Use of Contraception by Women with Chronic Medical Conditions

Women with chronic medical conditions have a greater need to plan pregnancies than ”healthy” women, due to increased risks for poor pregnancy outcomes. Little is known about use of contraception by women with chronic conditions. In a California managed care setting cost-effective contraception is a covered benefit for all reproductive age women. A retrospective cohort study of 459,181 women aged 15-44, 25,115 women with 5 chronic medical conditions: HIV (n=215), hypertension (n=18,962), cardiovascular disease (n=305), breast cancer (n=931) and diabetes (n=8,182), and 122,921 women with no known chronic condition (“healthy” women) were compared. Electronic data abstraction for contraceptive services was conducted between 1/1/2006-6/30/07. A detailed medical record review was included for 240 randomly chosen women who had no database documentation for family planning. Permanent female sterilization and long-acting reversible contraception (LARC: progestin and copper IUDs, implants) were used more by women with chronic conditions compared to “healthy” women (female sterilization: 15.4% vs. 4.1%, P <0.0001; LARC: 7.1% vs. 6.5%, P <0.01). When no contraceptive method was documented, there was more frequent documentation of contraceptive counseling (preconception or contraception) in “healthy” women compared to women with chronic conditions (17.1% vs. 10.2%, P <0.0001). The provision of contraceptive services to women with chronic medical conditions offer additional challenges to clinicians compared to providing contraception services for healthy women. Promotion of preconception health and family planning is essential when caring for reproductive age women with chronic medical conditions to reduce the risk of poor pregnancy outcomes.