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Ames JL, Anderson MC, Cronbach E, Lee C, Onaiwu MG, Vallerie AM, Croen LA. Reproductive healthcare in adolescents with autism and other developmental disabilities. Am J Obstet Gynecol 2024; 230:546.e1-546.e14. [PMID: 38218512 PMCID: PMC11070300 DOI: 10.1016/j.ajog.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND Adults with developmental disabilities often have less access to reproductive health services than adults without these disabilities. However, little is known about how adolescents with developmental disabilities, including autism, access reproductive healthcare. OBJECTIVE We aimed to characterize the use of reproductive healthcare services among adolescents with autism and those with other developmental disabilities in comparison with adolescents with typical development. STUDY DESIGN We conducted a cohort study of a sample of adolescents who were continuously enrolled members of Kaiser Permanente Northern California, an integrated healthcare system, from ages 14 to 18 years. The final analytical sample included 700 adolescents with autism, 836 adolescents with other developmental disabilities, and 2187 typically developing adolescents who sought care between 2000 and 2017. Using the electronic health record, we obtained information on menstrual conditions, the use of obstetrical-gynecologic care, and prescriptions of hormonal contraception. We compared healthcare use between the groups using chi-square tests and covariate-adjusted risk ratios estimated using modified Poisson regression. RESULTS Adolescents with autism and those with other developmental disabilities were significantly more likely to have diagnoses of menstrual disorders, polycystic ovary syndrome, and premenstrual syndrome than typically developing adolescents. These 2 groups also were less likely than typically developing peers to visit the obstetrician-gynecologist or to use any form of hormonal contraception, including oral contraception, hormonal implants, and intrauterine devices. Adolescents in all 3 groups accessed hormonal contraception most frequently through their primary care provider, followed by an obstetrician-gynecologist. CONCLUSION Adolescents with autism and those with other developmental disabilities are less likely than their typically developing peers to visit the obstetrician-gynecologist and to use hormonal contraception, suggesting possible care disparities that may persist into adulthood. Efforts to improve access to reproductive healthcare in these populations should target care delivered in both the pediatric and obstetrics-gynecology settings.
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Affiliation(s)
- Jennifer L Ames
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.
| | | | - Emily Cronbach
- The Permanente Medical Group, Obstetrics and Gynecology, Kaiser Permanente Northern California Park Shadelands, Walnut Creek, CA
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Morénike Giwa Onaiwu
- Autistic Women and Nonbinary Network, Lincoln, NE; Rice University Center for the Study of Women, Gender, and Sexuality, Houston, TX; AJ Drexel Autism Institute, Drexel University, Philadelphia, PA
| | - Amy M Vallerie
- The Permanente Medical Group, Obstetrics and Gynecology Kaiser Permanente Northern California, Oakland, CA
| | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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Powell RM. Reproductive justice for disabled people post-Dobbs: A call-to-action for researchers. Disabil Health J 2024; 17:101572. [PMID: 38071137 DOI: 10.1016/j.dhjo.2023.101572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/20/2023] [Accepted: 12/02/2023] [Indexed: 04/09/2024]
Abstract
The recent Supreme Court ruling in Dobbs v. Jackson Women's Health Organization endangers reproductive freedom, particularly for marginalized communities, including disabled people. Disability and health equity researchers possess unique insights into the needs and experiences of disabled people, making our involvement crucial in response to the Dobbs decision. Accordingly, guided by disability justice and reproductive justice principles, researchers should undertake disability-inclusive studies on the consequences of abortion restrictions, advocate for policy changes that uphold the reproductive autonomy of disabled people, and collaborate with disability-led movements advocating for reproductive freedom. Indeed, it is imperative for researchers to actively promote the inclusion and self-determination of disabled people regarding their reproductive health and well-being. Given the escalating threats to reproductive freedom and their profound impact on disabled people, there has never been a more pivotal moment for disability and health equity researchers to join the fight for reproductive justice.
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Affiliation(s)
- Robyn M Powell
- University of Oklahoma College of Law, 300 Timberdell Road, Norman, OK 73019, USA; The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02453, USA.
