Structured Contraceptive Counseling: A Policy and Economics Brief
This policy and economics brief recommends that an outpatient OB/GYN clinic adopt structured contraceptive counseling as standard practice. Drawing on national public health goals set by the Department of Health and Human Services — which aims to increase the proportion of intended pregnancies by 10% between 2010 and 2020 — the brief outlines the significant social, economic, and health consequences of unintended pregnancy. It evaluates the evidence supporting structured contraceptive counseling over abstinence programs and unstructured counseling, presents an economic analysis of implementation costs, and argues that the program's benefits substantially outweigh its costs, making it both a clinically sound and fiscally responsible policy choice.
- Executive Summary: Overview of policy recommendation and key rationale
- Background and Significance: Public health data on unintended pregnancy consequences
- Position Statement: Clinic values and evidence supporting adoption of counseling
- Economic Analysis: Fixed, variable, and opportunity costs of the program
- Conclusion: Final recommendation to implement counseling policy
✍️ How to write this paper — guide, tools & examples ▾
What makes this paper effective
- The brief follows a clear professional policy format — executive summary, background, position, economic analysis, and conclusion — making it immediately accessible to administrators and decision-makers.
- Claims are consistently grounded in peer-reviewed literature, including systematic reviews and longitudinal studies, lending credibility to each recommendation.
- The economic analysis is thorough and well-organized, distinguishing between fixed costs, variable (volume-based) costs, and opportunity costs, before framing the program's net effect as a positive return on investment.
- The position statement balances ethical advocacy (bodily autonomy, vulnerable populations) with evidence-based reasoning, demonstrating persuasive writing that appeals to both values and data.
Key academic technique demonstrated
The paper exemplifies policy brief writing by structuring argument around a stated mandate (the HHS goal), systematically eliminating weaker alternatives (abstinence programs, unstructured counseling), and culminating in a specific, actionable recommendation. This technique — known as comparative policy analysis — allows the writer to justify a recommendation not only on its own merits but relative to available alternatives.
Structure breakdown
The brief opens with an executive summary that previews all key claims. The background section establishes the public health problem using statistics and citations. The position statement articulates the clinic's values and applies them to the evidence. The economic analysis methodically categorizes costs and introduces the concept of opportunity benefit. The conclusion synthesizes all sections into a final recommendation, modeling the standard structure of a professional health policy document.
Executive Summary
The Department of Health and Human Services has a mandate to increase the proportion of wanted pregnancies by 10% by 2020, which means reducing unwanted pregnancies. While there are a number of different options for achieving this goal, the one that is most proven in the literature is structured contraceptive counseling. As our clinic has a mandate to safeguard the health of the women in our community, and as unwanted pregnancies have a variety of adverse impacts — particularly on vulnerable populations — we should offer structured contraceptive counseling. Doing so would allow us to reduce the number of unwanted pregnancies among our patients, improving their health and economic outcomes.
Furthermore, the economics of such counseling are exceptionally positive. As with much preventative medicine, structured contraceptive counseling carries little in the way of fixed or ongoing costs. Because it diverts patients away from unwanted pregnancy, it also lowers demand on our services, producing a net opportunity benefit rather than an opportunity cost.
Background and Significance
Reducing the unintended pregnancy rate in the United States is a national public health goal, driven by the Department of Health and Human Services, which aims to see a 10% increase in the proportion of pregnancies that are intended between 2010 and 2020 (Guttmacher Institute, 2016). In 2011, 45% of pregnancies in the US were unintended. There are significant social, economic, and health consequences to unintended pregnancies, and these consequences are the issues driving the campaign to increase the proportion of intended pregnancies. In particular, it has been found that unintended pregnancy is correlated with lower rates of positive health behaviors during the prenatal period (Lindberg et al., 2015).
The consequences are more strongly negative the younger the mother is. For teen mothers, unintended pregnancy is associated with increased dropout rates, living in poverty, and reliance on public assistance (Logan et al., 2007). There are also mental health consequences for the mother later in life associated with unplanned pregnancy (Herd et al., 2016).
There are social and economic consequences as well as health consequences. Some of the documented negative social and economic consequences include reduced quality of life and diminished workforce efficiency. Furthermore, public health care systems often bear the burden of the cost, largely because unintended pregnancies frequently lead to poverty or occur more frequently in low-income communities (Guttmacher Institute, 2016). Sixty-four percent of births from unintended pregnancies were publicly funded, compared with 48% of all births and 35% of births resulting from planned pregnancies (Sonfield et al., 2011). Across social, economic, and health measures, none have been found to improve with unplanned pregnancy. This is the background against which HHS has instituted its policy to reduce the number of unplanned pregnancies.
The HHS mandate and the public health consequences are the drivers of the policy proposed in this document. It has been documented that abstinence programs are ineffective at delaying the onset of intercourse or at reducing the number of unplanned pregnancies (DiCenso et al., 2002). By contrast, women who receive contraceptive counseling are more likely to report the use of contraceptives after counseling (Lee et al., 2011). Contraceptive counseling increases knowledge of different forms of contraception, leading to greater adoption of intrauterine devices and subdermal implants compared with women who received unstructured contraceptive counseling (Madden, 2013). These results show that the best means of reducing unintended pregnancies — and therefore avoiding the health, social, and economic costs — is to implement structured contraceptive counseling.
Our role as health care providers is to use the best available medical evidence to guide our decision-making. When we do this, we achieve superior health outcomes and better serve our communities. As health care administrators, we seek to lower the cost of health care and reduce the barriers to accessing it. When we can accomplish this at the same time as providing superior health care, it is a tremendous achievement. In the case of structured contraceptive counseling, the evidence is clear: not only does contraceptive counseling of all types correlate with superior health and economic outcomes, but it also lowers the cost of care for the provider. Structured contraceptive counseling is, according to the literature, the best available form of contraceptive counseling.
