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

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.

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.

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).

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.