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3
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Anshebo AA, Markos Y, Behera S, Gopalan N. Contraceptive dynamics among women with disabilities of reproductive age in Ethiopia: systematic review. Syst Rev 2024; 13:42. [PMID: 38279168 PMCID: PMC10811808 DOI: 10.1186/s13643-024-02456-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/08/2024] [Indexed: 01/28/2024] Open
Abstract
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.
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Affiliation(s)
- Abebe Alemu Anshebo
- Department of Epidemiology and Public Health, School of Life Sciences, Central University of Tamil Nadu, Thiruvarur, India.
- Deparment of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia.
| | - Yilma Markos
- Department of Epidemiology and Public Health, School of Life Sciences, Central University of Tamil Nadu, Thiruvarur, India
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Sujit Behera
- Department of Epidemiology and Public Health, School of Life Sciences, Central University of Tamil Nadu, Thiruvarur, India
| | - Natarajan Gopalan
- Department of Epidemiology and Public Health, School of Life Sciences, Central University of Tamil Nadu, Thiruvarur, India
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Brown HK, Ouedraogo M, Pablo L, Evans M, Vandermorris A. Contraception use among female youth with disabilities: Secondary analysis of a Canadian cross-sectional survey. Disabil Health J 2023; 16:101445. [PMID: 36804185 DOI: 10.1016/j.dhjo.2023.101445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
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.
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Affiliation(s)
- Hilary K Brown
- Department of Health and Society, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, Canada.
| | - Mariame Ouedraogo
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, Canada
| | - Lesley Pablo
- Department of Health and Society, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario, Canada
| | - Meredith Evans
- Department of Health and Society, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario, Canada
| | - Ashley Vandermorris
- Division of Adolescent Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada
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Abstract
Almost half of all pregnancies each year in the United States are mistimed or unwanted and associated with adverse health outcomes. Deaf women are as likely to be pregnant as their hearing counterparts but are 67% more likely to experience unintended pregnancy. Although there are limited data on the sexual health behaviors of deaf individuals, research has shown that deaf people are more likely than the general population to rely on withdrawal and condoms to prevent pregnancy. Further, health resources and communication with physicians are often not fully accessible, with the former often in spoken or written English and the latter when sign language interpreters are not present. The combination of use of less--effective methods of contraception and inaccessible health resources puts deaf women at heightened risk for unintended pregnancy. Deaf women are denied reproductive justice when they are inadequately equipped to practice bodily autonomy and prevent unintended pregnancies. In this commentary, I present literature to illustrate the disparity deaf women face compared with hearing women and to make the case for the association among unintended pregnancy, its adverse effects, and reproductive injustice for deaf women. As a medically trained deaf woman conducting reproductive health research, I leverage my lived experience and accrued knowledge to elucidate the shortcomings and strategies to use. As public health researchers and health care professionals, we can alleviate this injustice with inclusive research methodology, representation on research and health care teams, and ensuring access to health information with time given and accommodations provided.
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Sexual Violence Against Women With Disabilities: Experiences With Force and Lifetime Risk. Am J Prev Med 2022; 62:895-902. [PMID: 35184946 DOI: 10.1016/j.amepre.2021.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/23/2021] [Accepted: 12/09/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Emerging research suggests that people with disabilities experience an increased risk of sexual violence. However, few studies have examined the relationship between disability types and various forms of sexual violence, involving either physical or nonphysical force. METHODS This cross-sectional study used nationally representative data from years 2011-2017 of the National Survey of Family Growth among women aged 18-44 years. Analyses were conducted in March 2020-June 2021. Using binary and multinomial logistic regression models, lifetime risk of sexual violence and experience of physical or nonphysical force at first intercourse were modeled as a function of disability type (sensory, physical, cognitive, or ≥2 disabilities). Models also controlled for relevant demographic confounders. RESULTS Women with any type of disability reported experiencing sexual violence in their lifetime approximately double the proportion of that experienced by nondisabled women (∼30% vs 16.9%), with women with multiple disabilities experiencing the greatest prevalence (42.1%) and risk (AOR=2.94, p<0.001) than nondisabled women. Women with cognitive disabilities or multiple disabilities were significantly more likely to experience either physical (cognitive: AOR=1.55, p<0.001; multiple: AOR=1.50, p<0.05) or nonphysical force (cognitive: AOR=2.28, p<0.01; multiple: AOR=2.74, p<0.001) during their first intercourse than nondisabled women. CONCLUSIONS Results of this study suggest that future research should focus on the association between various types of disability and sexual violence. The development of inclusive evidence-based violence intervention and prevention programs for girls and women with disabilities is recommended.
