Contraceptive and Pregnancy Decision-Making Autonomy and Health Care Experiences Among Women With Intellectual Disabilities.
Women with ID can guide their own birth-control choices if we slow down and speak plainly.
01Research in Context
What this study did
Vallury et al. (2025) talked with women who have intellectual disabilities. They asked how the women pick birth control or plan a pregnancy.
The team used long interviews. They wanted to know what helps and what blocks good choices.
What they found
The women could make smart choices when helpers gave clear facts. Yet many felt pushed into shots or pills they did not want.
Some were told they should never have babies. Others said doctors used big words and rushed the visit.
How this fits with other research
Bouck et al. (2016) saw the same push-and-pull with adults who have ID and diabetes. Choice was not yes-or-no; it was talked out day by day.
Houseworth et al. (2023) counted choices made by over 9,800 adults with IDD. Everyday choices like food or clothes went up, but big health choices stayed flat. The new study shows one reason why: the system talks over them.
Lotan et al. (2010) warned that respect must come first. Dee’s findings give real voices to that old warning.
Why it matters
You can fix this in your next health session. Use plain words, pictures, and extra time. Ask the woman what she wants before you ask the guardian. Write the plan in her own words and give her a copy. Small moves like these turn ethical slogans into real autonomy.
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02At a glance
03Original abstract
BACKGROUND: There is currently limited research exploring the extent to which women with an intellectual disability experience autonomy over contraception, pregnancy timing and pregnancy outcome decisions. Previous studies have highlighted inequities in sexual and reproductive health outcomes. However, barriers and facilitators of reproductive autonomy for women with an intellectual disability across the reproductive journey, including health care experiences, are poorly described; this is the focus of the current study. METHODS: Ten women with intellectual disabilities participated in focus groups or individual interviews where they discussed their experiences of accessing sexual and reproductive health services and making reproductive health decisions. Data were analysed using reflexive thematic analysis. RESULTS: Three themes elucidate how a lack of sexual and reproductive health information and violence impacted many participants' ability to control timing of conception and make informed pregnancy outcome decisions. The first theme describes contraceptive literacy as a barrier to reproductive autonomy. Most participants received no contraception or reproductive health education prior to their first pregnancy. While most women were aware of common forms of contraception and pregnancy options, their contraceptive knowledge was incomplete or incorrect. The second theme explores how most participants experienced agency over pregnancy outcome decisions, though informed decision-making was hampered by reproductive coercion and abuse, delayed pregnancy detection and insufficient information about all pregnancy options. The third theme identifies health professionals as pivotal in empowering reproductive agency and facilitating informed decision-making. CONCLUSIONS: Women with intellectual disabilities demonstrate the willingness and the ability to make informed and autonomous reproductive health decisions when appropriately supported with care and information. However, they face reproductive coercion and abuse and are often required to overcome numerous systemic challenges to assert their reproductive rights. Significant efforts are needed to better understand and address barriers to informed reproductive decision-making.
Journal of intellectual disability research : JIDR, 2025 · doi:10.1111/jir.13207