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Mitchell L, Vellanki B, Tang L, Hunter K, Finnegan A, Swartz JJ, Huchko M. Contraceptive Provision to Women With Intellectual and Developmental Disabilities Enrolled in Medicaid. Obstet Gynecol 2023; 142:1477-1485. [PMID: 38051293 PMCID: PMC10642699 DOI: 10.1097/aog.0000000000005421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/06/2023] [Accepted: 08/17/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE To compare contraceptive provision to women with and without intellectual and developmental disabilities enrolled in North Carolina Medicaid. METHODS Our retrospective cohort study used 2019 North Carolina Medicaid claims to identify women aged 15-44 years with and without intellectual and developmental disabilities at risk for pregnancy who were continuously enrolled during 2019 or had Family Planning Medicaid with at least one claim. We calculated the proportion in each cohort who received 1) most or moderately effective contraception, 2) long-acting reversible contraception, 3) short-acting contraception, and 4) individual methods. We classified contraceptive receipt by procedure type and disaggregated across sociodemographic characteristics. Adjusting for age, race, ethnicity, and urban or rural setting, we constructed logistic regression models to estimate most or moderately effective contraceptive provision odds by intellectual and developmental disability status and by level or type of intellectual and developmental disability. We performed subanalyses to estimate co-occurrence of provision and menstrual disorders. RESULTS Among 9,508 women with intellectual and developmental disabilities and 299,978 without, a significantly smaller proportion with intellectual and developmental disabilities received most or moderately effective contraception (30.1% vs 36.3%, P <.001). With the exception of injectable contraception, this trend was consistent across all measures and remained statistically significant after controlling for race, ethnicity, age, and urban or rural status (adjusted odds ratio 0.75, 95% CI 0.72-0.79; P <.001). Among those who received most or moderately effective contraception, a significantly greater proportion of women with intellectual and developmental disabilities had co-occurring menstrual disorders (31.3% vs 24.3%, P <.001). CONCLUSION These findings suggest disparities in contraceptive provision and potential differences in clinical indication by intellectual and developmental disability status. Future studies should investigate reasons for and barriers to contraceptive use among women with intellectual and developmental disabilities.
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Affiliation(s)
- Lauren Mitchell
- Duke Global Health Institute, the Sanford School of Public Policy, the Department of Political Science, Department of Obstetrics and Gynecology, and the Center for Global Reproductive Health, Duke University, Durham, and IntraHealth International, Chapel Hill, North Carolina
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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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de Mattos Leão T, Paula Soares RB, Capellari CA, Nisihara R. Gynecological Care for Women With Intellectual Disabilities: A Brazilian Study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2022:17446295221123871. [PMID: 36062387 DOI: 10.1177/17446295221123871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We aimed to identify the main challenges in the gynecological care and management of patients with intellectual disability by gynecologists. Gynecologists answered to online questionnaires about situations in which the professional reports their confidence in caring for patients with intellectual disability. Were studied 143 responses, 75% women. Among them, 53.8% felt apprehensive to conduct a routine gynecological screening, 60% were confident in advising about contraceptive services and examining the genitals. The greatest difficulty was indicating drugs to suppress menstruation and managing patients with severe intellectual disability. The female doctors were more prepared in the care of disability patients and recent certified gynecologists were more insecure. The main difficulty was time for examinations (39.2%) and the main solution was to improve medical training (64.2%). The main challenges of the gynecologist included the amount of time needed to provide clinical services, the lack of knowledge and skill; and ethical concerns.
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Affiliation(s)
| | | | | | - Renato Nisihara
- Post Graduate Program in Gynecology and Obstetrics, Federal University of Paraná, Curitiba, Brazil
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McConnell D, Phelan S. The devolution of eugenic practices: Sexual and reproductive health and oppression of people with intellectual disability. Soc Sci Med 2022; 298:114877. [PMID: 35276622 DOI: 10.1016/j.socscimed.2022.114877] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 11/28/2022]
Abstract
Early 20th century eugenicists propagated a system of ideas, values and dispositions that constituted adults with intellectual disability as the antithesis of the paradigmatic citizen, and a biological threat to society. The eugenic schema was encoded in sex-segregated institutionalization and, in many places, forced sterilization. These eugenic practices are no longer sanctioned. However, eugenic practices did not disappear. In this paper we argue that the eugenic schema is now encoded and purveyed through a multiplicity of social arrangements and practices that deny adults with intellectual disability the respect, opportunity and means necessary to participate on a par with others in social life. Such practices include, for example, covert or coerced contraception, and discriminatory child welfare interventions leading to high rates of custody deprivation. Drawing on relational theory, we problematize normative assumptions of embodiment and citizenship, which give rise to attributions of incapacity, and argue that adults with intellectual disability need what all other adults need to make and effect choices concerning their sexuality, relationships and parenthood, i.e., recognition, opportunity and support.
