Contraceptive use at last intercourse among reproductive-aged women with disabilities: an analysis of population-based data from seven states

Pattern of contraceptive use among reproductive-aged women with disabilities in Bangladesh: Evidence from multiple indicator cluster survey 2019

BACKGROUND

Contraception is crucial for reproductive-aged women with disabilities, empowering them to manage reproductive choices and enhancing overall health, autonomy, and well-being.

OBJECTIVE

The objective of this study was to examine the usage patterns of contraceptive methods among reproductive-aged women with disabilities in Bangladesh.

METHODS

We analyzed data from 47,465 reproductive-aged women from the 2019 Bangladesh Multiple Indicator Cluster Survey. Outcome variables included contraceptive usage patterns, grouped into any contraceptive methods, any modern contraceptive methods, and any traditional contraceptive methods. The primary explanatory variable considered was disabilities level (women with no disabilities, women with moderate disabilities, and women with severe disabilities), along with types of disabilities. A multilevel mixed-effects logistic regression model was used to assess associations between outcomes and explanatory variables while accounting for confounding.

RESULTS

The prevalence of any contraceptive methods use was 66.4 %, declining to 54 % among women with severe disabilities. The odd of modern contraception use was 31 % lower (aOR, 0.69, 95 % CI, 0.65-0.73) among women with moderate disabilities and 47 % lower (aOR, 0.53, 95 % CI, 0.47-0.60) among those with severe disabilities, compared to women with no disabilities. Within the individual domains of disabilities, those with vision, walking, cognitive, and self-care-related disabilities reported lower odds of modern contraception uptake than those with no disabilities.

CONCLUSIONS

The study highlights that women with disabilities use contraceptives less often, increasing vulnerability to unintended and short interval pregnancies and unsafe abortion. Strengthening family planning and prioritizing women with disabilities for modern contraceptives are vital.

Screening women in young adulthood for disabling dysmenorrhoea: a nationwide cross-sectional study from the CONSTANCES cohort

RESEARCH QUESTION

How do different warning indicators help to identify disabling dysmenorrhoea among women in young adulthood?

DESIGN

A nationwide cross-sectional study of women aged 18-25 years from the CONSTANCES cohort was constructed. Disability was assessed with the Global Activity Limitation Indicator question 'For the past 6 months, have you been limited in routine activities?Yes, severely limited/Yes, limited/ No, not limited'. Dysmenorrhoea pain intensity and other chronic pelvic pain symptoms (dyspareunia and non-menstrual pain) were evaluated according to questions from a specific questionnaire. Probability of disability was estimated using a logistic prediction model according to dysmenorrhoea intensity, other indicators of pelvic pain symptoms and other obvious covariates. The results of the predictive model of disabling dysmenorrhoea were presented on a nomogram.

RESULTS

Among 6377 women, the rate of disability was estimated at 7.5%. Increased intensity of dysmenorrhoea (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.04-1.13), increased frequency of dyspareunia (from OR 1.69, 95% CI 1.33-2.14 up to OR 3.41, 95% CI 2.16-5.38) non-menstrual chronic pelvic pain (OR 1.75, 95% CI 1.40-2.19), body mass index over 25 kg/m2 (OR 1.45, 95% CI 1.17-1.80) and non-use of the hormonal contraceptive pill (OR 1.29, 95% CI 1.05-1.59) were significantly associated with disability. According to the nomogram, a predicted probability of 15% or more could be chosen as a threshold. This represents almost 4.6% of young women in this sample being classified at risk of disabling dysmenorrhoea.

CONCLUSIONS

Dysmenorrhoea pain intensity and associated pelvic pain symptoms are warning indicators that can be measured to help screen young women who may suffer from disabling dysmenorrhoea.

Obstetric and Gynecologic Care for Individuals with Disabilities

This article explores the inequities experienced by individuals with disabilities when accessing obstetric and gynecologic care. The unique needs, abilities, and barriers to care are reviewed, as well as recommendations for provision of care to people with disabilities.

