Foundation Year 2 Doctor Chelsea and Westminster Hospital NHS Trust London, England, United Kingdom
Background: Long-acting reversible contraception (LARC) is the most effective and least used by adolescents. Personal contraceptive use has been shown to influence provider recommendations. Objective: Describe contraceptive methods used by pediatric providers. Explore the method they would recommend to a hypothetical daughter. Design/Methods: An online survey was sent to pediatric and adolescent gynecology (PAG) academic societies and fellowship/division directors to share with their clinicians. This study analyzed two main survey items: “What type of prescription contraceptive methods have you (or your partner) ever used personally?” and “Imagine you have a 17-year-old cis-gender daughter who is sexually active with a male partner. What form of prescription contraception would you recommend she use to prevent pregnancy at her next sexual encounter?” Respondents selected if they ever used, never, or not applicable for 5 contraceptive types: pill, patch/ring, injection, implant, intrauterine device (IUD). Responses were dichotomized into ever used IUD and/or implant (LARC) or not. Bivariate tests assessed LARC use across demographics and training characteristics (feeling prepared to prescribe contraception). Results: Among 669 providers who completed the survey, most were female (78%), non-Hispanic white (70%) and between 35-44 years-old (42%). Most practiced pediatric hospital medicine (75%) or sexual health subspecialties (25%) and most (61%) reported feeling somewhat/very prepared to prescribe contraception. Nearly half (46%) reported personal/partner ever use of LARC, and of these 38% reported IUD alone, 2% reported implant alone, and 7% reported both. Females (83% vs 17% male, p=0.02), non-Hispanic White (76% vs 10% Asian and 14% Underrepresented in Medicine, p< 0.01), sexual health specialists (35% vs 65% hospitalist, p< 0.01), and those feeling prepared to prescribe contraception (67% vs 33% not prepared, p< 0.01) were more likely to report ever personally using LARC. Overall, 77% reported recommending a LARC method for their hypothetical daughter. Those reporting ever using LARC were more likely to recommend LARC to a hypothetical daughter (89% LARC users recommend it vs 66% non-LARC users, p< 0.01).
Conclusion(s): Results inform the potential content of shared decision-making discussions. When families ask, “what do you use” or “what would you start for your daughter,” pediatricians might consider sharing this aggregate perspective of pediatrician personal practices with families, while maintaining adolescent autonomy and agency. Funded by K23HD097291, Organon ISP#60445
