Assistant professor, Departments of Family Medicine and Obstetrics and Gynecology, The University of Michigan, Ann Arbor.
Research fellow, Department of Family Medicine, The University of Michigan, Ann Arbor.
Perspect Sex Reprod Health. 2017 Sep;49(3):141-147. doi: 10.1363/psrh.12031. Epub 2017 May 17.
Women with disabilities experience a higher rate of adverse pregnancy outcomes than women without disabilities. Preventing or delaying pregnancy when that is the best choice for a woman is a critical strategy to reducing pregnancy-related disparities, yet little is known about current contraceptive use among women with disabilities.
A cohort of 545 reproductive-age women with physical disabilities (i.e., difficulty walking, climbing, dressing or bathing) or sensory disabilities (i.e., difficulty with vision or hearing) was identified from among participants in the 2011-2013 National Survey of Family Growth. Those at risk for unplanned pregnancy were categorized by whether they were using highly effective reversible contraceptive methods (IUD, implant), moderately effective ones (pill, patch, ring, injectable), less effective ones (condoms, withdrawal, spermicides, diaphragm, natural family planning) or no method. Multinomial regression was conducted to examine the association between disability and type of contraceptive used.
Some 39% of women with disabilities were at risk of unplanned pregnancy, and 27% of those at risk were not using contraceptives. The presence of disability was associated with decreased odds of using highly effective methods or moderately effective methods, rather than less effective ones (odds ratio, 0.6 for each), but had no association with using no method.
There is a significant need to reduce contraceptive disparities related to physical or sensory disabilities. Future research should explore the extent to which contraceptive use differs by type and severity of disability, as well as identify contextual factors that contribute to any identified differences.
与非残疾女性相比，残疾女性的不良妊娠结局发生率更高。对于女性而言，选择最佳时机预防或延迟妊娠是减少妊娠相关差异的关键策略，但目前对于残疾女性的避孕措施使用情况知之甚少。
从 2011-2013 年全国家庭生育调查的参与者中，确定了 545 名有身体残疾（即行走、爬楼梯、穿衣或洗澡困难）或感觉残疾（即视力或听力困难）的育龄期女性。根据是否使用高效可逆避孕方法（IUD、植入物）、中效避孕方法（避孕药、贴片、环、注射剂）、低效避孕方法（避孕套、撤出、杀精剂、子宫帽、自然避孕法）或不使用任何避孕方法，将有意外怀孕风险的人进行分类。采用多项二项式回归来检验残疾与所使用的避孕方法类型之间的关联。
约 39%的残疾女性有意外怀孕的风险，其中 27%有风险的女性未使用避孕措施。残疾的存在与使用高效或中效避孕方法的可能性降低有关，而与使用低效避孕方法的可能性无关（每种方法的比值比为 0.6），但与不使用任何避孕方法无关。
需要大力减少与身体或感觉残疾相关的避孕措施差异。未来的研究应探讨避孕措施的使用情况在多大程度上因残疾的类型和严重程度而不同，并确定导致任何已识别差异的环境因素。