Contraceptive dynamics among women with disabilities of reproductive age in Ethiopia: systematic review

BACKGROUND

In low-income countries, women with disabilities have limited access to essential sexual and reproductive health services and are disadvantaged socioeconomically. Even though some studies have been conducted previously, there are scanty findings on contraceptive use and associated factors among women with disabilities. Thus, this systematic review aimed to assess contraceptive use and associated factors among women with disabilities of reproductive age in Ethiopia.

METHODS

The Preferred Reporting Item for Systematic Review and Meta-Analyses [PRISMA] guidance is used to conduct this systematic review. Data were searched from electronic databases: PubMed/Medline, Scopus, Google Scholar, and other relevant sources. Studies screening was done using Rayyan software. The findings were narratively synthesized using a socio-ecological framework for health promotion.

RESULT

Ten cross-sectional studies and 4436 women with disabilities of reproductive age were included in this review. According to this review, women with disabilities are less likely to use contraceptives, with a prevalence of 21.7% in Gondor City and 44.4% in Addis Ababa. The associated factors were identified and themed at individual, interpersonal, community, and institutional levels.

CONCLUSION

Overall, the review findings revealed that women with disabilities continue to encounter challenges ranging from individual level to disability-unfriendly health facility infrastructure or institutional level. Therefore, health professionals and other relevant stakeholders should draw attention to creating awareness towards contraceptive use at individual and interpersonal levels, ensuring accessible contraceptive services and disability-friendly health facilities.

Contraceptive use among people with disabilities in sub-Sahara Africa: A systematic review and meta-analysis

In sub-Saharan Africa, there are different studies on contraceptive use and associated factors among people with disabilities. However, the findings are inconsistent and inconclusive. This study aimed to estimate the pooled prevalence of contraceptive use and associated factors among women with disabilities in sub-Saharan Africa. Comprehensive search was performed from different databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline was followed to report the results. The data were analyzed by using STATA software. Heterogeneity and publication bias was checked. The pooled odds ratio (POR) with a 95% confidence interval (CI) was used to report the measures of associations. The pooled prevalence of contraceptive use was 25.61% (95% CI: 20.68, 30.54). Being married (POR = 2.96; 95% CI: 1.31, 4.62), high income (POR = 2.20; 95% CI: 1.42, 2.97), having media access (POR = 1.74; 95% CI: 1.24, 2.23), being in the age group of 25-34 (POR = 2.52; 95% CI: 1.01, 3.94), vision impairment (POR = 3.82; 95% CI: 2.05, 5.59), good contraceptive knowledge (POR = 2.09; 95% CI: 1.27, 2.91), primary education (POR = 1.82; 95% CI: 1.25, 2.39), secondary education (POR = 2.31; 95% CI: 1.03, 3.59) and tertiary educational status (POR = 3.37; 95% CI: 1.28, 5.46) were factors associated with contraceptive use. Contraceptive use among women with disabilities is considerably low in sub-Saharan Africa. The use of contraceptives is primarily dependent on socio-demographic and economic status.

Sexual lives of reproductive-aged people with disabilities in Central Sidama National Regional State, Ethiopia: a mixed-methods study

BACKGROUND

Sexuality is an important part of human life; people with disabilities have the same sexual desires as people without disabilities. However, the status of the sexual lives of reproductive-aged people with disabilities is unfolded in Ethiopia. Therefore, this study was aimed to assess sexual lives and its associated factors among reproductive-aged people with disabilities in central Sidama National Regional State, Ethiopia.

METHODS

A mixed-methods study was conducted among randomly selected 685 reproductive-age people with disabilities and fifteen (15) in-depth interviews among individuals who have sexual practice experience from June 20 to July 15, 2022. The quantitative data were collected through face-to-face interviewing techniques using a structured and semi-structured questionnaire. A multilevel logistic regression analysis model was employed to analyze the data. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the measures of associations. The qualitative data were managed and analyzed using the phenomenological research analysis approach.