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Senders A, Horner-Johnson W. Contraceptive Use Among Adolescents With and Without Disabilities. J Adolesc Health 2022; 70:120-126. [PMID: 34353722 DOI: 10.1016/j.jadohealth.2021.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/19/2021] [Accepted: 06/23/2021] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Angela Senders
- Oregon Health & Science University, Institute on Development and Disability, Portland, Oregon; OHSU-PSU School of Public Health, Portland, Oregon
| | - Willi Horner-Johnson
- Oregon Health & Science University, Institute on Development and Disability, Portland, Oregon; OHSU-PSU School of Public Health, Portland, Oregon.
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Horner-Johnson W, Klein KA, Campbell J, Guise JM. Experiences of Women With Disabilities in Accessing and Receiving Contraceptive Care. J Obstet Gynecol Neonatal Nurs 2021; 50:732-741. [PMID: 34389287 PMCID: PMC8759451 DOI: 10.1016/j.jogn.2021.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Contraceptive Provision and Quality Care Measures for Insured Individuals in Massachusetts Who Are Deaf or Hard of Hearing. Obstet Gynecol 2021; 138:398-408. [PMID: 34352855 DOI: 10.1097/aog.0000000000004505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/06/2021] [Indexed: 11/26/2022]
Abstract
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.
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Multimorbidity and use of reversible contraception: Results from a Canadian cross-sectional survey. Contraception 2021; 104:628-634. [PMID: 34329608 DOI: 10.1016/j.contraception.2021.07.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Despite the importance of contraception for pregnancy planning in females with chronic conditions, little is known about contraception use in those with two or more chronic conditions-i.e., multimorbidity. We examined contraception use among females with multimorbidity, one chronic condition, and no identified chronic conditions. STUDY DESIGN We used data from the 2015 to 2016 Canadian Community Health Survey on 15 to 49-year-old females at risk of unintended pregnancy (n = 12,741), comparing females with ≥2 chronic conditions (21.3%) and one chronic condition (27.7%) to those with no identified chronic conditions (51.0%). We used modified Poisson regression to derive adjusted prevalence ratios (aPR) for any contraception vs no contraception, and multinomial logistic regression to derive adjusted odds ratios (aOR) for highly effective, moderately effective, and no contraception vs less effective contraception. RESULTS Compared to females with no identified chronic conditions, those with multimorbidity were less likely to use any contraception (aPR 0.93, 95% CI 0.89 - 0.98). Females with multimorbidity were more likely than those with no identified chronic conditions to use no contraception (aOR 1.29, 95% CI 1.13 - 1.46), with little to no difference in the use of highly (aOR 1.08, 95% CI 0.91 - 1.29) or moderately effective contraception (aOR 0.98, 95% CI 0.86 - 1.13), vs less effective contraception. There were no differences between females with one chronic condition and no identified chronic conditions. CONCLUSION The lower overall rate of contraception use in females with multimorbidity reflects a need for more attention to family planning in this population, with prompt and convenient access to highly effective options.
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Namkung EH, Valentine A, Warner L, Mitra M. Contraceptive use at first sexual intercourse among adolescent and young adult women with disabilities: The role of formal sex education. Contraception 2020; 103:178-184. [PMID: 33359508 DOI: 10.1016/j.contraception.2020.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study examines receipt of formal sex education as a potential mechanism that may explain the observed associations between disability status and contraceptive use among young women with disabilities. STUDY DESIGN Using the 2011-2017 National Survey of Family Growth, we analyzed data from 2861 women aged 18 to 24 years, who experienced voluntary first sexual intercourse with a male partner. Women whose first intercourse was involuntary (7% of all women reporting sexual intercourse) were excluded from the analytic sample. Mediation analysis was used to estimate the indirect effect of receipt of formal sex education before first sexual intercourse on the association between disability status and contraceptive use at first intercourse. RESULTS Compared to nondisabled women, women with cognitive disabilities were less likely to report receipt of instruction in each of 6 discrete formal sex education topics and received instruction on a fewer number of topics overall (B = -0.286, 95% CI = -0.426 to -0.147), prior to first voluntary intercourse. In turn, the greater number of topics received predicted an increased likelihood of contraceptive use at first voluntary intercourse among these women (B = 0.188, 95% CI = 0.055-0.321). No significant association between noncognitive disabilities and receipt of formal sex education or contraceptive use at first intercourse was observed. CONCLUSIONS Given the positive association between formal sex education and contraceptive use among young adult women with and without disabilities, ongoing efforts to increase access to formal sex education are needed. Special attention is needed for those women with cognitive disabilities.
