Bodily autonomy, or the power to fully control our own individual bodies, lives, and futures, is a non-negotiable component of living a self-determined life. Without bodily autonomy, people can’t craft a life that truly feels like their own. Yet the institutions and policies we witness daily often create additional barriers, particularly for those who have been minoritized in our society or seek stigmatized forms of care.

When we prioritize client autonomy in every interaction, we can make gradual shifts toward a reproductive health culture that connects patient preferences with their ability to access interrelated forms of care. Healthcare is central to someone’s ability to make decisions about their body and future. Centering autonomy in every client interaction helps providers stay aware of their own biases and offer clients a stigma and judgment-free environment.

Before we can offer autonomy-infused care, we must shift autonomy from a theoretical concept to a practical, easily identifiable set of principles in patient-client interactions.

Operationalizing autonomy-infused care

Though not an exhaustive list, when we ensure clients experience the following, we’re on the right path:

• Able to make decisions for themselves
• Free from pressure and coercion
• Honored as experts of their own experiences
• In possession of the means to act on their life decisions

Being the expert of one’s own experience

No one experiences the full spectrum of what it’s like to hold your history, understand your circumstances, or deal with the consequences of your choice like you do. Your clients live this same truth. The daily practice of living our lives as ourselves—complete with our desires and barriers—makes each of us an expert on our own experience. When approaching the client, we are not the ‘chief expert’ of their lives. We understand we can advise, but shouldn’t override their understanding of their lives. Honoring patients’ autonomy requires accepting that they are the experts of their own experience. Even when we don’t know someone’s full context—which we’re not entitled to—we should trust their making decisions with those factors in mind.

Trusting patients as the experts of their lives doesn’t mean they’re subject matter experts or formally trained medical professionals. It means each of us provides invaluable insight into our lived experience. You can find another health or social service professional to offer support. But there’s only one person who accompanies them through every stage of the process.

Making decisions for oneself

When people can make decisions about their own healthcare, including whether and when to have children, they have more control over their circumstances and economic security. They are also better able to care for their own physical, mental, and emotional well-being.

Respecting clients’ decisions means that we honor them as capable of making choices on their own behalf and for their family. Trusting patients to decide for themselves requires providing them with all the information they need to make a decision and challenging misinformation when necessary. Again, we won’t always agree with their selected action. And we don’t have to.

Having access to the means to act on one’s decision

An overlooked element of autonomy-infused care is access to the support, tools, or resources to act on their desired decision. You’re aware that patients often experience countless barriers when seeking the services and support they need, especially, but not limited to, when experiencing an unintended pregnancy. Sometimes those needs are material things, such as resources to overcome financial, transportation-based, and safety and security barriers. Other times, they require more general support, like information about the pros and cons of their options and connection with someone who offers complex solutions that address their complex lives. Offering quality referrals is a crucial yet understated aspect of this process. We can’t hope to solve all of our patients’ challenges in one visit. But we can empower them to move closer to the life they want, one connection at a time.

Being free from pressure and coercion

Lastly, it’s not enough for clients to make a decision. They need the opportunity to do so, without pressure or influence from others. There’s a fine line between informing someone about potential benefits and disadvantages of their options. The key difference between the autonomy-infused care we aim to offer patients and the biased, stigma-based facilities we discourage them from visiting is that we inform, support, and encourage them while giving them space to reach their own conclusions.

Supporting clients through a decision looks like

• Offering balanced pros and cons
• Respecting their timelines
• Supporting decision-making process by exploring the client’s values and priorities
• Encouraging self-reflection
• Breaking down complex decisions

Pressure and coercion in care look like

• Withholding information to make one sound better
• Using fear to influence behavior
• Rushing decisions
• Dismissing client concerns
• Asking leading questions (Don’t you think it would be better to..)
• Using authority to shape the decision

Our goal is to ensure people can make decisions about their own healthcare and have more control over their circumstances and economic security while being better able to care for their own well-being. This includes whether and when to have children. When implemented consistently, autonomy-based care can lead to systemic changes and empower clients to advocate for themselves, their families, and their communities.

Interested in next steps? The following resources are available to learn more about autonomy and related principles of care:

• Try Our Self-Paced Asynchronous “All-Options: Pregnancy Counseling, Education, and Referrals” training.
• Explore our Risk to Reasons initiative, online tools intentionally designed to center the needs of Black women and other people who can get pregnant.