Contraceptive and pregnancy attitudes and practices
Eighty-seven percent (n=78) of respondents reported they refer patients to other providers for counseling and management of contraception, 11% (n=10) reported they recommend birth control to selected patients and prescribe it themselves, and 2 participants reported they recommend birth control to no one.
Over a third (38%, n=35) respondents reported a preferred method of contraception for AYA female patients with SCD. Of this subset, 37% (n=13) preferred the hormonal IUD, 37% (n=13) preferred contraceptive injection, 11% (n=4) preferred progestin-only pills, 5% (n=2) preferred the copper IUD, 5% (n=2) preferred Nexplanon, and 1 chose the combined OCP. Half of respondents did not deem CHC acceptable for birth control in this population (52%, n=48). There were no statistical differences between pediatric and adult providers.
Regarding attitudes around CHC and pregnancy in SCD, 36% agree or strongly agree that CHC should never be used in AYA with SCD (Table 2). Almost half agree that CHC can be used if no other risk factors are present. About a quarter agree or strongly agree with the CDC recommendation that CHC is unacceptable in women with SCD. The majority (89%) believe that pregnancy is high risk in any woman with SCD. We found no significant differences between pediatric and adult providers related to the strict avoidance of CHC in AYA with SCD (p =.10), agreement with the CDC recommendation that CHC as unacceptable in women with SCD (p =.15), and belief that pregnancy is considered high risk in women with SCD (p =.23). Overall, pediatric providers were significantly more agreeable to using CHC if there were no other contraindications, with 51% (n=38) of pediatric versus 25% (n=3) of adult providers agreeing or strongly agreeing that CHC can be used if there are no other risk factors; however, 58% (n=7) of adult providers, compared to 21% (n=16) of pediatric providers, disagreed or strongly disagreed with CHC use even if no other contraindications were present (p =.03).