Women with intellectual and developmental disabilities (IDD) are less likely to receive effective reversible contraception, according to the large study

A separate study found that women with IDD had close to double the rate of repeat pregnancy within a year compared to women without these disabilities.

Dr. Justine Wu from University of Michigan, Ann Arbor, a co-author of one of the studies, said pervasive stereotypes about women with disabilities negatively affect the way health care providers counsel women about their reproductive and contraceptive options and how women perceive their own sexual and reproductive agency.

These stereotypes, she wrote by email, include the notions that women with IDD "are neither interested in – nor able to have – mutually consensual sex and romantic relationships and are also unsuitable to be parents."

Dr. Wu and colleagues used data from the 2012 Massachusetts All-Payer Claims database to study fertile women with (n=13,059) and without (n=902,502) IDD. Overall, 4.1% of women were provided long-acting reversible contraception (LARC), 29.8% were prescribed moderately effective methods, and 66.1% received neither, they reported August 6th online in Obstetrics and Gynecology.

Women with IDD were provided moderately effective methods less often than their peers without IDD (21.1% vs. 29.9%). This difference was far greater for LARC (2.1% versus 4.2%, respectively).

After adjusting for demographic variables, women with IDD had a 57% lower odds of receiving LARC and 32% lower odds of receiving moderately effective methods, compared with women without IDD.

Contraception counseling

A second study published online August 13 in CMAJ found that Canadian women with IDD had close to double the rate of repeat pregnancy within a year than women without these disabilities.

"Healthcare providers should keep in mind that a single week-6 postpartum visit, when contraception counseling is usually provided to women, may be inadequate for this population," coauthor Dr. Hilary K. Brown of the University of Toronto told Reuters Health by email.

"Longer and more frequent visits with accessible take-home materials may be necessary to ensure that they are equipped to make informed decisions about contraception and childbearing," she said.

Dr. Brown's study involved 2,855 women with IDD and 923,367 without IDD who had a live birth between 2002 and 2013. After controlling for demographic factors, the rate of rapid repeat pregnancy was 7.6% in women with IDD vs. 3.9% in women without IDD (adjusted relative risk, 1.34). The risk was attenuated upon further adjustment for social, health and healthcare disparities (adjusted RR, 1.00).

Interactions between disability status and neighborhood income (p=0.01) and receipt of social assistance (p=0.004) were statistically significant, Brown's team notes.

Further analyses suggested that the impact of disability status was weakest for women living in lower-income neighborhoods and those receiving social assistance. All other interactions were nonsignificant.

"Our research showed that issues like poverty also partly explained high rates of rapid repeat pregnancy in (these) women," Dr. Brown pointed out. "Therefore, efforts should also focus on addressing vulnerabilities which may act as barriers to accessing high-quality reproductive health care."

"Physicians need to listen to patients and to their family members or caretakers to attend to their concerns, informing them as well about medical management options," she said. Issues of importance to girls and women with IDD, she noted, include "sexuality, risks of sexual abuse, menstrual hygiene, medical comorbidities that may have a menstrual exacerbation (seizures, etc.), and behavioral issues with a menstrual relationship."

Dr. Carol Hogue, professor of child and maternal health at Emory University's Rollins School of Public Health in Atlanta, noted by email that in the Canadian study, "among women on social assistance, intellectually challenged women were somewhat less likely to have a rapid repeat pregnancy than non-challenged women."