Position Statement
As an outpatient OB/GYN clinic, we serve women of childbearing age specifically. This constituency comes from all corners of our community through a variety of payers, and we serve them all. The objectives by which we operate our clinic and treat our patients should only be to look after the best interests of women. While some may come to us with high confidence, we are often on the front lines serving marginalized women, teenagers, women of color, and other vulnerable populations. These are the populations most at risk for unwanted pregnancy and in the greatest need of our help.
We believe that pregnancy and parenthood are among the greatest things that a woman can experience, but we also believe these should be her choice. We believe it is a fundamental right of every woman to have full control and sovereignty over her own body.
These beliefs should be evident in everything that we do. First and foremost, we serve as experts who can leverage our education and experience to provide knowledge, insight, and guidance for the women who walk through our doors. Being an expert requires performing as one every single day, and part of that means aligning current practice with the best available evidence in medical practice.
Recent research supports the use of structured contraceptive counseling as a means of both improving health for vulnerable communities and improving the social and economic health of our society as a whole. Our facility will also benefit from adopting this practice because of the impacts it has on the overall cost environment. The upfront costs are just a fraction of what it costs our facility in the long run.
We should adopt structured contraceptive counseling as a matter of policy because it fits our mandate of providing low-cost access to health care for women in our community. It fulfills our mandate of lowering health risks to the women in our community, and by extension to their children as well. Structured contraceptive counseling provides superior results in terms of both health care behaviors and outcomes compared with alternative programs. Abstinence counseling has no impact on adult women and minimal, if any, impact on teen girls. Unstructured contraceptive counseling has some positive impact, but less than structured contraceptive counseling.
The benefits afforded by structured contraceptive counseling arise specifically because of its structured nature. The structure allows the counselor to guide the conversation in a way that ensures the patient hears all available options. The patient can then make an informed decision about her body. The structure of the counseling also allows for the consistent delivery of services to the community. In all fields, both in and out of health care, consistent service delivery is associated with superior results.
Structured contraceptive counseling also fits within the general mandate of our specialization. As an OB/GYN clinic, all aspects of female health fall within our scope. Structured contraceptive counseling is preventative medicine, and many of the most effective health care measures we can take are preventative in nature. Unwanted pregnancy is one of the conditions that is relatively easy to prevent. While pregnancy is not necessarily a negative health event, the research clearly indicates that it is associated with a number of negative health outcomes — both in the short run for mother and child, and in the long run for the mother. As such, preventing unwanted pregnancy can and does fall within the scope of care for an OB/GYN clinic.
Furthermore, adopting this policy would be the best option we can utilize for helping to meet the HHS objective to increase the proportion of pregnancies that are planned. Clinics such as ours deal with many vulnerable women who are less likely to have access to these services elsewhere. We also have as patients many other women who might have access to other health care options but choose us for our specialized knowledge in female health.
We are the experts in this area, and we have access to the best knowledge that exists in our field. It is our duty as health care providers — our duty to our patients, to our community, and to all of our other stakeholders — to fulfill our obligations to deliver the best possible care based on the best available evidence. That obligation therefore includes the delivery of structured contraceptive counseling to our patients as part of our program to reduce the incidence of unwanted pregnancy.
Conclusion
The best available evidence shows that structured contraceptive counseling is the best means by which we can reduce unwanted pregnancies. Reducing unwanted pregnancies is a stated national health goal, and it has positive impacts on the social and economic well-being of the affected women and families. As such, providing this service fits within our mandate to our community and to our patients. The costs associated with implementing a structured contraceptive counseling program are relatively low and are likely minimal in comparison to the benefits that the program will deliver to both our clinic and to the women we serve. It is therefore recommended that we adopt, as a matter of policy, a program to provide structured contraceptive counseling services at our OB/GYN clinic.
References
DiCenso, A., Guyatt, G., Willan, A., & Griffith, L. (2002). Interventions to reduce unintended pregnancies among adolescents: Systematic review of randomized controlled trials. British Medical Journal, 324(7351), 1426.
Guttmacher Institute. (2016). Unintended pregnancy in the United States. Guttmacher Institute. Retrieved May 3, 2018, from https://www.guttmacher.org/fact-sheet/unintended-pregnancy-united-states
Herd, P., Higgins, J., Sicinski, K., & Merkurieva, I. (2016). The implications of unwanted pregnancies for mental health later in life. American Journal of Public Health, 106(3), 421–429.
Lee, J., Parisi, S., Akers, A., Borrerro, S., & Schwarz, E. (2011). The impact of contraceptive counseling in primary care on contraceptive use. Journal of General Internal Medicine, 26(7), 731–736.
Lindberg, L., Zimet, I., Kost, K., & Lincoln, A. (2016). Pregnancy intentions and maternal and child health: An analysis of longitudinal data in Oklahoma. Maternal and Child Health Journal, 19(5), 1087–1096.
Logan, C., Holcombe, E., Manlove, J., & Ryan, S. (2007). The consequences of unintended childbearing. The National Campaign to Prevent Teen and Unplanned Pregnancy. White paper.
Madden, T., Mullersman, J., Omvig, K., Secura, G., & Peipert, J. (2013). Structured contraceptive counseling provided by the Contraceptive CHOICE Project. Contraception, 88(2), 243–249.
Sonfield, A., Kost, K., Benson, R., & Fisher, L. (2011). The public costs of births resulting from unintended pregnancies: National and state-level estimates. Perspectives on Sexual and Reproductive Health, 43(2), 94–101.
Create your account
Always verify citation format against your institution’s current style guide requirements.