Adolescents and young adults (AYAs) with chronic medical conditions (CMCs) face unique challenges related to sexual and reproductive health (SRH). Although they have similar sexual interests and activity to their healthy peers, they may navigate limited contraceptive options, use of teratogenic medications, and higher risk of complications during pregnancy.1 Thus, routine discussion of SRH with specific considerations for their CMCs is an important part of their care. However, young people with CMCs receive less contraceptive counseling than their healthy peers and are less likely to use any form of contraception.2., 3., 4., 5.

Pediatric subspecialty providers play a key role in the SRH education of their AYA patients. Often seeing patients more frequently than primary care providers, they are highly trusted by patients and families and provide much of their patients’ routine and preventive care.6 SRH counseling is especially important for patients with childhood conditions that pose significant pregnancy health risks.7 This counseling should include pregnancy risks associated with their disease or medications and contraceptive options counseling tailored to their specific needs and CMCs.

Pediatric subspecialists acknowledge the importance of this counseling and recognize their unique role in addressing SRH care with their adolescent patients. However, they report many barriers to providing SRH care, including provider discomfort, lack of knowledge or expertise, concern for confidentiality, and lack of time.8., 9., 10., 11., 12., 13. These provider limitations may significantly reduce patient knowledge and access to safe and effective contraception, especially for patients with CMCs. Additionally, some pediatric subspecialists may underestimate the SRH needs of patients because of the complexity of their underlying medical conditions.

Previous literature has evaluated the SRH knowledge and attitudes of specialty providers.8,10,13,14 However, these studies often categorize providers by their respective specialties and do not always include those who care for adolescents. It is important to include the perspective of these providers because adolescent patients present a unique set of challenges and considerations, including concerns related to confidentiality, consent, and mandated reporting. This study diverges from previous approaches of categorizing providers by disease system and instead aims to comprehensively assess SRH care for youth with CMCs across various pediatric subspecialties and different institutions.

The purpose of this study was to examine the SRH knowledge, attitudes, and practices of providers from a variety of pediatric subspecialty clinics. We aimed to identify trends and gaps in their knowledge and understand practices that occur across multiple subspecialties. We hypothesized that across pediatric subspecialties, providers would believe SRH is important for AYAs yet lack the knowledge and confidence to provide comprehensive SRH counseling.