Disparities and Reproductive Health in Rheumatic Diseases: Deficits in Counseling and Contraception Use in an Urban...

Systemic lupus erythematosus (SLE) and inflammatory arthritis disproportionately affect reproductive-age Hispanic women, who experience more severe disease and worse outcomes. Certain factors may contribute to disparities in reproductive health counseling. This survey-based study examined the association between reproductive health counseling and contraceptive use, considering a variety of demographics and teratogenic medication use in a predominantly Hispanic population in urban Los Angeles.

An anonymous survey, based on the 2020 American College of Rheumatology Reproductive Health Guideline, was administered to 304 female patients of childbearing age with SLE, rheumatoid arthritis (RA), or juvenile idiopathic arthritis (JIA). Analyses included two-sample t-tests, Pearson's chi-square test, multivariable logistic regression, and Fisher's exact tests, with significance set at P ≤0.05.

Of 304 patients, English speakers were significantly more likely to receive contraception counseling than Spanish speakers (odds ratio [OR] 3.36; 95% confidence interval [CI] 1.52-7.40; P < 0.01). Older age was associated with lower odds of receiving counseling (OR 0.95; 95% CI 0.91-0.98; P = 0.01). Among those on teratogenic medications not desiring pregnancy, contraception counseling was linked to higher odds of using long-acting reversible contraception (OR 5.12; 95% CI 1.26-20.71; P = 0.02). Younger patients, those with SLE (vs RA or JIA), and English speakers had higher odds of perceiving their physician as knowledgeable about reproductive health (all P < 0.05).

Reproductive health counseling was inadequate for Spanish-speaking and older patients. However, reproductive health counseling was positively associated with effective contraception use among patients on teratogenic medications. Clinicians should be aware of these disparities and the potential benefit of counseling to improve highly effective contraception use.