The use of contraception by women with intellectual disabilities.

The team mailed short surveys to 234 women living in Dutch residential homes. All women had an intellectual disability. Staff filled out the form about each woman’s contraceptive use.

They asked what method the woman used and why it was chosen. The survey took five minutes. No medical exams were done.

Forty-eight percent of the women used some form of birth control. Most picked hormonal pills or implants. The top reason was heavy or painful periods. The second reason was behavior concerns during menstruation. Pregnancy prevention came third.

Age and level of disability did not change the method chosen.

McIntyre et al. (2002) saw the same pattern in Belgium nine years earlier. They also found that staff rules, not health needs, decided who got contraception. The new Dutch numbers are slightly higher, showing the trend is steady.

Diemer et al. (2023) moved beyond the facility walls. They tracked every Dutch woman with ID who used health insurance. These women visited gynecologists more often, yet still had higher rates of miscarriage. Together the three papers draw a line: women with ID get contraception mainly to manage periods and behavior, but once they seek pregnancy they face extra risk.

Tassé et al. (2013) interviewed women with ID about sex. Most said they avoided it because they were scared. This fear matches the low pregnancy focus seen in the survey data.

If you write behavior plans for teen or adult women with ID, ask about period-related problem behavior first. A simple referral for menstrual suppression may cut aggression or self-injury faster than a new token system. Also flag any future pregnancy plans early so the medical team can add extra prenatal monitoring.