Cafeteria Approach in Contraceptive Methods
The cafeteria approach means counseling women about the full range of contraceptive options for which they are medically eligible, allowing them to select the optimal method based on their individual preferences, circumstances, and values—similar to choosing from a variety of options in a cafeteria. 1
Core Principle
The approach requires providers to present all available contraceptive methods that a client can safely use, rather than limiting discussion to only certain methods or those preferred by the provider. 1 This ensures patient autonomy and informed decision-making in contraceptive selection. 1
Implementation Strategy
Presentation Method
Use a tiered approach when presenting options, starting with the most effective methods first (long-acting reversible contraceptives like IUDs and implants with <1% failure rates) before discussing less effective methods (such as oral contraceptives with 9% typical use failure rates). 1, 2, 3
Present information on all methods regardless of onsite availability—if certain methods are not available at your facility, establish strong referral links to ensure clients can obtain their preferred medically appropriate method. 1
Key Elements to Discuss
When counseling clients, the cafeteria approach requires addressing multiple factors: 1
- Safety for the individual client based on medical eligibility criteria
- Effectiveness (both perfect use and typical use failure rates)
- Availability (accessibility and affordability considerations)
- Acceptability (personal preferences, cultural factors, partner preferences)
Special Populations
LARC methods should be discussed with all women and adolescents if medically appropriate, including nulliparous women and adolescents, as these are safe and highly effective first-line options. 1, 2, 3
Dual protection counseling is mandatory—all clients must be counseled about condom use for STI/HIV prevention regardless of their chosen contraceptive method, since hormonal contraceptives and IUDs provide no STI protection. 1, 3
Common Pitfalls to Avoid
Do not omit methods solely because they are unfamiliar to you or not available onsite—this violates the cafeteria principle and limits patient choice. 1
Do not assume what method a patient wants based on age, parity, or other characteristics—present the full range and let them choose. 1
Do not present only user-dependent methods to adolescents or populations at high risk for unintended pregnancy without first discussing LARC options. 2, 3