Mann Emily S, Hartheimer Joline, Bullington Brooke W, Thornton Madeline J, Arora Kavita S, Allison Bianca A
Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States; Department of Women's and Gender Studies, College of Arts and Sciences, University of South Carolina, Columbia, SC, United States.
School of Medicine, University of North Carolina, Chapel Hill, NC, United States.
Contraception. 2025 Jan;141:110718. doi: 10.1016/j.contraception.2024.110718. Epub 2024 Sep 25.
Sexual and gender minority (SGM) youth experience disparities in sexual and reproductive health; however, little is known about how clinicians engage in contraceptive counseling with this patient population. This study describes pediatric clinician patterns and biases in contraceptive counseling with SGM youth.
We conducted 16 in-depth interviews with a convenience sample of clinicians who counsel adolescents on contraception. Participants were recruited and interviewed in-person at the American Academy of Pediatrics National Conference in October 2022. We used codebook thematic analysis.
When discussing contraceptive counseling among SGM youth, three major themes emerged: (1) participants' acceptance of SGM youth identities varied from support to suspicion and rejection; (2) participants' conceptualizations of their SGM youth patients' identities circumscribed the scope of the contraceptive care they provided; and (3) participants described using a universal approach to contraceptive counseling that disregarded the relevance of SGM youth identities. For transgender patients, many clinicians focused on menstrual regulation and overlooked potential pregnancy risk. When discussing sexual minority patients, clinicians overemphasized pregnancy prevention and encouraged the use of highly effective contraceptive methods rather than taking a shared decision-making approach to contraceptive care.
Many clinicians demonstrated bias in approaches to contraceptive care provision to SGM youth patients by holding patients accountable to normative assumptions in transgender medicine and family planning. Training and support for adolescent-facing clinicians in bias recognition and comprehensive contraceptive care are necessary to provide person-centered reproductive health care to SGM youth.
This qualitative study of pediatric clinicians' self-reported contraceptive care delivery revealed limited acceptance of sexual and gender minority youth identities and biased assumptions about which patients may need or desire specific contraceptive methods. Such practices overlook clinically-relevant differences among pediatric patients.
性取向和性别认同少数群体（SGM）青年在性健康和生殖健康方面存在差异；然而，对于临床医生如何与该患者群体进行避孕咨询，我们知之甚少。本研究描述了儿科临床医生在为SGM青年提供避孕咨询时的模式和偏见。
我们对为青少年提供避孕咨询的临床医生进行了16次深入访谈，样本为便利抽样。2022年10月，在美国儿科学会全国会议上对参与者进行了招募和面对面访谈。我们采用了编码本主题分析方法。
在讨论为SGM青年提供避孕咨询时，出现了三个主要主题：（1）参与者对SGM青年身份的接受程度各不相同，从支持到怀疑和拒绝；（2）参与者对其SGM青年患者身份的概念化限定了他们提供的避孕护理范围；（3）参与者描述采用通用的避孕咨询方法，而忽视了SGM青年身份的相关性。对于跨性别患者，许多临床医生专注于月经调节，而忽视了潜在的怀孕风险。在讨论性取向少数群体患者时，临床医生过度强调预防怀孕，并鼓励使用高效避孕方法，而不是采取共同决策的方式提供避孕护理。
许多临床医生在为SGM青年患者提供避孕护理的方法上表现出偏见，要求患者遵循跨性别医学和计划生育中的规范性假设。对面向青少年的临床医生进行偏见识别和全面避孕护理方面的培训和支持，对于为SGM青年提供以患者为中心的生殖健康护理是必要的。
这项对儿科临床医生自我报告的避孕护理提供情况的定性研究表明，对性取向和性别认同少数群体青年身份的接受程度有限，并且对哪些患者可能需要或渴望特定避孕方法存在偏见性假设。这种做法忽视了儿科患者之间与临床相关的差异。