RESULTS

In this study, 59.9% (95% CI: 56.1, 63.5) of the people with disabilities have practiced sexual intercourse. Of these, 30.8% (95% CI: 27.4, 34.4) were males and 29.1% (95% CI: 25.7, 32.6) were females with disabilities. Being female (AOR = 2.81; 95% CI: 1.70, 4.62), having an occupation (AOR = 7.55; 95% CI: 4.03, 14.1), having a disability and being in a wheelchair (AOR = 0.27; 95% CI: 0.09, 0.82), having a good self-perception (AOR = 0.46; 95% CI: 0.28, 0.77), and having a rich economic status (AOR = 2.05; 95% CI: 1.08, 3.89) were factors associated with the sexual practice. The qualitative findings revealed that having sexuality information (training) is the facilitator, and community discrimination and low economic income are the barriers to sexual practice.

CONCLUSION

Sexual practice among people with disabilities is low in the Dale and Wonsho districts and Yirgalem city administration. Socio-demographic and economic factors and sexuality training are the associated factors. Therefore, creating job opportunities and economic empowerment, providing sexuality training, and creating community awareness are crucial to improving the sexual practice of reproductive-age people with disabilities.

Contraception use among female youth with disabilities: Secondary analysis of a Canadian cross-sectional survey

BACKGROUND

Non-use of contraception among sexually active youth is an important contributor to unintended pregnancy, but contraception use among disabled youth is poorly understood.

OBJECTIVE

To compare contraception use in female youth with and without disabilities.

METHODS

We used data from the 2013-2014 Canadian Community Health Survey on sexually active 15 to 24-year-old females with (n = 831) and without (n = 2,700) a self-reported functional or activity limitation, who reported that it was important to them to avoid getting pregnant. We used log binomial regression to derive adjusted prevalence ratios (aPR) for use of any vs. no contraception, and for oral contraception, injectable contraception, condoms, other contraception methods, and dual methods separately, comparing youth with and without disabilities. Adjusted analyses controlled for age, school enrollment, household income, marital status, race/ethnicity, immigrant status, and health region.

RESULTS

There were no differences in the use of any contraception (85.4% vs. 84.2%; aPR 1.03, 95% CI 0.998-1.06), oral contraception (aPR 0.98, 95% CI 0.92-1.05), condoms (aPR 1.00, 95% CI 0.92-1.09), or dual methods (aPR 1.02, 95% CI 0.91-1.15), comparing youth with and without disabilities. Those with disabilities were more likely to use injectable contraception (aPR 2.31, 95% CI 1.59-3.38) and other contraception methods (aPR 1.54, 95% CI 1.25-1.90).

CONCLUSION

Youth at risk of unintended pregnancy had similar overall use of contraception, regardless of disability status. Future studies should examine the reasons for higher uptake of injectable contraception in youth with disabilities, with possible implications for health care provider education on access to youth-controlled methods for this group.

Contraceptive use among reproductive-age females with disabilities in central Sidama National Regional State, Ethiopia: a multilevel analysis

Background

Contraceptive use is an important and cost-effective intervention to prevent unwanted pregnancies. People with disabilities face discrimination when it comes to using contraception and are doubly burdened by unwanted pregnancies. However, the status of contraceptive use and associated factors among reproductive-aged females with disabilities was not adequately determined in Ethiopia.

Objective

This study aimed to assess contraceptive use and associated factors among reproductive-age females with disabilities in Dale and Wonsho districts and Yirgalem city administration of central Sidama National Regional State, Ethiopia.

Methods

A community-based cross-sectional study was conducted among randomly selected 620 reproductive-age females with disabilities living in the selected districts from June 20 to July 15, 2022. The data were collected through face-to-face interviewing techniques using a structured questionnaire. A multilevel logistic regression analysis model was employed to analyze the data. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the measures of associations.

Results

In this study, 27.3% (95% CI [23.8%-31.0%]) of the reproductive-age females with disabilities were current contraceptive users. Regarding the methods, 82 (48.5%) of the reproductive-age females with disabilities used implants. Having good contraceptive knowledge (AOR = 9.03; 95% CI [4.39-18.6]), transport accessibility to health facilities (AOR = 2.28; 95% CI [1.32-3.94]), being an adult (25 to 34 years old) (AOR = 3.04; 95% CI [1.53-6.04]), having a hearing disability (AOR = 0.38; 95% CI [0.18, 0.79]), having paralysis of the extremities (AOR = 0.06; 95% CI [0.03-0.12]), and wheel-chaired disability (AOR = 0.10; 95% CI [0.05-0.22]) were factors associated with contraceptive use.

