‘I have the jab so I can't be blamed for getting pregnant’: Contraception and women with learning disabilities

Abstract

The aim of this research was to investigate whether, and to what extent, women with learning disabilities were enabled to exercise choice and control when it came to their use of contraception. Semi-structured in-depth interviews were conducted with 23 women with learning disabilities in the UK to explore these issues. Findings suggest that most women with learning disabilities did not make their own decisions and some of those who did, found their choices constrained by various factors, such as their young age, fears of losing their service, and previous traumatic experiences. The over-use of Depo-Provera is discussed, as are the common practices of giving contraception to women who are not sexually active and those whose fertility has declined naturally due to their age. The factors which lead to women's relative lack of autonomy are explored.

Contraceptive choices for women with learning disabilities

“…28 per cent of respondents said that contraception was required because the women concerned were sexually active, in 15 per cent of cases there was an expectation that that the women would become sexually active, whilst a fear of pregnancy and the need to manage menstruation were cited in 31 and 17 per cent of cases respectively. These figures from third parties appear to confirm McCarthy's (2009aMcCarthy's ( , 2009bMcCarthy's ( , 2010 earlier findings that contraception is frequently used 'just in case' without a clear clinical or social rationale for the benefits . 21 responses from the online survey were from third parties with involvement in contraceptive decision-making with women with high support needs.…”

“…This applies to starting contraceptive use, duration of use and deciding to discontinue (McCarthy, 2009a;2009b). Instead they report that decisions are imposed on them (Rowlands, 2011).…”

“…Although there has been considerable research into issues concerning parents with learning disabilities (see Llewellyn et al, 2010 for a comprehensive overview of this literature), in the UK, aside from the work of a few (see for example McCarthy, 2009a;2009b;2010a;2010b;Stansfield, 2007;Stansfield et al, 2007;Rowlands, 2011) far less attention has been paid to the question of how learning disabled women's reproductive capacity is managed , and the associated processes of contraceptive decision-making. Contraceptive decision-making with women who have high support needs remains particularly under-researched (McCarthy, 2010: 294).…”

Contraceptive decision-making and women with learning disabilities

“…They take contraception when they are not sexually active, in case they become pregnant; to manage menstruation (Carlson and Wilson, 1994;McCarthy, 2009a); and, disturbingly, to protect against abuse (McCarthy, 2009b;Chou and Lu, 2011;WHO, 2014). They are, as…”

“…This applies to starting contraceptive use, duration of use and deciding to discontinue (McCarthy, 2009a;2009b). learning disabilities, and present findings from a small scale, UK-based survey that invited third parties involved in supporting women with learning disabilities with contraceptive decisionmaking to share their views and experiences.…”