The Contraceptive Care Gap: Women with CKD Report Lower Rates of Contraception Use

Background: Pregnancy in patients with chronic kidney disease (CKD) is associated with complications, including low birth weight, gestational diabetes, pre-eclampsia, and pre-term birth. Clinical practice guidelines recommend contraception counseling for women with CKD of childbearing age. Furthermore, given the potential risk of complications, reproductive care should be prioritized when caring for young women with CKD. Currently, large-scale population data quantifying rates of contraception usage among women with CKD are lacking. Methods: We utilized the Behavioral Risk Factor Surveillance System in 14 states and territories in 2017, 2019, and 2022. For women aged 21-49, we extracted data on self-reported diagnosis of CKD, contraception use, and method of contraception use. We adjusted for age, sex, race/ethnicity, US census region, reported access to a primary physician, and educational level using a log-binomial regression model. We subsequently examined factors associated with contraception use among women with CKD and explored the methods used. Results: Women aged 21-49 with CKD were less likely to report contraception usage than women without CKD, even when adjusting for confounders (RR 0.88, 95% CI [0.80,0.97], p=0.01). This difference did not meaningfully vary over the 5-year period of our analysis (p=0.35). Among analyzed co-variates, the only factor associated with contraception use among women with CKD was age, with younger women more likely to use contraception (p<0.001). The most used methods of contraception among women with CKD were barrier methods or topical spermicide (29.1%), female or male surgical sterilization (20.7%), and hormonal methods including contraceptive pills, transdermal patches, hormonal rings, and the Depo-Provera injection (20.0%). Conclusion: Despite substantially higher rates of pregnancy-related complications, rates of reported contraception usage were significantly lower among women of childbearing age with CKD as compared to women without CKD. Likelihood of contraception usage declined with age, even in this age group. Assuring access to and counseling about contraception among women with CKD should be a priority for physicians treating these patients.