Rutgers University, 26 Nichol Avenue, New Brunswick, NJ, 08901, United States.
Soc Sci Med. 2018 Sep;212:145-152. doi: 10.1016/j.socscimed.2018.07.020. Epub 2018 Jul 19.
Although women in the United States use birth control at high rates, they also discontinue it at high rates, often citing dissatisfaction and side effects. At the same time, research shows that clinicians often neglect to discuss or discursively downplay the importance of side effects in contraceptive counseling. Scholars have yet to consider how clinicians' beliefs about the legitimacy of patient concerns and dissatisfaction may undergird these patterns. This study uses in-depth interviews with reproductive healthcare providers (N = 24) to examine their attitudes about common complaints regarding hormonal birth control. I identify how their reliance on formal medical knowledge, including evidence-based models, can lead them to frame patients' experiences or concerns about side effects as "myths" or "misconceptions" to be corrected rather than legitimized. I also describe a pattern of providers portraying negative side effects as normal to contraception and therefore encouraging patients to "stick with" methods despite dissatisfaction. Finally, I explore how these themes manifest in racialized and classed discourses about patient populations. I discuss the potential cumulative impact of these attitudes - if providers do carry them into clinical practice, they can have the effect of minimizing patient concerns and dissatisfaction, while steering women towards more effective methods of contraception.
尽管美国女性的避孕使用率很高，但她们的避孕措施中断率也很高，这通常是因为对避孕措施不满和出现副作用。与此同时，研究表明，临床医生在避孕咨询中常常忽视或轻描淡写地讨论副作用的重要性。学者们尚未考虑临床医生对患者关注和不满的合法性的看法如何支撑这些模式。本研究通过对生殖健康护理提供者（N=24）进行深入访谈，考察了他们对激素避孕常见投诉的态度。我确定了他们对包括循证模型在内的正式医学知识的依赖如何使他们将患者对副作用的体验或担忧视为需要纠正而不是合法化的“神话”或“误解”。我还描述了一种提供者将负面副作用描绘为避孕的正常现象的模式，从而鼓励患者尽管不满仍坚持使用这些方法。最后，我探讨了这些主题在关于患者群体的种族和阶级话语中的表现。我讨论了这些态度的潜在累积影响——如果提供者将这些态度带入临床实践，可能会使他们最小化患者的担忧和不满，同时引导女性选择更有效的避孕方法。
