Contraceptive, Reproductive Health Counseling Crucial for Women With CKD – Pharmacy Times

Report on Reproductive Health Barriers for Women with Chronic Kidney Disease (CKD) in the Context of Sustainable Development Goals

A recent study highlights significant barriers to contraceptive use and reproductive health management for women with Chronic Kidney Disease (CKD). These challenges directly impede progress toward several United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 5 (Gender Equality). The findings underscore an urgent need for a holistic, patient-centered framework of care that addresses systemic gaps in provider training, clinical guidelines, and interdisciplinary coordination.

Public Health Implications and Alignment with SDG 3

CKD is a critical public health issue, affecting up to 6% of women in their childbearing years. The management of reproductive health in this population is essential for achieving SDG Target 3.7, which aims to ensure universal access to sexual and reproductive health-care services, including family planning, information, and education.

Health Risks and Disparities in Care

• Increased Maternal and Fetal Risks: Compared to the general population, pregnancy in women with CKD is associated with a 10-fold higher risk of preeclampsia and a 6-fold greater risk of preterm delivery. Pregnancy can also accelerate the progression of CKD.
• Low Contraceptive Use: Despite these risks, contraceptive use among women with CKD is below 10%. Patients frequently report a lack of adequate counseling and coordinated care, representing a significant gap in achieving universal health coverage as outlined in SDG Target 3.8.
• Provider Confidence Gap: A majority of nephrologists report a lack of confidence in managing women’s health issues, including preconception counseling and pregnancy management, further hindering the delivery of comprehensive care.

Analysis of Systemic Barriers to Achieving Health and Gender Equality

A qualitative study involving US nephrologists identified four primary themes that act as barriers to effective reproductive healthcare. These findings reveal systemic weaknesses that must be addressed to advance both SDG 3 and SDG 5, which calls for ensuring universal access to reproductive health and rights.

Key Themes Identified from a Qualitative Study

1. Physician Discomfort Regarding Reproductive Health Discussions
   • Hesitation with counseling and reliance on patient initiation for discussions.
   • Uncertainty among providers about their scope of practice in reproductive health.
2. Insufficient Training and Inadequate Guidelines
   • A significant lack of formal, evidence-based guidelines for contraception and reproductive health in CKD patients.
   • Limited exposure and formal training for nephrologists, leading to a reliance on self-education. This points to a need for improved professional development, aligning with SDG 4 (Quality Education).
3. Lack of Interdisciplinary Coordination
   • A fragmented care system where the patient often serves as the primary intermediary between specialists.
   • This lack of integrated services highlights the need for stronger collaborations, as promoted by SDG 17 (Partnerships for the Goals).
4. The Need for Holistic and Patient-Centered Care
   • A call for a comprehensive and sustained approach to patient care.
   • An emphasis on shared decision-making to empower patients, which is fundamental to achieving the goals of SDG 5 by ensuring women have agency over their health decisions.

Recommendations for a Sustainable and Equitable Framework of Care

To address these barriers and align clinical practice with global health and equality goals, a multi-faceted approach is required. The study’s findings support the implementation of a new framework focused on education, collaboration, and patient empowerment.

Strategic Actions Required

• Develop and Disseminate Clear Guidelines: Establish and promote standardized clinical guidelines for contraceptive counseling and reproductive health management in women with CKD.
• Enhance Provider Education (SDG 4): Integrate comprehensive reproductive health training into nephrology fellowships and continuing medical education to build provider confidence and competence.
• Establish Interdisciplinary Care Models (SDG 17): Create formal partnerships and referral pathways between nephrology, gynecology, and reproductive health specialists to provide seamless, coordinated care.
• Promote Patient-Centered, Empathetic Communication (SDG 5): Foster a culture of shared decision-making where nephrologists are equipped to support patients’ reproductive goals and choices, thereby upholding their rights and ensuring gender-responsive healthcare.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article primarily addresses issues related to two Sustainable Development Goals (SDGs):

• SDG 3: Good Health and Well-being: The core of the article focuses on a specific health challenge—the intersection of chronic kidney disease (CKD) and reproductive health. It discusses health risks for women with CKD during pregnancy (preeclampsia, preterm delivery), the need for better healthcare services, and the importance of patient counseling and provider education to ensure the well-being of this specific patient population.
• SDG 5: Gender Equality: The article specifically examines a health issue affecting women of childbearing age, highlighting gaps in a healthcare system that inadequately addresses their reproductive needs. By focusing on women’s access to contraceptive counseling, family planning, and the right to make informed decisions about their reproductive health (“shared decision-making”), the article connects directly to the goal of ensuring women have control over their health and reproductive rights.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the issues discussed, the following specific SDG targets can be identified:

1. Target 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.
   • Explanation: The article’s central theme is the barrier to “contraceptive use and reproductive health management in women with chronic kidney disease.” It explicitly mentions a low rate of contraceptive use, a “lack of adequate counseling,” and the need for nephrologists to provide “family planning counseling,” which directly aligns with this target’s goal of ensuring access to family planning services and information.
2. Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights…
   • Explanation: This target complements Target 3.7 by emphasizing the rights-based aspect of reproductive health. The article points to a system where women with CKD are not receiving the necessary information and support to make autonomous decisions. The call for “holistic and patient-centered care” and “shared decision-making” supports the principle that women should have the right and ability to manage their reproductive lives.
3. Target 3.8: Achieve universal health coverage, including… access to quality essential health-care services…
   • Explanation: The article identifies significant gaps in the quality of care. Issues like “provider discomfort because of limited training,” “lack of clear guidelines,” and “fragmented care” demonstrate that women with CKD are not receiving quality, comprehensive, and essential healthcare services related to their reproductive needs. The need for an established “framework of care” is a call to improve the quality and accessibility of these services.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions and implies several indicators that can be used to measure progress:

• Rate of Contraceptive Use: The article explicitly states that “the rate of contraceptive use in women with CKD remains low at less than 10%.” This is a direct quantitative indicator for measuring access to and uptake of family planning services (relevant to Targets 3.7 and 5.6).
• Access to Counseling and Information: The article notes that “patients report a lack of adequate counseling and coordinated care.” Measuring the proportion of women with CKD who receive comprehensive counseling on contraception and family planning would be a key indicator of progress (relevant to Targets 3.7 and 5.6).
• Provider Competence and Training: The finding that the “majority of US and Canadian nephrologists reported lacking confidence in managing women’s health issues” serves as a qualitative indicator of gaps in healthcare quality. Progress could be measured by tracking the percentage of nephrologists who have received formal training in reproductive health (relevant to Target 3.8).
• Maternal Health Outcomes: The article mentions that women with CKD face a “10-fold higher chance of developing preeclampsia and a 6-fold greater risk of preterm delivery.” These specific adverse pregnancy outcomes can be used as indicators to measure the effectiveness of reproductive and maternal healthcare for this population. A reduction in these rates would signify improved health and well-being.

4. Table of SDGs, Targets, and Indicators

Source: pharmacytimes.com