Contraception and Disabilities

As a woman with a disability, you have the right to decide whether to become pregnant and give birth, as well as the number, spacing, and timing of your children. You have a right to obtain accurate information and counseling regarding contraception (birth control). Remember, only you and your healthcare provider can determine which birth control method is safe for you.

Below you will find information about various contraceptive methods including hormonal medications, barrier devices, behaviors, and other methods of preventing pregnancy, with comments about possible concerns for women with disabilities.

Hormonal Methods

Taking the hormones estrogen, progestin, or both together on a regular basis is an effective way to prevent pregnancy.^1,2 Many women also use these hormones to reduce menstrual bleeding or have less painful periods of shorter duration.^2-6

Some other medications used to control disability-related symptoms may interfere with the action of estrogen and progestin to prevent pregnancy.^2,3,7,8 In some cases, medications for disability and hormonal contraceptives can affect each other’s effectiveness.⁹ Be sure to talk with your healthcare provider about how hormonal contraceptives may interact with your other medications.

Below you will find information about various contraceptive methods including hormonal medications, barrier devices, behaviors, and other methods of preventing pregnancy, with comments about possible concerns for women with disabilities.

The Pill

“The Pill” is a prescription tablet containing estrogen, progestin, or both. When taking the pill, women with disabilities may have an increased risk of blood clots.¹⁰ They may also experience weight gain that could complicate transfers.⁵ Some other medications may make the pill less effective.^3,11 Some women with disabilities take “the pill” to reduce blood flow and make it easier to manage menstruation.^5,6 Research shows that menopausal or post-menopausal women have a higher risk of blood clots if they take a contraceptive pill containing estrogen.^3,12-16

Progestin Only Contraceptive

Progestin Only Contraceptive (POC) contains progestin instead of a combination of progestin and estrogen. There are three types of POCs:

1. Mini-pill
2. Implant (inserted and removed by a provider)
3. The Depo shot. Shot/injection (Depo-Provera). This is a hormone that your provider injects in your arm or buttocks once every three months. The shot can cause weight gain,^5,17 which, for women with mobility impairments, could affect walking and transfers. It also may cause losses in bone mineral density,18 compounding the risk of osteoporosis that can be caused by immobility and lack of weight-bearing exercise.^19,20

Patch

The Patch delivers hormones through contact with the skin. Women with limited use of their hands may need assistance with opening the foil package, removing the plastic covering, and applying the patch. The patch may not be safe for women with a history of coronary artery disease, migraines, high blood pressure and certain other health conditions.³

Emergency Contraception

Emergency Contraception (ECT) should be used as soon as possible within 3-5 days after having unprotected sex. The two main types of ECT are the emergency contraception pill and a copper T-shaped IUD which is placed in the uterus by a healthcare provider. Although ECT can prevent pregnancy after unprotected sex, it cannot cause an abortion.²¹

Many women with disabilities with limited use of their hands, such as arthritis, spinal cord injury, multiple sclerosis, neuromuscular disorders, cerebral palsy, or amputation of the fingers, hands, or arms, find it difficult to use barrier methods of contraception. Some use assistive devices or ask their partner to help them place the barrier.

Male or External Condom

Condoms The male condom is a thin film cover placed over an erect penis. When used properly, it is the only contraceptive method shown to be effective against both pregnancy and many sexually transmitted infections (STIs). Most condoms are made of latex but can also be plastic or lambskin. Lambskin condoms do not protect against STIs. Women with certain disabilities are more allergic to latex than the general population.²² 

Female or Internal Condom

The female or internal condom is a thin pouch with a flexible, soft ring on each end that is made with non-latex rubber. One end of the female condom fits inside the vagina and the other end stays outside. The female condom helps prevent pregnancy but may not be as effective as male condoms in protecting against STIs. Women with hand limitations may need assistance placing this condom in their vaginas.

Intrauterine Device

An Intrauterine Device (IUD) is a small, plastic, T-shaped device containing either copper or hormones put into a uterus by a healthcare provider. Women with spinal cord injury, lupus, and certain other disabilities may be advised against using IUDs. Some reasons for this are:

• Increased risk of severe bleeding
• An inability to feel if the device moves from its proper location
• Autonomic dysreflexia (AD)      
• Possible weight gain.⁵

Cervical Cap

A cervical cap is a prescribed silicone cup that fits securely in the vagina to cover the cervix. When used with spermicide, it helps prevent pregnancy. Women with mobility impairment may have difficulty inserting the cervical cap correctly and removing it by hooking their finger under the removal strap and pulling it out. It is recommended that diaphragms are used with a spermicide.

Diaphragm

A diaphragm is a small cup made of rubber with a rim formed by a rubber-covered steel spring that sits in the vagina. It may be difficult to insert and remove independently if you have limited use of your hands. It is recommended that diaphragms are used in conjunction with a spermicide (a chemical that kills sperm).

