Reproductive health of women with intellectual disability: antenatal care, pregnancies and outcomes in the Dutch population.
More clinic visits did not protect Dutch women with ID from higher pregnancy loss—add explicit decision-making support to every reproductive-health goal.
01Research in Context
What this study did
The Dutch team tracked every woman with intellectual disability (ID) in the national medical register. They counted contraceptive visits, pregnancies, and pregnancy endings for 2008-2018. Each woman with ID was matched to four same-age women without ID for comparison.
What they found
Women with ID visited doctors for birth control 1.7 times more often than other women. They also got pregnant slightly more often. Yet their chance of losing the pregnancy was a large share higher. More contraceptive care did not shield them from worse outcomes.
How this fits with other research
Arana et al. (2019) saw a similar gap in breast-cancer screening: women with ID still get fewer mammograms even when they use more general services. The pattern repeats—more contacts, but not the right ones.
Rojahn et al. (2012) showed one computer lesson can grow HIV and condom knowledge in women with mild-moderate ID. Their small trial proves women can learn when teaching fits their needs. Diemer et al. (2023) now shows the Dutch system is still missing that tailored piece.
Perry et al. (2024) scoping review finds cancer awareness is low across adults with ID, carers, and doctors. Together the papers point to the same hole: services grow in number, not in disability-friendly content.
Why it matters
You can write a goal for decision-making support, not just contraception. Ask, “Can she explain her birth-control plan in her own words?” If not, add visuals, role-play, or teach-back. One extra teaching step may turn a routine visit into real protection.
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Join Free →During the next ISP review, add a task analysis for the client to state her contraceptive method and why she uses it—use pictures or role-play if needed.
02At a glance
03Original abstract
BACKGROUND: Research in a handful of countries found that women with intellectual disability (ID) faced barriers and risks regarding antenatal care and reproductive health. This study tested disparities between women in the Netherlands with and without ID in antenatal care, pregnancy rates and pregnancy outcomes. METHODS: Secondary analyses on the large representative panel of primary health patients in the Netherlands by the Netherlands Institute for Health Services Research (NIVEL) compared women in their reproductive age (18-49 years) with (n = 2397) and without (n = 228 608) indicators of ID. Bias due to underreporting and under-identification was reduced by linkage with an index of ID for the total Dutch population from Statistical Netherlands. RESULTS: Women with ID were more likely to receive contraceptive care [95% confidence interval (CI) for odds ratio (OR) = 1.37-1.61] and became somewhat more often pregnant (95% CI OR = 1.06-2.30) than women from the general population, adjusting for age difference and follow-up time. No statistical differences were found in medical complications during pregnancy, delivery and immediately after birth, but women with indicators of ID had a higher risk of losing their pregnancy, including through induced abortion (95% CI OR = 1.26-1.99). CONCLUSIONS: Women with ID have specific needs around contraceptive care and risks around their pregnancy that may require more awareness among practitioners and better understanding of the processes of care and decision-making.
Journal of intellectual disability research : JIDR, 2023 · doi:10.1111/jir.12982