Women with learning disabilities left out of contraception decisions

By Sarah Guy, medwireNews Reporter

Women with learning disabilities are frequently left out of decisions concerning contraception, and often use contraceptives despite not being sexually active, show the results of a UK survey.

Just over a third of women included in the survey had been assessed under the UK Mental Capacity Act 2005 regarding contraception decisions, indicating that the Act's strictures are not being implemented in full, say the researchers.

The findings also reveal that the most common form of contraception used in this population is the contraceptive implant, which must be reviewed regularly among women who may not be able to communicate their symptoms easily in the case of possible side effects, suggests the team.

"While it is understandable that family members and staff want to prevent women with learning disabilities from becoming pregnant inappropriately, these women should be involved in decisions about their reproduction and medication," write Liz Tilley (Open University, Milton Keynes) and colleagues in Learning Disability Practice.

The team distributed an online survey to family members, advocates, and staff who work with UK women with learning disabilities and received 90 responses.

The matter of contraception was only raised by the women themselves in 15% of cases; residential support staff brought it up most commonly, show the results. The most frequent reasons given for women needing contraception were a fear that they would get pregnant (31%), and the need to manage menstruation (17%).

The contraceptive implant and combined contraceptive pill were the most common forms of contraception prescribed, at 46% and 24%, respectively.

A total of 28% of respondents stated that contraception was necessary because the woman concerned was sexually active, while a further 15% expected that the woman would become so.

This finding confirms previous research which shows that "contraception is frequently used by women with learning disabilities 'just in case'," say Tilley and co-investigators.

Overall, formal Mental Capacity Act assessments were completed in just 32% of women covered by the survey, and 62% of women were entirely left out of discussions about which contraceptive time to use. General practitioners were the second most common decision-makers after the women, at 23%, followed by the women's mothers, at 16%.

The authors are planning a separate, accessible version of the survey for women with learning disabilities to complete, focusing on their specific experiences.

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