(16) Assessment of Inpatient Sexual and Reproductive Health Services for Adolescents Assigned Female at Birth: A Survey of Children’s Hospitals

Background: Adolescents assigned female at birth (AFAB) are at high risk for sexually transmitted infections (STI) and unintended pregnancy and face barriers to accessing sexual and reproductive health (SRH) services. Existing literature supports the need to provide SRH to hospitalized adolescents and their willingness to receive it. It is unknown, on a national scale, which adolescent SRH services are provided in children’s hospitals and what resources are available to provide these services. The purpose of this study is to describe SRH services available to adolescents AFAB admitted to U.S. children’s hospitals and to assess facilitators and barriers to the integration of SRH services into inpatient settings.

Methods: We conducted a cross-sectional study via electronic survey of inpatient clinical leaders at freestanding and nested children’s hospitals in the U.S. One participant per hospital was identified via Children’s Hospital Association database or internet search. Survey domains included availability of trained providers, equipment to perform pelvic exams, contraceptive methods offered, and facilitators and barriers in providing SRH services. Univariate statistics were used for descriptive analysis.

Results: Of 160 invited hospitals, 52 (33%) clinicians responded with 25 (48%) Pediatric Hospital Medicine and 23 (44%) Adolescent Medicine specialists. Twenty-two (42%) worked in free-standing and 30 (58%) in nested children’s hospitals with 42 (81%) reporting academic- or university- affiliations and 100% with medical trainees providing direct clinical care. Only 3 (6%) reported having all the equipment needed to perform pelvic exams on the inpatient unit. Eleven (21%) reported providing some form of long-acting reversible contraception (LARC), of which all provided implants and 5 (45%) offered IUD insertion. The majority of clinicians (46; 89%) reported it was somewhat or very important to provide SRH services on pediatric inpatient units and 16 (31%) were confident or very confident hospital leadership would expand SRH services if recommended by clinicians. The most common facilitator was having clinicians with required skills (65%) and the most common barrier was SRH not considered an inpatient problem (83%).

Conclusions: This is the first known study describing SRH services provided to adolescents AFAB in children’s hospitals. While clinicians identify these services as important, hospitals lack the basic equipment needed to provide such care. Future research is needed to explore interventions to promote the inclusion of SRH care at children’s hospitals.