J Pediatr Adolesc Gynecol. 2016 Sep 14.

Pediatricians' attitudes and beliefs about long-acting reversible contraceptives influence counseling

Berlan ED, Pritt NM and Norris AH

Purpose: Adolescents are at high risk for unintended pregnancy. Given pediatricians' potential role in contraceptive counseling, understanding their attitudes and beliefs and counseling practices about use of long acting reversible contraceptives (LARC) [i.e., etonogestrel implant and intrauterine devices (IUDs)] is vital.

Methods: We interviewed primary care pediatricians (N=23) in a Midwestern city in June-August 2014. We transcribed the interviews, developed a coding schema, and analyzed these qualitative data using a priori and open coding of transcripts.

Results: Few pediatricians had favorable views on adolescent IUD use and most did not include IUDs in routine contraception counseling. Pediatricians perceived IUDs to impose significant risks for adverse reproductive outcomes and to be poorly tolerated by adolescents. Poor and/or outdated knowledge influenced inaccurate beliefs and unsupportive attitudes. While some pediatricians were advocates for adolescent use of IUDs, many others had concerns that IUDs were not appropriate and not favored by adolescents. In contrast, participants viewed the etonogestrel implant more favorably and often included it in routine counseling. Some pediatricians focused on the familiar and readily available methods (injectable and oral contraceptives) or assumed patients had predetermined expectations for those methods. Time spent counseling on LARC was also perceived as a barrier. Pediatricians described how education and increased familiarity with LARC changed viewpoints.

Conclusion: A variety of beliefs and attitudes, as well as factors such as time and personal habits, influence pediatricians' contraceptive counseling practices. Until knowledge deficits are addressed, uninformed viewpoints and unfavorable attitudes will limit adolescents' access to LARC, especially IUDs.

Comment: : In many countries paediatricians play an important role in the healthcare of teenage girls. Since these girls are often at high risk of an unplanned pregnancy, long-term reversible contraception, including implants or IUDs, is a good choice for them. We know now that these methods are perfectly safe and effective, also for nulliparous women. It appears that paediatricians are not always in favour of these methods, because of either lack of knowledge and understanding, or personal preference. There is a role for educators and universities to make sure that also paediatricians are aware of the pros and cons of the different contraceptives (HMV).