Prescribing Contraception to Women with Intellectual Disabilities: General Practitioners’ Attitudes and Practices

Abstract

The challenges of providing appropriate reproductive healthcare to women with intellectual disabilities are set within the context of a primary health care system. The rationale for this study was to explore the prescribing practices and attitudes of General Practitioner's (GP) when women with intellectual disabilities come to them for contraception. The data reported in this paper come from a cross-sectional postal questionnaire survey conducted with 162 GPs across two counties in England. The majority of respondents had 10 or fewer women with intellectual disabilities of child bearing age on their caseloads. The most commonly prescribed methods of contraception were the Pill (39.7%) and depot medroxyprogesterone acetate (DMPA), (34.2%). The difficulties faced by GPs in determining 'best interests' are explored, as are the issues related to the women's capacity to consent to sex.

Attitudes of health care professionals toward people with intellectual disability: a comparison with the general population

“…For instance, professionals' knowledge of the rights and capacities of persons with ID may not necessarily translate into practice when these rights are to be exercised in decisions about end‐of‐life care (Bekkema et al . ), contraception (McCarthy ) or sterilisation (Gilmore & Malcolm ).…”

Meeting the Reproductive Needs of Female Adolescents With Neurodevelopmental Disabilities

“…Information regarding sexual behavior, menstruation, contraception, and pregnancy needs to be discussed openly with female adolescents with disabilities and their parents, caregivers, and/or partners to teach and reinforce skills necessary for healthy psychosexual development (McCarthy, ). When contraception is requested, the clinician needs to evaluate who is requesting contraception and for what reason.…”

“…Combined oral contraceptives (COCs) can be taken cyclically or continuously, and both options need to be discussed. Although short‐acting contraceptives are the most common methods selected by adolescents, McCarthy () interviewed general practitioners about prescribing COCs to women with intellectual disabilities and found that clinicians were less likely to prescribe COCs because of user error and variability in following the method. Management considerations for adolescents with disabilities are (a) difficulties with swallowing a pill or maintaining a daily dosing schedule, (b) immobility that may increase risk of venous thromboembolism (VTE), (c) medications taken concurrently that may interfere with contraceptive efficacy, (d) pill packaging that may be difficult to manipulate, (e) contraceptive ring insertion, (f) contraceptive patch placement in areas prone to skin breakdown, and (g) hygiene issues with spotting and during menses.…”

Model of Intellectual Disability and the Relationship of Attitudes Towards the Sexuality of Persons with an Intellectual Disability

“…Also available are studies on the attitudes of medical students towards persons with intellectual disabilities [11–14]. Research on attitudes towards the sexuality of persons with intellectual disabilities, including students of obstetrics as participants [15], nurses employed as caring staff at institutions for disabled persons [16], personnel who work with intellectually disabled persons within the scope of their professional competences (nurses, physiotherapists, general practitioners) of various forms [17–19], addressed several issues within the broadly understood area of sexuality of persons with intellectual disabilities.…”