Vaginal Ring

A vaginal ring is a small, flexible, plastic ring that you insert into your vagina. It prevents pregnancy by releasing synthetic estrogen and progestin. Inserting the ring may be difficult for women with limited hand function or spasticity in the legs.¹⁹

Spermicides

Spermicides are chemicals that prevent pregnancy by killing sperm. They are available over the counter, but are not considered a highly effective method of birth control.²³ Women with mobility impairments may have difficulty opening the package and inserting the spermicide using either their fingers or the applicator.

Behavioral methods for avoiding pregnancy may be used for various reasons, such as access, affordability, and belief systems. Abstinence, or refraining from all forms of sexual activity and genital contact, is the only 100% effective way to protect against unplanned pregnancy and sexually transmitted infections. However, other behavioral methods are often less effective than other methods because they require cooperation and agreement between a woman and her partner. The advantage, however, is that they have far fewer side effects and risks. This is especially true for women with mobility impairments who may have a high risk for blood clots.

Withdrawal

Withdrawal, also called Coitus Interruptus, depends on the man’s willingness and ability to withdraw his penis before ejaculation. It is not a highly effective method of pregnancy prevention. It has been determined that sperm can be found in pre-ejaculation fluid.²⁴

Natural Family Planning Method

The Natural Family Planning Method, or the "rhythm" method, relies on avoiding intercourse during ovulation. A woman can tell if she is ovulating by taking her body temperature every day and noticing when it goes up. This method may not be reliable for women with spinal cord injuries or other disabilities that affect body temperature. These disabling conditions may interfere with the connection between body temperature patterns and ovulation. Moreover, women who cannot feel parts of their body may not be aware of pain related to ovulation.

There are several tools available now that measure body temperature, including fertility monitors, ovulation strips, single use tests, or apps on your phone. 

Sterilization is a highly effective (usually permanent) method of birth control. It can be done using surgical procedures (tubal ligation, hysterectomy) and non-surgical procedures (tubal implants or occlusion). A tubal ligation is also known as “having your tubes tied.” In this procedure, a surgeon cuts, seals, clips, or ties the fallopian tubes. A hysterectomy involves removing the uterus through an incision in the lower abdomen or vagina. Hysterectomies sometimes include removal of the cervix and ovaries, although this is typically for medical reasons other than pregnancy prevention. Both tubal ligations and hysterectomies are immediately effective in preventing pregnancy.

A tubal implant involves placing a tiny, spring-like coil in the fallopian tubes, which causes scar tissue to build up and block the tubes. Tubal implants typically take about three months to become effective at preventing pregnancy. Women with autoimmune diseases may be at a higher risk of chronic pelvic pain following tubal implants.^27,28      

 A woman’s rights are violated when sterilization is unnecessary or performed without the woman’s consent. There is much in the literature that discusses forced sterilization laws as a form of eugenics (controlling who can have children) for women with disabilities—a horrible mark on history.²⁹ It is also a violation of rights when a woman gives consent for sterilization or requests it but is denied the procedure due to state laws or policies.¹⁹ Providers may be more likely to recommend sterilization for women with disabilities compared to women without disabilities, even without medical reasons.^30,31

Endometrial Ablation involves a surgical procedure to remove the lining of the uterus (endometrium). This procedure can help reduce heavy menstrual flow and the length of a period. It is also an effective way to prevent pregnancy.³² In many cases, it stops menstruation completely.^33,34 The effect is permanent, so it should not be used for adolescents with disabilities.²⁵ Women, together with their family, partner, and healthcare provider, should make the decision to have the ablation procedure only after trying hormonal methods. The surgery may be done in a hospital, outpatient surgery center, or the provider's office.

Optimal reproductive health demands equal access to inclusive, competent, and medically appropriate reproductive health services and information. The reproductive health of women with disabilities relies on the freedom to exercise their rights to decide whether to become pregnant and give birth, as well as the number, spacing, and timing of their children.^35,36 It also involves the right to prevent unplanned pregnancies by having access to effective, affordable, and accessible methods of contraception. Research suggests that women with disabilities may receive sterilization at higher rates and certain types of birth control at lower rates compared to other women.³⁷ Women with disabilities also report experiencing both negative attitudes and misguided assumptions from clinicians when seeking contraceptive information, and facing inaccessible facilities and exam tables.^38,39 Interventions are needed to improve preconception care, family planning, and the prevention of unplanned pregnancy among women with disabilities.

For General Information about Different Birth Control Options:

• Contraceptives 101| Demystifying Science Video

For Easy Compare and Contrast Sites:

• Birth Control Methods FAQ | Women’s Health Article
• Birth Control Guide | Planned Parenthood

Hormonal

• How Does the Birth Control Pill Work and is it Safe to Use | Planned Parenthood Video
• Birth Control Patch | Mayo Clinic
• How Effective is the Birth Control Shot | Planned Parenthood Video
• Effectiveness of the Birth Control Implant in Your Arm | Planned Parenthood Video

Barrier

• What is a Female Condom (aka Internal Condom) and How Does it Work? | Planned Parenthood Video

Emergency

• Emergency Contraception | U.S. Health and Human Services Article

Funded by the National Institutes of Health, National Library of Medicine (Grant #G08 LM012702) and Paralyzed Veterans of America Educational Foundation (Grant #848).

Page updated October 2020