative data analysis reveals that clinicians center their own contraceptive preferences and behaviors, prioritize pregnancy prevention via LARC use above other priorities patients may have, and communicate that contraceptive use is compulsory for women of reproductive age. By mobilizing their medical authority under the guise of achieving seemingly value-neutral public health goals, clinicians obscure the role that normative assumptions about reproductive behavior play in their practices of contraceptive counseling. By highlighting the strategies clinicians use to enact LARC-first contraceptive counseling as a normative accountability structure, this article demonstrates how these practices curtail women's reproductive autonomy and undermine ongoing efforts to achieve reproductive justice.