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Affiliation(s)
- Eun Ha Namkung
- Lurie Institute for Disability Policy, Heller School for Social Policy & Management, Brandeis University, Waltham, MA, United States.
| | - Anne Valentine
- Lurie Institute for Disability Policy, Heller School for Social Policy & Management, Brandeis University, Waltham, MA, United States
| | - Lee Warner
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Monika Mitra
- Lurie Institute for Disability Policy, Heller School for Social Policy & Management, Brandeis University, Waltham, MA, United States
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Tarasoff LA, Lunsky Y, Chen S, Guttmann A, Havercamp SM, Parish SL, Vigod SN, Carty A, Brown HK. Preconception Health Characteristics of Women with Disabilities in Ontario: A Population-Based, Cross-Sectional Study. J Womens Health (Larchmt) 2020; 29:1564-1575. [PMID: 32678692 DOI: 10.1089/jwh.2019.8273] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: There is growing recognition that preconception health, defined as the health of all reproductive-age individuals, impacts reproductive and perinatal outcomes. Although women with disabilities are becoming pregnant at increasing rates, little is known about their preconception health. Our objective was to describe the preconception health characteristics of women with physical, sensory, and intellectual/developmental disabilities and compare these characteristics with women without disabilities. Materials and Methods: We conducted a population-based cross-sectional study of 15- to 44-year-old women with physical (n = 253,184), sensory (n = 93,170), intellectual/developmental (n = 8,986), and multiple disabilities (n = 29,868), and women without these disabilities (n = 2,307,822) using Ontario health administrative data (2017-2018). We described preconception health variables related to social determinants of health, physical health status, psychosocial well-being, history of assault, medication use, and continuity of primary care and compared women with and without disabilities in crude and age-standardized analyses, with standardized differences >0.10 indicating clinically meaningful results. Results: Women with physical, sensory, intellectual/developmental, and multiple disabilities had poorer preconception health than women without disabilities. Disparities were pronounced for physical health status, psychosocial well-being, use of potentially teratogenic medications, and history of assault. Of all groups, women with intellectual/developmental disabilities had the greatest disparities. Conclusion: Further research is needed to identify contributors to poor preconception health among women with disabilities and to develop tailored preconception health interventions to meet their unique needs and experiences.
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Affiliation(s)
- Lesley A Tarasoff
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Scarborough, Canada.,Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada
| | | | - Astrid Guttmann
- ICES, Toronto, Canada.,Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Susan L Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Women's College Hospital and Research Institute, Toronto, Canada
| | - Adele Carty
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Hilary K Brown
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Scarborough, Canada.,ICES, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Women's College Hospital and Research Institute, Toronto, Canada
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13
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Horner-Johnson W, Dissanayake M, Wu JP, Caughey AB, Darney BG. Pregnancy Intendedness by Maternal Disability Status and Type in the United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2020; 52:31-38. [PMID: 32096336 DOI: 10.1363/psrh.12130] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/20/2019] [Accepted: 09/24/2019] [Indexed: 05/07/2023]
Abstract
CONTEXT Societal views about sexuality and parenting among people with disabilities may limit these individuals' access to sex education and the full range of reproductive health services, and put them at increased risk for -unintended pregnancies. To date, however, no national population-based studies have examined pregnancy -intendedness among U.S. women with disabilities. METHODS Cross-sectional analyses of data from the 2011-2013 and 2013-2015 waves of the National Survey of Family Growth were conducted; the sample included 5,861 pregnancies reported by 3,089 women. The proportion of pregnancies described as unintended was calculated for women with any type of disability, women with each of five types of disabilities and women with no disabilities. Multivariate logistic regression analyses were conducted to examine the relationship of disability status and type with pregnancy intendedness while adjusting for covariates. RESULTS A higher proportion of pregnancies were unintended among women with disabilities than among women without disabilities (53% vs. 36%). Women with independent living disability had the highest proportion of unintended pregnancies (62%). In regression analyses, the odds that a pregnancy was unintended were greater among women with any type of disability than among women without disabilities (odds ratio, 1.4), and were also elevated among women with hearing disability, cognitive disability or independent living disability (1.5-1.9). CONCLUSIONS Further research is needed to understand differences in unintended pregnancy by type and extent of disability. People with disabilities should be fully included in sex education, and their routine care should incorporate discussion of reproductive planning.
