Vallury Kari Dee, Tucker Victoria, Sheeran Nicola
Children by Choice, Brisbane, Australia.
School of Applied Psychology, Griffith University, Brisbane, Australia.
J Intellect Disabil Res. 2025 Apr;69(4):274-282. doi: 10.1111/jir.13207. Epub 2024 Dec 23.
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.
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.
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.
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.
目前，关于智障女性在避孕、怀孕时机和妊娠结局决策方面的自主程度的研究有限。先前的研究强调了性健康和生殖健康结果方面的不平等。然而，智障女性在整个生殖过程中的生殖自主权的障碍和促进因素，包括医疗保健经历，却鲜有描述；这正是本研究的重点。
十名智障女性参与了焦点小组或个人访谈，她们在访谈中讨论了获得性健康和生殖健康服务以及做出生殖健康决策的经历。使用反思性主题分析法对数据进行了分析。
三个主题阐明了性健康和生殖健康信息的缺乏以及暴力如何影响了许多参与者控制受孕时机和做出明智的妊娠结局决策的能力。第一个主题将避孕知识素养描述为生殖自主权的障碍。大多数参与者在首次怀孕前没有接受过避孕或生殖健康教育。虽然大多数女性了解常见的避孕方式和怀孕选择，但她们的避孕知识不完整或不正确。第二个主题探讨了尽管大多数参与者在妊娠结局决策方面有自主决定权，但生殖胁迫和虐待、怀孕检测延迟以及关于所有怀孕选择的信息不足阻碍了她们做出明智的决策。第三个主题指出医疗保健专业人员在增强生殖自主权和促进明智决策方面起着关键作用。
智障女性在得到适当的护理和信息支持时，表现出做出明智和自主的生殖健康决策的意愿和能力。然而，她们面临生殖胁迫和虐待，并且往往需要克服众多系统性挑战来维护自己的生殖权利。需要做出重大努力，以更好地理解和解决明智的生殖决策的障碍。
