Literature Review on Provision of Appropriate and Accessible ...

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2.0 Contraception and consent to medical treatment
2.1 Introduction
<strong>Literature</strong> <strong>Review</strong> on Provision of Appropriate and Accessible
This section will explore use of contraception and pregnancy risk
Support to People with an Intellectual Disability who are
for women with Experiencing intellectual Crisis disability Pregnancy as well as discussing capacity
issues and consent to medical treatment, with a particular focus on
contraceptive treatment.
2.2 Contraceptive provision for women with intellectual disability
The fertility of women with learning disabilities has long been subject
to control by others. McCarthy (1998) notes that there is a long history
of eugenics-based practice in many countries, where the emphasis
has been to prevent people with learning disabilities - along with
so-other called ‘unfit’ people - from reproducing, either through
sterilisation and/or through institutionalisation (Barker, 1983). Support
for involuntary sterilisation derived from the belief that persons with
intellectual disability were incapable of giving informed consent, and
that the practice was necessary ‘to avoid genetic transmission of mental
retardation’ (Carpenter, 1992). In relation to sexuality and reproductive
health, historically decisions were based in public policy that was deeply
influenced by discrimination and pervasive stereotypes. Meanwhile,
Brown (1996) observes that, in the UK context, procedures such as
the use of Depot Medroxyprogesterone Acetate (Depo-Provera) as a
contraceptive and long-term use of the Pill are still widespread, despite
the acknowledged health risks.
McCarthy (1998) notes that the reason for prescribing contraception to
women with learning disabilities is not always a straightforward matter
of preventing an unwanted pregnancy in a sexually active woman of childbearing
age. In her experience, a reason provided for many women was
the existence of heavy or painful periods, which she suggests may be
exaggerated by carers and staff in order to have a long-term strategy to
avoid any possibility of pregnancy for all of the woman’s reproductive life.
She argues that the very long-term use of the Pill, and the ways in which
intrauterine devices (IUDs) and Depot Medroxyprogesterone Acetate
are used with women with learning disabilities, combined with a lack of
attention to side-effects and after-effects, suggests that less importance