Doctor knows best? Provider bias in the context of contraceptive counseling in the United States

The study examined how clinicians described their patients in relation to their practices of contraceptive counseling. This qualitative study involved individual interviews with 15 clinicians working in obstetrics and gynecology in South Carolina about their approaches to contraceptive counseling. We analyzed the data using a combination of deductive and inductive approaches. Clinicians attributed challenges of working with diverse patient populations to patients’ race/ethnicity, socioeconomic status, and age. Clinicians often interpreted patient concerns about or refusal to use effective contraceptive methods as a problem with patients themselves. When clinicians described patients in disparaging ways, they often focused on adolescent patients. Bias informed by structural inequalities and power relations influences how clinicians perceive their patients and approach counseling them about contraception. Such practices may limit patients’ informed decision-making and autonomy regarding initiating or continuing contraceptive use. Greater attention to redressing structural inequalities and power relations that inform provider bias in the context of contraceptive counseling is needed to ensure patients receive person-centered healthcare free from prejudice and discrimination. Fostering structural competency among clinicians may improve provider-patient interactions and support patients' reproductive autonomy.