Contraceptive Preferences of Women with Systemic Lupus Erythematosus: Results from a Nigerian Survey

Women with systemic lupus erythematosus (SLE) are at increased risk of adverse maternal and fetal outcomes, particularly when pregnancy occurs during periods of active disease. Effective contraception is therefore essential, yet data on sexual activity and contraceptive practices among women with SLE in Nigeria are limited.

A cross-sectional survey was conducted between April and July 2025 among women aged 18-48 years with rheumatologist-diagnosed SLE in Nigeria. Participants were recruited through rheumatology clinics and an online survey platform. Information obtained included sociodemographic characteristics, disease duration, disease activity assessed using the Mexican SLE Disease Activity Index, sexual activity, reproductive intentions, contraceptive use, and perceived risk of unintended pregnancy. Descriptive statistics were used, and Kendall's tau-b assessed the association between sexual activity and disease activity.

Eighty-five women were analyzed. The mean age was 35.0 ± 7.7 years, and the median disease duration was 50 months (interquartile range: 22-108). Fifty-eight participants (68.2%) were sexually active. Among these, 39 (67.2%) reported using contraception, although only 19 (48.7%) used it consistently. Barrier methods, predominantly condoms, were the most commonly used (31.1%). Most contraceptive users (74.4%) did not intend pregnancy within the next 12 months. Sexual activity was inversely associated with disease activity (Kendall's tau-b = -0.184, P = 0.048). Despite low perceived risk, 23.2% reported at least one episode of unintended pregnancy risk in the preceding year.

This study demonstrates that women with SLE in Nigeria remain sexually active and, despite their strong pregnancy avoidance intentions, frequently rely on barrier methods and inconsistently use contraception. These patterns closely mirror global experience and highlight the urgent need to integrate structured, disease-specific contraceptive counseling into routine SLE care in Nigeria to reduce potentially unintended pregnancy and associated maternal-fetal risks.