Early View

Contraceptive Provision to Postpartum Women With Intellectual and Developmental Disabilities: A Population‐Based Cohort Study

CONTEXT

Women with intellectual and developmental disabilities who experience pregnancy, like all women, require postpartum care that supports their contraceptive knowledge and decision making. Yet, little is known about the postpartum contraceptive care these women receive, or how it compares with care given to other women.

METHODS

A population‐based study using linked health and social services administrative data examined provision of postpartum contraceptive care to women who had a live birth in Ontario, Canada, in 2002–2014 and were beneficiaries of Ontario's publicly funded drug plan. Modified Poisson regression was used to compare care between 1,181 women with and 36,259 women without intellectual and developmental disabilities. Outcomes were provision of any nonbarrier contraceptive in the year following the birth and type of method provided.

RESULTS

In the first year postpartum, women with intellectual and developmental disabilities were provided with contraceptives at a higher rate than were other women (relative risk 1.3); the difference was significant for both nonsurgical and surgical methods (1.2 and 1.8, respectively). The higher rate of nonsurgical contraceptive provision was explained by provision of injectables (1.9); there were no differences for pills or IUDs.

CONCLUSION

Nonbarrier contraceptives may be the most appropriate methods for some women with intellectual and developmental disabilities. However, future research should investigate why women with such disabilities are more likely than others to receive injectable contraceptives, which have possible negative side effects, and surgical contraception, which is irreversible. Research also should investigate how these women perceive their participation in contraceptive decision making.

Authors' Affiliations

Hilary K. Brown is assistant professor, Interdisciplinary Centre for Health and Society, University of Toronto Scarborough, and Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario. Yolanda A. Kirkham is assistant professor, Department of Gynecology, Women’s College Hospital, Toronto. Yona Lunsky is professor, Centre for Addiction and Mental Health, and ICES, Toronto. Virginie Cobigo is associate professor, School of Psychology, University of Ottawa, and ICES, Ottawa, Ontario. Simone N. Vigod is associate professor, Women’s College Research Institute, Women’s College Hospital, and ICES, Toronto.

Disclaimer
The views expressed in this publication do not necessarily reflect those of the Guttmacher Institute.

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