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Affiliation(s)
- David McConnell
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Canada.
| | - Shanon Phelan
- Faculty of Health, School of Occupational Therapy, Dalhousie University, Canada.
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Kirkpatrick L, Collins A, Harrison E, Miller E, Patterson C, Sogawa Y, Van Cott AC, Kazmerski TM. Pediatric Neurologists' Perspectives on Sexual and Reproductive Health Care for Adolescent and Young Adult Women With Epilepsy and Intellectual Disability. J Child Neurol 2022; 37:56-63. [PMID: 34657501 DOI: 10.1177/08830738211041824] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore perspectives of pediatric neurologists regarding sexual and reproductive health care for adolescent women with epilepsy (WWE) and intellectual disability. METHODS We interviewed pediatric neurologists regarding sexual and reproductive health for WWE with intellectual disability. We audio-recorded and transcribed interviews and conducted qualitative analysis. RESULTS 16 pediatric neurologists participated. Themes included the following: (1) Pediatric neurologists have differing perspectives about how intellectual disability affects WWE's sexual and reproductive health needs, (2) pediatric neurologists provide sexual and reproductive health counseling variable in content and frequency to this population, (3) pediatric neurologists tend to recommend longer-term methods of contraception for this population, and (4) pediatric neurologists are asked to be involved in decision-making around sterilization, yet express ethico-legal reservations. CONCLUSION Our findings suggest pediatric neurologists provide variable, often suboptimal, sexual and reproductive health care for WWE and intellectual disability. Themes reveal ethical concerns among neurologists about sexual and reproductive health practices including sterilization. More tailored clinical guidelines and provider training on sexual and reproductive health for this population may be beneficial.
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Affiliation(s)
- Laura Kirkpatrick
- Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Amy Collins
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,Allegheny Reproductive Health Center, Pittsburgh, PA, USA
| | - Elizabeth Harrison
- Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Christina Patterson
- Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Yoshimi Sogawa
- Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Anne C Van Cott
- Department of Neurology, UPMC Presbyterian Hospital, Pittsburgh, PA, USA.,Veterans Affairs Neurology Service, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Traci M Kazmerski
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, PA, USA
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Scime NV, Brown HK, Metcalfe A, Brennand EA. Prevalence of Hysterectomy by Self-Reported Disability Among Canadian Women: Findings from a National Cross-Sectional Survey. WOMEN'S HEALTH REPORTS 2021; 2:557-565. [PMID: 34909762 PMCID: PMC8665278 DOI: 10.1089/whr.2021.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/25/2022]
Abstract
Introduction: Our objective was to investigate differences in prevalence of hysterectomy by self-reported disability status among Canadian women. Materials and Methods: We analyzed cross-sectional data from the Canadian Community Health Survey 2012 on 30,170 women aged ≥20 years. Disability was defined as reports of sometimes or often (vs. never) experiencing functional limitations or reduction in daily activities at home, school, or work. Frequency of these limitations was used as a proxy for disability severity. The outcome was self-reported hysterectomy status. Modified Poisson regression was used to quantify the prevalence ratio (PR) and 95% confidence interval (CI) for hysterectomy according to any, functional, or activity-limiting disability, after adjustment for household income, employment, education, ethnicity, and marital status. Results were stratified by age at time of data collection, categorized as childbearing (20–44 years), perimenopausal (45–59 years), and postmenopausal (60 years and older). Results: Disability was significantly and consistently associated with higher prevalence of hysterectomy in women. The strength of association was inversely related to age category, and PRs for a given age category were similar across disability types and severity levels. PRs for the association between any disability and hysterectomy were 2.18 (95% CI 1.36–3.50) for childbearing-aged women, 1.48 (95% CI 1.21–1.80) for perimenopausal women, and 1.12 (95% CI 1.02–1.24) for postmenopausal women. Conclusions: Prevalence of hysterectomy is disproportionately higher among women with self-reported disabilities compared with women without disabilities, with these differences most pronounced in women of childbearing age.
