Contraceptive selection integrates patient preferences, medical eligibility, lifestyle factors, and reproductive goals into shared decision-making. The tiered efficacy model categorizes methods by typical-use failure rates: Tier 1 (most effective, <1% failure) includes LARC methods (IUDs, implant) and sterilization; Tier 2 (effective, 4-7% failure) includes injectables, pills, patch, and ring; Tier 3 (moderately effective, 13-27% failure) includes condoms, diaphragm, fertility awareness, and withdrawal. Patient autonomy and reproductive justice principles require offering all eligible methods without coercion and supporting informed choice regardless of provider preference.