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Provision of Moderately and Highly Effective Reversible Contraception to Insured Women With Intellectual and Developmental Disabilities

Wu, Justine, MD, MPH; Zhang, Jianying, MPH, MSc; Mitra, Monika, PhD; Parish, Susan L., PhD, MSW; Minama Reddy, Geeth Kavya, MD

doi: 10.1097/AOG.0000000000002777
Contraception: Original Research: PDF Only

OBJECTIVE: To estimate provision of moderately and highly effective reversible contraceptives to women with intellectual and developmental disabilities.

METHODS: We used data from the Massachusetts All-Payer Claims Database to identify women aged 15–44 years with and without intellectual and developmental disabilities who were continuously enrolled in a private commercial insurance plan, Medicaid, or Medicare in 2012. We calculated the percentage of women aged 15–44 years who were not medically or surgically sterile and were provided 1) highly effective, long-acting reversible contraception (LARC, the intrauterine device or subdermal implant); or 2) prescriptions for moderately effective methods (pill, patch, ring, shot, or diaphragm). Logistic regression models estimated the odds of LARC and moderately effective method provision by disability status, adjusted for age, income, and Medicaid receipt.

RESULTS: Among 915,561 women who were not medically or surgically sterile, 13,059 women (1.4%) had at least one intellectual and developmental disability. Women with intellectual and developmental disabilities were less likely to be provided LARC (2.1% vs 4.2%, P<.001, adjusted odds ratio [OR] 0.43, 95% CI 0.38–0.48, P<.001) and moderately effective methods (21.1% vs 29.9%, P<.001, adjusted OR 0.68, 95% CI 0.65–0.71, P<.001) than women without intellectual and developmental disabilities. The one exception was the progestin shot, which was provided more often to women with intellectual and developmental disabilities than women without these disabilities (14.7% vs 4.3%, P<.001). Among a subset of women who only received moderately effective methods or LARC (n=310,344), women with intellectual and developmental disability had lower odds of receiving LARC than moderately effective methods (adjusted OR 0.59, 95% CI 0.52–0.67).

CONCLUSION: The study findings raise concerns that the provision of LARC and moderately effective methods differs based on the presence of intellectual and developmental disabilities. Greater understanding is needed regarding factors that underlie lower provision of LARC in comparison with moderately effective methods, especially the progestin shot, among women with intellectual and developmental disabilities.

Women with intellectual and developmental disabilities are less likely to be provided moderately effective and highly effective reversible contraceptive methods than women without intellectual and developmental disabilities.

Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; the Lurie Institute for Disability Policy, Brandeis University, Waltham, and the Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts; and Mt. Sinai Downtown Residency in Urban Family Medicine, New York, New York.

Corresponding author: Justine Wu, MD, MPH, University of Michigan Department of Family Medicine, 1018 Fuller Street, Ann Arbor, MI 48104; email: justinep@med.umich.edu.

Justine Wu receives support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) under award number 1K23HD084744-01A1. Three of the authors (J.Z., M.M., S.L.P.) receive support from the NICHD of the National Institutes of Health under Award Number R01HD082105. This publication was also made possible by Grant Number R40MC30754 from the Health Resources and Services Administration), an operating division of the U.S. Department of Health and Human Services. Its contents are solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the Health Resources and Services Administration, or the U.S. Department of Health and Human Services. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review and approval of the manuscript; or decision to submit the manuscript for publication.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received March 19, 2018

Received in revised form May 11, 2018

Accepted May 24, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.