USE OF HORMONAL CONTRACEPTIVES IN AN INSTITUTIONAL SETTING - REASONS FOR USE, CONSENT AND SAFETY IN WOMEN WITH PSYCHIATRIC AND INTELLECTUALDISABILITIES

Aim. To describe the use of hormonal contraceptives in institutionalis ed women with psychiatric and/or intellectual disabilities. Methods. W omen who had been disability or mental health service inpatients for s ix months or more and were prescribed hormonal contraceptives were inc luded. Data were collected from their clinical files and from structur ed interviews of the women and of their primary care givers. Results. Forty two women were prescribed contraceptives, of whom 23 were intell ectually disabled and 28 had mental illnesses. Most women had no child ren; four had had one child and two, two children. Thirteen were not s exually active. Depot medroxyprogesterone acetate (Depo Provera) was p rescribed for 69%, combined oral contraceptive agents for 14% and prog estin-only oral contraceptives for 17%. Contraceptives were initially prescribed by hospital staff for all but 1 woman, and were administere d without consent for over half the group, including 11 women for whom this administration was not legally authorised. Less than half the gr oup had blood pressure measured within the previous 12 months and only a third had a cervical smear within the previous 3 years. Of the wome n who were sexually active, less than half knew how to protect themsel ves from sexually transmitted diseases and less than 10% regularly use d condoms. Conclusions. Improvements in reproductive health care for t hese women are needed, in particular attention to education and client participation in decisions about contraceptive treatment. It is sugge sted that gynaecological and family planning services be provided sepa rately from psychiatric services.