Use of hormonal contraceptives in an institutional setting: reasons for use, consent and safety in women with psychiatric and intellectual disabilities
Egan, T.M.; Siegert, R.J.; Fairley, N.A.
New Zealand Medical Journal 106(961): 338-341
1993
ISSN/ISBN: 0028-8446 PMID: 8341476 Document Number: 408212
A study was made of all women who had been inpatients of the mental health or disability units of Porirua Hospital in New Zealand for at least 6 months who were prescribed oral or injectable hormonal contraceptives during January 1992. The aim was to describe the use of hormonal contraceptives in this population and assess the appropriateness and safety of this method as well as the patient consent process and patient satisfaction. Data were collected from medical records and from interviews with the patients (when possible) and their nurses. 42 women were prescribed contraceptives (60% of those under 50). 3 were married, 3 separated or divorced, and 36 never married. 32 were nulliparous, none had more than 2 children. 11 were Maoir, 1 Pacific Islander, and 29 New Zealand pakeha. 23 women were intellectually disabled, 28 had mental disorders, 9 had both. 29 of the women received Depo Provera, 7 progesterone-only oral contraceptives (OCs), and 6 combined OCs. 25 had been using their current contraceptive for more than 3 years. Treatment was prescribed by psychiatric staff in 16 cases, other staff in 25, and outside practitioners in 1. The reason for treatment was contraception in 32 women and menstruation prevention in 9. 27 women were smokers (21 heavy). 7, including 6 of the heavy smokers, had other contraindications to the use of estrogens. Of the 26 women interviewed, 12 complained of side effects, 8 of weight gain, 2 of depression, and 5 of other effects (the nurses identified only 2 of 42 women as suffering side effects). Of the 22 interviewees who were treated for contraception, 15 stated they were sexually active. The nurses thought that 29 of the 42 were or might be sexually active. Therefore, 13 women considered definitely not sexually active were prescribed contraceptives. Very few of the women used condoms, although 38% knew how to practice safe sex. 14 of the women interviewed stated they chose contraception. The nurses said 8 had given consent, the families of 2 gave consent, consent information was unknown for 10, and a unilateral staff decision was made for 22. 17 of the 28 women definitely treated without consent were mentally retarded. The women were given very little information about their contraceptive method and knew of very few other methods. These results indicate that contraceptives have been used to manage menstrual hygiene and address staff concerns. In some cases, their administration without consent was illegal. The patients received inadequate medical care and some of the prescriptions were inappropriate. Ethically correct ways in which to address the problem of contraception in this population exist through educationally-focused family planning services for both in- and out-patients.