The role of pediatric subspecialists in adolescent contraceptive care: knowledge, attitudes, and barriers.

Abstract

Study objective: Adolescents and young adults (AYA) with chronic medical conditions (CMC) have similar sexual behaviors to their healthy peers but are less likely to use contraception. Provision of CMC-specific sexual and reproductive health (SRH) care within pediatric subspecialty clinics may improve access for this population, although system and provider level barriers exist. The purpose of this cross-sectional study was to assess the attitudes, practices, and knowledge of SRH among providers in a variety of pediatric subspecialities.

Methods: Listservs were used to recruit pediatric subspecialists caring for pregnancy capable AYA (12-24 years-old) who use teratogenic medications or have CMC that pose significant pregnancy health risk, as defined by the World Health Organization. Participants completed an online survey about their contraceptive attitudes and practices and rated their knowledge and comfort discussing contraception.

Results: A total of 510 pediatric subspecialists participated. Although 92% said addressing SRH is important for pediatric subspecialists, most believed their role included SRH discussion(78.1%) and referral(82.2%) rather than provision(12.1%). Only 4.3% felt totally comfortable with contraceptive counseling. Identified facilitators included time(64.2%), referral resources(67.5%), and training in contraceptive options(62.9%). Most participants would recommend long-acting reversible contraception if medically appropriate, but few reported confidence in their knowledge and ability to counsel about them.

Conclusion: SRH is an important part of comprehensive care for youth with CMC. Discomfort and lack of knowledge decrease a provider's ability to confidently provide SRH care in subspecialty clinics. Expanding collaborations between subspecialty and SRH providers may increase access to quality SRH tailored to these young people's unique medical needs.