Purpose of review The COVID-19 pandemic has highlighted existing healthcare disparities worldwide and has challenged access to family planning (FP) services. Recent findings Research has identified ways in which government regulations and healthcare programs have inhibited or increased access to FP services, as well as how the pandemic has changed individuals’ sexual and reproductive health behaviors and intentions. Summary The pandemic has had both positive and negative effects on access to FP services. Innovations in various delivery services, extended use of contraception, telehealth for medication abortion, and a no-test medication abortion protocol have decreased the need for in-person visits and improved access to FP services.

Purpose of review To provide an overview of recent research and guidelines regarding contraception and breastfeeding. Recent findings Recent studies assessed lactogenesis, breastfeeding rates, and milk supply concerns in patients starting postpartum hormonal contraception. One study showed a small but statistically significant increase in milk supply concerns between users and nonusers of postpartum hormonal contraception. Mean time to lactogenesis and breastfeeding rates were similar between patients with immediate and delayed insertion of the levonorgestrel (LNG) implant in one study and the LNG intrauterine device (IUD) in another study. Two studies assessed nursing knowledge and attitudes toward postpartum contraception in breastfeeding women, showing that postpartum nurses had incorrect knowledge of contraceptive safety in this patient population. Both studies demonstrated persistent erroneous beliefs that depot medroxyprogesterone acetate (DMPA) adversely affects breastfeeding. In postpartum patients intending to breastfeed, more than half intended to initiate contraception within 6 weeks postpartum and few indicated effect on breastfeeding as a factor in their decision. Summary There are no significant differences in lactogenesis, breastfeeding, and infant growth parameters between immediate postpartum (IPP) and delayed insertion of LNG implants and IUDs. Labor and delivery and postpartum nurses have persistent erroneous beliefs that DMPA negatively affects breastfeeding. Patients desire to use contraception postpartum but prenatal counseling rates and practices are of variable content and quality.

Purpose of review The current article explores some of the more complex subtopics concerning adolescents and long-acting reversible contraceptives (LARC). Recent findings Recent research has highlighted ways in which LARC provision can be optimized in adolescents and has identified gaps in adolescent LARC access and utilization. Summary Contraceptive counseling for adolescents should be patient-centered, not necessarily LARC-first, to avoid coercion. There are increasing applications for the noncontraceptive benefits of LARC for several unique patient populations and medical conditions.

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INTRODUCTION: Adolescent women with chronic diseases need effective contraception as pregnancy may exacerbate their disease. Additionally, they often take teratogenic medications that may harm a developing fetus. This study aims to understand current practices of pediatric subspecialists caring for adolescents with regards to contraception counseling and provision. METHODS: Pediatric subspecialists at a Chicago based academic center completed a Qualtrics survey assessing current practices and knowledge about contraception. RESULTS: A total of 37 pediatric subspecialists routinely caring for adolescent women were surveyed. Nearly all stated their patients were on teratogens (78.1%). Many reported that none (40.6%) or few (21.9%) of their patients desired pregnancy. They were comfortable talking to their patients (81.3%) and parents (72.0%) about contraception, however only a minority believed that pediatric subspecialists should be the ones to provide contraceptive counseling (41.4%) or initiate contraception (17.2%). Physicians surveyed refer patients to gynecologists (65.2%), adolescent medicine (17.4%), and general pediatricians (8.7%) for prescription or placement of contraceptives. However, some never refer patients to gynecologists (25.0%) or refer at ages 15 and above (56.3%). 75.9% of subspecialists note barriers to providing contraception to their patients, including lack of time and inadequate training. CONCLUSION: Pediatric subspecialists generally recognize contraception as important to their patients. However, self-reported referral for contraception is often later in the teenage years and a sizeable minority of physicians never refer adolescents, despite having a significant proportion of patients on teratogens. Increased training of pediatric subspecialists about contraception and facilitating referral for contraception services could decrease barriers for adolescent women with chronic diseases.