Conclusion

Contraceptive use among reproductive-age females with disabilities is low. Transport accessibility, contraceptive knowledge, being in the age groups of 25 to 34 years, and the types of disability determine their contraceptive use. Therefore, designing appropriate strategies to provide contraceptive education and information and provide contraceptive services in their homes is important to enhance contraceptive use.

"It Would Have Been Nice to Have a Choice": Barriers to Contraceptive Decision-making among Women with Disabilities

INTRODUCTION

Engaging in contraceptive decisions is an important part of reproductive health for women and other people with the capacity for pregnancy. However, not all individuals capable of pregnancy have equal access to information and/or opportunities to make fully informed decisions. The goal of this study was to understand barriers women with disabilities experience around contraceptive decision-making and whether these differ based on type of disability.

METHODS

We conducted focus groups with 17 reproductive age adult women (aged 18-45 years). Focus groups were homogenous with regard to disability type and consisted of one group for each of the following disability categories: 1) physical disability, 2) intellectual and developmental disabilities, 3) blind or low vision, and 4) Deaf users of American Sign Language. Data were collected in the Portland, Oregon, metropolitan area during 2016-2017. We analyzed focus group transcripts using content analysis.

RESULTS

Barriers to informed contraceptive decision-making emerged in five main thematic areas: 1) lack of information in accessible formats, 2) incomplete information about contraceptive side effects, 3) limited clinician knowledge and relevant research specific to the care of women with disabilities, 4) taboos around discussing sexual activity, and 5) limited opportunities for shared contraceptive decision-making.

CONCLUSIONS

Women with disabilities faced numerous barriers to contraceptive decision-making. Although the barriers differed somewhat by disability type, many barriers were consistent across groups, suggesting commonalities associated with the experience of disability in the context of contraceptive decision-making. Increased attention to the reproductive health needs of people with disabilities is important for improving health care equity and quality.

The Use of Self-Reported Functional Limitation to Examine Pregnancy and Reproductive Health Experiences in a National Sample of Women

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Conclusions:

Contraceptive Use Among Adolescents With and Without Disabilities

PURPOSE

The aim of this study is to assess contraceptive use at last intercourse among adolescent girls with and without disabilities.

METHODS

Data were from the 2015 and 2017 Oregon Healthy Teens survey, a state-wide representative sample of 11th grade students. Among respondents at risk for unplanned pregnancy (n = 3,702), we estimated the prevalence of contraceptive method used at last intercourse-including intrauterine device, implant, Depo-Provera, oral contraceptive pills, patch, ring, condoms, withdrawal, and emergency contraception-by disability status. We used multivariable Poisson regression to measure the association between disability status and use of any contraceptive.

RESULTS

Girls with disabilities were more likely to report having had intercourse compared to girls without disabilities (49.2% vs. 37.4%). Girls with disabilities were less likely to use oral contraceptive pills (32.8% vs. 36.6%) or condoms (51.9% vs. 59.7%) compared to their non-disabled peers. After adjusting for demographic factors, 92.3% of girls with disabilities reported using any contraceptive method compared to 94.7% of girls without a disability (adjusted prevalence difference -2.6%, 95% CI -.26%, -4.9%; adjusted prevalence ratio .97, 95% CI .95-1.00, p = .03).

CONCLUSIONS

We observed high levels of contraceptive use among Oregon high school girls. Still, girls with disabilities were slightly less likely to report contraceptive use compared to their non-disabled peers. Given the high proportion of teens with disabilities who are sexually active, the magnitude of the difference in contraceptive use could be of concern on a national scale and further research is warranted.

Experiences of Women With Disabilities in Accessing and Receiving Contraceptive Care

OBJECTIVE

To conduct an initial exploration of the experiences of women with different types of disability when they attempt to obtain contraceptive care.

