Objective
One in 10 reproductive-aged women has a physical, sensory, or intellectual/developmental disability.1 Prevailing assumptions are that these women are not sexually active, or are unlikely to experience pregnancy because of their medical risk.2 We compared rates of recognized pregnancy among women with and without disabilities.
Study design
This population-based repeated cross-sectional study was completed in Ontario, Canada. Health administrative datasets, covering the whole population, were linked using a unique encoded identifier and accessed and analyzed at ICES. Included were women aged 15–44 years, who had an identified physical, sensory, or intellectual/developmental disability, based on ≥2 physician visits or ≥1 emergency department visits or hospitalizations between database inception and study entry.3,4 Rates of recognized pregnancy—any livebirth, pregnancy loss, or induced abortion—were calculated per 1,000 women in fiscal year 2017/18 for each disability group overall and by 5-year age groups, and then compared by Poisson regression to women without any documented disability. Changes in rates between 2003/04 and 2017/18 were also assessed by Poisson regression, with a year*disability status interaction term. Time trends were plotted using 3-year moving averages. Data use was authorized under section 45 of Ontario’s Personal Health Information Protection Act.
Results
In 2017/18, there were 253,661 15–44 year-old women with a physical, 91,695 with a sensory, 8,919 with an intellectual/developmental, and 29,515 with ≥2 (multiple) disabilities, and 2,335,019 women without disabilities. Compared to women without disabilities, overall recognized pregnancy rates were slightly lower in those with physical or sensory disabilities and much lower in women with intellectual/developmental or multiple disabilities (Figure 1). Adolescent pregnancy rates were highest in women with intellectual/developmental disabilities, and also higher in women with physical and sensory disabilities, each compared to women without disabilities (Figure 1).
Figure 1. Rates and unadjusted rate ratios of a recognized pregnancy among 15 to 44 year-old women in Ontario, Canada, 2017/18, who had a physical, sensory, or intellectual/developmental disability (“IDD”) or ≥2 (“multiple”) disabilities, compared to women without any such disability (“none”).
Data are presented overall, and by 5-year age group.
Between 2003/04 and 2017/18, pregnancy rates decreased slightly in women without disabilities and appeared stable among those with physical or intellectual/developmental disabilities. However, pregnancy rates rose significantly in women with sensory or multiple disabilities (year*disability status interaction term p-value <0.0001) (Figure 2). Of all pregnancies, the proportion in women with any disability increased from 8.5% in 2003/04 to 13.0% in 2017/18.
Figure 2. Temporal trends in the rates of a recognized pregnancy among 15 to 44 year-old women in Ontario, Canada, in 2003/04–2005/06 to 2015/16–2017/18, who had a physical, sensory, or intellectual/developmental disability (“IDD”), or ≥2 (“multiple”) disabilities, contrasted with women without any such disability (“none”).
Data are presented as three-year moving averages.
In additional analyses, there were lower rates of pregnancies ending in livebirth or induced abortion per 1,000 women in each disability group, vs. women without disabilities. However, rates of pregnancy loss were slightly, though non-significantly, elevated in women with physical (RR 1.04, 95% CI 1.00–1.09) or sensory disabilities (RR 1.06, 95% CI 0.99–1.13) compared to non-disabled women.
Conclusion
Our findings counter assumptions that pregnancy rarely occurs in women with disabilities.2 Higher pregnancy rates in adolescents with (vs. without) disabilities are concerning and may speak to the need for better access to sexual health education and contraception. Women with disabilities have reported barriers accessing reproductive health care services, including providers who are reluctant to discuss their reproductive health, physically inaccessible care settings, and lack of tailored information.5 Given that 1 in 8 pregnancies herein was among women with a disability, greater attention to the reproductive and perinatal health care needs of women with disabilities is warranted.
Sources of financial support:
Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under award # 5R01HD092326-02. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Role of the funding source: The funding source had no role in the study design, data collection, analysis, data interpretation, report writing, or decision to submit the article for publication.
Footnotes
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Disclosure statement: The authors report no conflicts of interest.
Paper presentation: This paper was presented at Public Health 2019 in Ottawa, Ontario, Canada, April 30-May 2.
Publisher's Disclaimer: Disclaimer: This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed herein are those of the author, and not necessarily those of CIHI.
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