Research Spotlight: Better Informing Women with Spinal Cord Injuries on Birth Control Options

Chloe Slocum, MD, MPH, of the Department of Physical Medicine and Rehabilitation at Spaulding Rehabilitation, led a review examining the current medical research and guidance for women following a spinal cord injury. Her research was recently published Topics in Spinal Cord Injury Rehabilitation.

Q: What led you to research this topic?

Counseling and education on women’s health, specifically contraception, following spinal cord injury (SCI) is an important component of patient care. After SCI, which is often a catastrophic neurologic injury causing partial or complete paralysis, all body systems are affected and women with SCI can expect changes in their cardiovascular, endocrine, musculoskeletal, gastrointestinal, and urologic functioning as well as overall mobility. While a plethora of available contraceptive options exists, research in this area for this patient population is relatively scarce. We sought to complete a comprehensive analysis on the quality and quantity of research on contraception for individuals with SCI, which could answer patient questions and inform what future research might be needed for this population.

Q: How did you conduct your study?

Our team conducted a systematic review comprising literature searches of three medical databases to identify articles that addressed contraception and family planning for women with SCI. Articles were then screened in a two-stage selection process and evaluated for content. We found 165 articles, and of those, only 21 were identified that fit our study inclusion criteria.

Q: What did you find?

We found a paucity of evidence-based information on contraception tailored to women with SCI. The majority of articles were literature reviews or professional practice guidelines. Fourteen included information on short-acting hormonal oral contraception, 11 included information on long-acting reversible contraception, 15 included information on barrier methods, six included information on fertility awareness, nine included information on permanent contraception, and one included information on emergency contraception. Our review highlights a need for research and comprehensive guidelines on primary and emergency contraception for women with SCI.

Q: What are the implications and next steps?

A fundamental aspect of reproductive autonomy is the ability to choose whether to have children or not. This choice is no less critical for women with SCI. Our review has highlighted the need to address critical issues in contraception access and use for women with SCI.

There is a need for more comprehensive studies assessing potential side effects of primary and emergency contraceptive options for women with SCI, and for SCI to be included in rehabilitation-specific and wider medical guidelines used by primary care providers and gynecologists. Inclusive research, specialized health care training, and tailored health care services are imperative steps that are needed to ensure that women with SCI can make fully informed decisions about their reproductive health, free from undue risks and obstacles.

Authorship: In addition to Slocum, Mass General Brigham authors include Lauren M. Hall, MD (Spaulding), Amber Trujillo Lalla, MD (Brigham and Women’s Hospital), Claudia B. Hentschel, MD (Spaulding) and Chinenye C. Nnoromele, MD (who completed her residency from Spaulding).

Paper cited: Hall et al. “Considerations for Contraception Following Spinal Cord Injury: A Systematic Review” Top Spinal Cord Inj Rehabil DOI: 10.4629/sci23-00081.