DESIGN

Multiple-category focus group design.

SETTING

Multiple community sites.

PARTICIPANTS

Seventeen women with disabilities of reproductive age.

METHODS

We purposively sampled women with different types of disability and conducted four focus groups organized by disability type: physical disability, intellectual and developmental disability, blind or low vision, and deaf or hard of hearing. We used a semistructured focus group guide to elicit participants' positive and negative experiences with contraceptive care. We analyzed focus group transcripts using content analysis.

RESULTS

Participants identified challenges to obtaining high-quality contraceptive care in three main thematic areas: Accessibility and Accommodations, Clinician Attitudes, and Health Insurance. Participants with physical disabilities encountered inaccessible clinic rooms and examination tables, and those with sensory disabilities or intellectual and developmental disability described inaccessible clinic forms and information. Participants from multiple disability groups described negative attitudes of health care providers and health insurance limitations.

CONCLUSION

As described by our participants, the processes and infrastructure of contraceptive care were based on an assumption of an able-bodied norm. Reliance on such a norm, for example, offering a paper pamphlet to a blind woman, is not helpful and can be harmful to women with disabilities. Increased attention to the reproductive health care needs of women with disabilities is important for improving health care equity and quality.

Contraceptive Provision and Quality Care Measures for Insured Individuals in Massachusetts Who Are Deaf or Hard of Hearing

OBJECTIVE

To evaluate contraceptive provision and contraceptive care quality measures for individuals who are deaf or hard of hearing and compare these outcomes to those individuals who are not.

METHODS

We conducted a claims analysis with data from the 2014 Massachusetts All-Payer Claims Database. Among premenopausal enrollees aged 15-44, we determined provision of any contraception (yes or no) and provision by contraception type: prescription contraception (pills, patch, ring, injectables, or diaphragm), long-acting reversible contraceptive (LARC) devices, and permanent contraception (tubal sterilization). We compared these outcomes by deaf or hard-of-hearing status (yes or no). The odds of contraceptive provision were calculated with regression models adjusted for age, Medicaid insurance, a preventive health visit, and deaf or hard-of-hearing status. We calculated contraceptive care quality measures, per the U.S. Office of Population Health, as the percentage of enrollees who used: 1) LARC methods or 2) most effective or moderately effective methods (tubal sterilization, pills, patch, ring, injectables, or diaphragm).

RESULTS

We identified 1,171,838 enrollees at risk for pregnancy; 13,400 (1.1%) were deaf or hard of hearing. Among individuals who were deaf or hard of hearing, 31.4% were provided contraception (23.5% prescription contraception, 5.4% LARC, 0.7% tubal sterilization). Individuals who were deaf or hard of hearing were less likely to receive prescription contraception (adjusted odds ratio 0.92, 95% CI 0.88-0.96) than individuals who were not deaf or hard of hearing. The percentage of individuals who were deaf or hard of hearing who received most effective or moderately effective methods was less than that for individuals who were not (24.2% vs 26.3%, P<.001). There were no differences in provision of LARC or permanent contraception by deaf and hard-of-hearing status.

CONCLUSION

Individuals who were deaf or hard of hearing were less likely to receive prescription contraception than individuals who were not; factors underlying this pattern need to be examined. Provision of LARC or permanent contraception did not differ by deaf or hard-of-hearing status. These findings should be monitored and compared with data from states with different requirements for contraceptive coverage.

Gynecological Care and Contraception Considerations in Women with Cerebral Palsy

The purpose of this literature review was to further explore gynecological care and contraceptive use in women with cerebral palsy. We address barriers to pelvic examinations for cervical cancer screenings and current contraceptive methods in severely debilitated patients with cerebral palsy.