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Affiliation(s)
- Natalie V. Scime
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Hilary K. Brown
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Erin A. Brennand
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada
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Powell RM, Parish SL, Mitra M, Rosenthal E. Role of family caregivers regarding sexual and reproductive health for women and girls with intellectual disability: A scoping review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:131-157. [PMID: 31808223 PMCID: PMC9016753 DOI: 10.1111/jir.12706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/10/2019] [Accepted: 11/15/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND While people with intellectual disability (ID) face disparities relating to sexual and reproductive health (SRH) services, little is known about the role of family caregivers who assist women and girls with ID access SRH services. This scoping review examined the findings of studies to elucidate the role of family caregivers with regard to SRH for women and girls with ID. METHOD We used Arksey and O'Malley's six-stage scoping framework, with Levac, Colquhoun and O'Brien's revisions, to evaluate identified sources. We searched three electronic databases, six ID journals and reference lists in full-text articles. Inclusion criteria included (1) primary and secondary source research studies in peer-reviewed journals; (2) published in English; (3) all research methodologies (i.e. qualitative, quantitative, mixed methods and systematic reviews or commentaries); (4) published between 2000 and 2016; and (5) studies from any country. RESULTS The search yielded 2062 studies; 57 articles met inclusion criteria. Most studies employed purposive, convenience or criterion sampling. Participants included people with ID, family caregivers, paid caregivers and health-care professionals. Findings were summarised thematically: (1) menstruation and menopause; (2) vaccinations and preventive screenings; (3) supporting sexuality and healthy relationships; (4) coordinating with health-care providers and (5) contraception and sterilisation. CONCLUSIONS Findings from this scoping review underscore the need for more and better-quality research, including how family caregivers assist women and girls with ID access perinatal and preventive SRH services and sexual abuse education. Family caregivers, women and girls with ID and health-care providers need increased access to information about SRH.
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Affiliation(s)
- R M Powell
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - S L Parish
- The College of Health Professions, Virginia Commonwealth University, Richmond, Virginia
| | - M Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - E Rosenthal
- School Psychology, College of Education, Lehigh University Bethlehem, Pennsylvania
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Gupta R, Brown HK, Barker LC, Dennis CL, Vigod SN. Rapid repeat pregnancy in women with schizophrenia. Schizophr Res 2019; 212:86-91. [PMID: 31420202 DOI: 10.1016/j.schres.2019.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/31/2019] [Accepted: 08/03/2019] [Indexed: 01/14/2023]
Abstract
AIM Women with schizophrenia are vulnerable to adverse reproductive health outcomes. Short inter-pregnancy interval, or rapid repeat pregnancy, is associated with maternal and infant complications, and may be preventable. Whether women with schizophrenia are at disproportionate risk for rapid repeat pregnancy is unknown. METHODS This population-based cohort study in Ontario, Canada (2002-2013) compared women with and without schizophrenia on their risk of rapid repeat pregnancy, defined as pregnancy within 12 months of an index live birth. Among women with public drug coverage, those with and without schizophrenia were compared on their use of non-barrier contraception (hormonal and surgical) post-delivery. RESULTS Women with schizophrenia (n = 1565) were at higher risk for rapid repeat pregnancy than women without schizophrenia (n = 924,657) (6.3% vs. 3.9%, adjusted relative risk, aRR 1.31, 95% confidence interval, CI, 1.07-1.59). They had more rapid repeat pregnancies resulting in live births (aRR 1.85, 95% CI 1.26-2.72), but not pregnancy losses (aRR 1.50, 95% CI 0.99-2.29) or induced abortions (aRR 1.07, 95% CI 0.81-1.42). Post-delivery non-barrier contraception use was similar between groups (43.7% vs. 43.6%, aRR 1.06, 95% CI 0.93-1.20), although women with schizophrenia were more likely to use injectable contraception (14.1% vs. 10.1%, aRR 1.67, 95% CI 1.35-2.07). DISCUSSION Women with schizophrenia are at higher risk than their peers for rapid repeat pregnancy, but use non-barrier contraception at similar rates. The postnatal period is an opportune time to initiate targeted interventions designed to optimize planning for any future pregnancies, and contribute to improving maternal and child health in this vulnerable group.
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Affiliation(s)
- Renu Gupta
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Hilary K Brown
- ICES, Toronto, Canada; Dalla Lana School of Public Health, Interdisciplinary Centre for Health & Society, University of Toronto, Toronto, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Lucy C Barker
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Cindy-Lee Dennis
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; Faculty of Nursing, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Simone N Vigod
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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