Contraception use in women with intellectual disability: a retrospective cohort study.

INTRODUCTION: Women with intellectual disability often have limited knowledge and decision-making input regarding their contraception use. This study aimed to examine and compare the prevalence of any and specific contraceptive use in women with intellectual disability and matched comparators.

METHODS: This was a retrospective, population-based, cohort study of women with intellectual disability and matched comparators aged 15-49 years in New South Wales, Australia in 2001-2018 using linked administrative datasets. Outcomes included overall and annual prevalence of any and specific contraceptive use calculated using person-years. We used a generalised linear model to examine the association between intellectual disability status and any contraceptive use.

RESULTS: Women with intellectual disability were slightly more likely to use contraception overall (26.8% vs 23.9%), with different patterns of prevalence by age. The contraceptive pill accounted for 48.9% of overall contraceptive use in women with intellectual disability and 58.1% in comparators. Contraceptive injection showed increased prevalence in women with intellectual disability (20.4% vs 4.8%), while hormonal intrauterine device use showed decreased prevalence (11.2% vs 18.3%). Annual prevalence graphs showed a larger increase in contraceptive implant use in women with intellectual disability over time. The model showed a significant association between intellectual disability and any contraception use after controlling for covariates (relative rate 1.15, 95% CI 1.12 to 1.17).

CONCLUSIONS: The tendency towards contraceptives that require minimal active management may reduce opportunities for decision-making involvement. We recommend the development of better information and support for women with intellectual disability to enable access to a wider range of contraceptive options and achieve greater agency in reproductive health.