Contraceptive Practices and Reproductive Health Considerations for Adolescent and Adult Women with Intellectual and Developmental Disabilities: A Review of the Literature

Whereas progress has been made on increasing access to comprehensive healthcare for individuals with intellectual and developmental disabilities (I/DD), disparities continue in health outcomes, including those related to the reproductive health of adolescent and adult women with I/DD. This review summarizes reproductive care considerations for adolescent and adult women with I/DD and current practices regarding the delivery of contraceptive services to these women. Forty-seven (47) articles based on research conducted in the US between 1999 and 2019 were selected for inclusion in the review. Primary themes discussed include (1) common reproductive health concerns for adolescent and adult women with I/DD, other than pregnancy prevention; (2) contraceptive methods and disability-related concerns; (3) informed consent and reproductive decision-making; and (4) provider knowledge and education. The management of menses and hormonal dysregulation were identified as concerns that providers encounter among patients with I/DD and their families. Disability-related concerns with regard to use of contraception in general and considerations regarding certain methods in particular include challenges with prescription adherence, physical effects of hormonal therapies, drug interactions for individuals with additional health conditions, and legal and ethical concerns involved with decision-making and consent. The results of this review also suggest that focused efforts in partnership with health care providers may be needed to address barriers that adolescent and adult women with I/DD face when trying to obtain quality reproductive health services and contraceptive guidance.

Inclusion of LGBTQ persons in research related to pregnancy risk: a cognitive interview study

INTRODUCTION

Recently, researchers have begun considering whether and how to include lesbian, gay, bisexual, transgender and queer (LGBTQ) people in research about abortion and contraception care. Including LGBTQ people in research about abortion and contraception care, as well as the risk for unintended pregnancy more broadly, requires accurate assessment of risk for unintended pregnancy, which involves different considerations for LGBTQ people.

METHODS

We created a survey with existing sexual orientation and gender identity measures, new reproductive anatomy questions to guide skip patterns, gender neutral terminology in sexual and behavioural risk questions, and existing contraception and pregnancy intentions questions that were modified to be gender neutral. We then assessed the appropriateness of these measures through cognitive interviews with 39 individuals aged 18-44 years who were assigned female at birth and identified as LGBTQ. Participants were recruited in the San Francisco Bay Area of California, Baltimore, Maryland and other cities.

RESULTS

Existing demographic questions on sexual orientation and gender identity were well received by participants and validating of participant reported identities. Participants responded positively to new reproductive anatomy questions and to gender neutral terminology in sexual behaviour and pregnancy risk questions. They felt skip patterns appropriately removed them out of inappropriate items (eg, use of contraception to avoid unintended pregnancy); there was some question about whether pregnancy intention measures were widely appropriate or should be further restricted.

CONCLUSIONS

This study provides guidance on ways to appropriately evaluate inclusion of LGBTQ people in abortion and contraception research.

Contraceptive use by disability status: new national estimates from the National Survey of Family Growth

OBJECTIVE

The objective was to determine population-based estimates of use of contraception among women 15-44 years of age in the United States by disability status.

STUDY DESIGN

We examined the relationship between disability status and use of contraception among 7505 women at risk of unintended pregnancy using data from the 2011-2015 National Survey of Family Growth.

RESULTS

After examining the full distribution of contraceptive method use by disability status, we found that disability status was significantly associated with differences in three categories of use: female sterilization, the oral contraceptive pill and nonuse of contraception. Multivariate analysis shows that use of female sterilization was higher among women with cognitive disabilities (aOR=1.54, 95% CI=1.12-2.12) and physical disabilities (aOR=1.59, CI=1.08-2.35) than for those without disabilities after controlling for age, parity, race, insurance coverage and experience of unintended births. Use of the pill was less common among women with physical disabilities than for those without disabilities (aOR=0.57, CI=0.40-0.82). Finally, not using a method was more common among women with cognitive disabilities (aOR=1.90, CI=1.36-2.66).

CONCLUSIONS

Self-reported cognitive disabilities ("serious difficulty concentrating, remembering or making decisions"), as well as physical disabilities, are significant predictors of contraceptive choices after controlling for several known predictors of use.

IMPLICATIONS

The patterns found here suggest that screening for self-reported cognitive and physical disabilities may allow health care providers to tailor counseling and sex education to help women with disabilities prevent unintended pregnancy and reach their family size goals.