Contraception in Medically Complex Adolescents and Young Adults

Area of Science:

• Reproductive Health
• Adolescent Medicine
• Public Health

Background:

• Contraception is crucial for adolescent and young adult (AYA) sexual and reproductive health (SRH).
• Providers may incorrectly assume AYA with chronic illnesses are not sexually active, leading to inadequate SRH screening and care.
• This oversight can result in decreased sexual knowledge, higher unplanned pregnancy rates, and health disparities among these AYA.

Purpose of the Study:

• To provide a comprehensive overview of contraceptive methods for AYA with chronic illnesses.
• To detail the efficacy and medical eligibility criteria for contraceptive use in AYA with specific medical conditions.
• To offer guidance on optimizing contraception decision-making for AYA with medical complexity.

Main Methods:

• Review of general contraception methods.
• Analysis of currently available contraceptive methods, their efficacy, and medical eligibility criteria.
• Inclusion of clinical case scenarios for specific populations (HIV, autoimmune conditions, solid organ transplant recipients).

Main Results:

• Contraceptive needs of sexually active AYA with chronic illnesses are often unmet due to provider assumptions.
• Specific medical conditions and clinical factors (e.g., thrombosis risk, drug interactions) influence contraceptive method selection.
• Tailored counseling and shared decision-making are essential for effective contraception use in this population.

Conclusions:

• Improved understanding of contraception complexities can increase utilization and reduce stigma.
• Providers must consider individual clinical status and risks when counseling AYA with chronic illnesses on family planning.
• Optimizing contraception care is vital for reducing health disparities and improving SRH outcomes for AYA with medical complexity.