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Affiliation(s)
- Willi Horner-Johnson
- Institute on Development and Disability, Oregon Health & Science University, Portland
| | - Mekhala Dissanayake
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Justine P Wu
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Blair G Darney
- Department of Obstetrics and Gynecology-all at the Oregon Health & Science University, Portland
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Crabb C, Owen R, Heller T. Female Medicaid Enrollees with Disabilities and Discussions with Health Care Providers About Contraception/Family Planning and Sexually Transmitted Infections. SEXUALITY AND DISABILITY 2019. [DOI: 10.1007/s11195-019-09599-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wu J, Zhang J, Mitra M, Parish SL, Minama Reddy GK. Provision of Moderately and Highly Effective Reversible Contraception to Insured Women With Intellectual and Developmental Disabilities. Obstet Gynecol 2019; 132:565-574. [PMID: 30095771 DOI: 10.1097/aog.0000000000002777] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate provision of moderately and highly effective reversible contraceptives to women with intellectual and developmental disabilities. METHODS We used data from the Massachusetts All-Payer Claims Database to identify women aged 15-44 years with and without intellectual and developmental disabilities who were continuously enrolled in a private commercial insurance plan, Medicaid, or Medicare in 2012. We calculated the percentage of women aged 15-44 years who were not medically or surgically sterile and were provided 1) highly effective, long-acting reversible contraception (LARC, the intrauterine device or subdermal implant); or 2) prescriptions for moderately effective methods (pill, patch, ring, shot, or diaphragm). Logistic regression models estimated the odds of LARC and moderately effective method provision by disability status, adjusted for age, income, and Medicaid receipt. RESULTS Among 915,561 women who were not medically or surgically sterile, 13,059 women (1.4%) had at least one intellectual and developmental disability. Women with intellectual and developmental disabilities were less likely to be provided LARC (2.1% vs 4.2%, P<.001, adjusted odds ratio [OR] 0.43, 95% CI 0.38-0.48, P<.001) and moderately effective methods (21.1% vs 29.9%, P<.001, adjusted OR 0.68, 95% CI 0.65-0.71, P<.001) than women without intellectual and developmental disabilities. The one exception was the progestin shot, which was provided more often to women with intellectual and developmental disabilities than women without these disabilities (14.7% vs 4.3%, P<.001). Among a subset of women who only received moderately effective methods or LARC (n=310,344), women with intellectual and developmental disability had lower odds of receiving LARC than moderately effective methods (adjusted OR 0.59, 95% CI 0.52-0.67). CONCLUSION The study findings raise concerns that the provision of LARC and moderately effective methods differs based on the presence of intellectual and developmental disabilities. Greater understanding is needed regarding factors that underlie lower provision of LARC in comparison with moderately effective methods, especially the progestin shot, among women with intellectual and developmental disabilities.
