Contraceptive options in sickle cell patients
Awarded 2014
Complex Family Planning Fellowship Research
Natalie Whaley, MD, MPH
Johns Hopkins University

Women with sickle cell disease (SCD) have unmet contraceptive needs.   A 2011 study of Medicaid claims in women with SCD found higher rates of pregnancy than encounters for contraception. Because of their known pregnancy risks, this is problematic.  Gaps in patient and provider knowledge and unanswered questions regarding contraceptive safety persist.  SCD pain significantly impacts quality of life and functional status, and historical studies suggest relationships between menses and SCD pain as well as improvement in SCD pain with a commonly used contraceptive injection called depot medroxyprogesterone acetate (DMPA).  Given the potential for contraceptive use in women with SCD to improve quality of life and survival, evaluation of their contraceptive attitudes and experiences of is important.
A descriptive survey of the contraceptive attitudes and knowledge of women with SCD in our urban clinic was completed.  The objectives of the research project are to describe contraceptive use, knowledge and attitudes in this population.  We aim to determine how women with SCD view contraception, and to identify barriers to use.
Recruitment occurred in adult and pediatric sickle cell clinic in our urban, academic center. A convenience sample was used to recruit for the survey study.  The survey was electronically administered.
Analysis of surveys from 54 women with SCD is completed thus far.  The median age of respondents is 35 years old.  Considering pregnancy intention, 55% report history of unintended pregnancy and 74% report they desire no further pregnancies.  While the majority of women (83%) have been told they had a high-risk pregnancy in the past, only 23% report knowledge that there are safety concerns with some contraceptive methods for women with SCD.
Our results show that women with SCD have knowledge deficits regarding the safety and risks of contraception vis-à-vis pregnancy.  Given the recognized risks of unplanned pregnancies in this population, as well as the potential for contraception to improve quality of life and pain, understanding how this population considers and uses birth control is important.