Written by Liza Brecher
Contraception for people with disabilities, including physical and cognitive disabilities, is similar to contraception for people without disabilities. Clinicians should discuss patient’s goals for pregnancy, parenting, and overall health to identify the contraceptive method that works best for each person. Most patients with disabilities are able to provide informed consent. Avoid making incorrect assumptions about a patient’s needs and capabilities by asking patients what their own preferences, needs, and goals are. The goal of this article is to empower clinicians to discuss contraception with patients with disabilities just as they do with all other patients.
While discrete categories of disabilities (such as physical, cognitive, behavioral, intellectual, developmental) are not specifically discussed in US Medical Eligibility Criteria for Contraceptive Use (MEC), the guide helps identify appropriate contraceptive options for people with specific medical conditions.
Prolonged immobility is discussed in the US-MEC as a relative contraindication to estrogen use. While people who use wheelchairs may have limited mobility, wheelchair use is not a proxy for prolonged immobility. The activity level of each patient should be assessed on a case-by-case basis.
Seizure disorders and other conditions that necessitate the use of anti-epileptic drugs (AED) disproportionately affect people with intellectual and developmental disabilities. The US-MEC provides guidance related to specific AEDs and separately, lamotrigine.
There is limited evidence that DMPA may decrease seizure frequency. DMPA can also lead to menstrual suppression, which may be desired or acceptable to some patients and their caregivers.
When discussing contraception care with patients who have physical, intellectual, developmental, or other disabilities, it is vital that the patient be empowered to make their own decisions. For patients who aren’t able to communicate their decisions independently, clinicians should work closely with guardians and caregivers to understand the patient’s needs and uphold their reproductive and bodily autonomy.
There’s a wide range of diversity among people with disabilities and a lot of important nuances that clinicians should take into consideration. This year, we hope to bring you more pearls on contraception care for people with disabilities.
The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.