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Affiliation(s)
- Justine Wu
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; the Lurie Institute for Disability Policy, Brandeis University, Waltham, and the Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts; and Mt. Sinai Downtown Residency in Urban Family Medicine, New York, New York
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16
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Wu J, Braunschweig Y, Harris LH, Horner-Johnson W, Ernst SD, Stevens B. Looking back while moving forward: a justice-based, intersectional approach to research on contraception and disability. Contraception 2019; 99:267-271. [DOI: 10.1016/j.contraception.2019.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/11/2019] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
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17
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Horner-Johnson W, Moe EL, Stoner RC, Klein KA, Edelman AB, Eden KB, Andresen EM, Caughey AB, Guise JM. Contraceptive knowledge and use among women with intellectual, physical, or sensory disabilities: A systematic review. Disabil Health J 2019; 12:139-154. [DOI: 10.1016/j.dhjo.2018.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/01/2018] [Accepted: 11/03/2018] [Indexed: 01/08/2023]
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18
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Mosher W, Hughes RB, Bloom T, Horton L, Mojtabai R, Alhusen JL. Contraceptive use by disability status: new national estimates from the National Survey of Family Growth. Contraception 2018; 97:552-558. [PMID: 29596784 PMCID: PMC6071327 DOI: 10.1016/j.contraception.2018.03.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 03/17/2018] [Accepted: 03/19/2018] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- William Mosher
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA 21205.
| | - Rosemary B Hughes
- University of Montana Rural Institute for Inclusive Communities, 52 Corbin Hall, Missoula, MT, USA 59812.
| | - Tina Bloom
- University of Missouri Sinclair School of Nursing, S421 Sinclair School of Nursing, Columbia, MO, USA 65211.
| | - Leah Horton
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA 21205
| | - Ramin Mojtabai
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA 21205
| | - Jeanne L Alhusen
- University of Virginia School of Nursing, Post Office Box 800782, Charlottesville, Virginia, USA 22908
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19
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Haynes RM, Boulet SL, Fox MH, Carroll DD, Courtney-Long E, Warner L. Contraceptive use at last intercourse among reproductive-aged women with disabilities: an analysis of population-based data from seven states. Contraception 2017; 97:538-545. [PMID: 29253580 DOI: 10.1016/j.contraception.2017.12.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 12/04/2017] [Accepted: 12/08/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess patterns of contraceptive use at last intercourse among women with physical or cognitive disabilities compared to women without disabilities. STUDY DESIGN We analyzed responses to 12 reproductive health questions added by seven states to their 2013 Behavioral Risk Factor Surveillance System questionnaire. Using responses from female respondents 18-50 years of age, we performed multinomial regression to calculate estimates of contraceptive use among women at risk for unintended pregnancy by disability status and type, adjusted for age, race/ethnicity, marital status, education, health insurance status, and parity. RESULTS Women with disabilities had similar rates of sexual activity as women without disabilities (90.0% vs. 90.6%, p=.76). Of 5995 reproductive-aged women at risk for unintended pregnancy, 1025 (17.1%) reported one or more disabilities. Contraceptive use at last intercourse was reported by 744 (70.1%) of women with disabilities compared with 3805 (74.3%) of those without disabilities (p=.22). Among women using contraception, women with disabilities used male or female permanent contraception more often than women without disabilities (333 [29.6%] versus 1337 [23.1%], p<.05). Moderately effective contraceptive (injection, oral contraceptive, patch, or ring) use occurred less frequently among women with cognitive (13.1%, n=89) or independent living (13.9%, n=40) disabilities compared to women without disabilities (22.2%, n=946, p<.05). CONCLUSIONS The overall prevalence of sexual activity and contraceptive use was similar for women with and without physical or cognitive disabilities. Method use at last intercourse varied based on presence and type of disability, especially for use of permanent contraception. IMPLICATIONS Although women with disabilities were sexually active and used contraception at similar rates as women without disabilities, contraception use varied by disability type, suggesting the importance of this factor in reproductive health decision-making among patients and providers, and the value of further research to identify reasons why this occurs.
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Affiliation(s)
- Renee Monique Haynes
- Satcher Health Leadership Institute, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310.
| | - Sheree L Boulet
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, MS F-74, Atlanta, GA 30341.
| | - Michael H Fox
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, Mailstop E-88, Atlanta, GA 30341-3717
| | - Dianna D Carroll
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, Mailstop E-88, Atlanta, GA 30341-3717; Commissioned Corps, U.S. Public Health Service, Atlanta, GA
| | - Elizabeth Courtney-Long
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, Mailstop E-88, Atlanta, GA 30341-3717
| | - Lee Warner
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, MS F-74, Atlanta, GA 30341
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