FHI - April 3, 1999

Chronic Medical Conditions Influence Contraceptive Choices -- April 3, 1999

RESEARCH TRIANGLE PARK, NC -- Many people have chronic medical conditions that should be considered carefully when choosing a contraceptive method, or when deciding to have children.

Because general information about contraceptives is often prepared with healthy people in mind, people with chronic diseases or other medical conditions may not be aware of special concerns that affect them. For example, if a woman suffers from severe headaches or is a heavy smoker, should she use oral contraceptives? What are the appropriate contraceptive choices for people who suffer from cancer, high blood pressure, diabetes, epilepsy or sickle cell disease? How do physical or mental disabilities influence method choice?

Because oral contraceptives contain hormones, which act upon many different body systems, the pill is not recommended for women with certain kinds of severe, recurrent headaches or for women who are heavy smokers and are 35 years of age or older.

However, some people may be overly cautious in selecting contraception. Because they fear how their condition and a contraceptive method may interact, some people avoid very effective methods that are actually good choices. As with healthy women, pregnancy poses health risks. For certain chronic conditions, the risks during pregnancy are even greater, scientists say in the current issue of Network, Family Health International's quarterly reproductive health bulletin.

"In general, pregnancy worsens diabetic complications," says Dr. Roberto Rivera, FHI director of international medical affairs. The hormonal changes during pregnancy may worsen diabetic complications, he says, and infants of diabetic women are at higher risk of congenital malformations, premature birth and stillbirth. "Access to effective contraceptive choices is often an important part of the medical management of diabetic women of reproductive age," says Dr. Rivera.

Based on guidelines developed by the World Health Organization, all modern contraceptive methods are good choices for diabetic women who do not experience vascular disease. For women with vascular disease or who have had diabetes for more than 20 years, the intrauterine device (IUD) is a good method, and some hormonal contraceptives (Norplant and oral contraceptives that use only progestin) are second choices. However, oral contraceptives that use both estrogen and progestin and injectable contraception are usually contraindicated or undesirable. While male or female sterilization is a good option for diabetic people, extra precautions are needed during the surgical procedures.

Physical and mental disabilities

The contraceptive needs of people with chronic physical or mental disabilities are often overlooked. Many disabled people are able to have children and, like able-bodied people, may wish to use contraception temporarily. Others may seek permanent or long-acting methods, since childbearing or child rearing may be too difficult for them.

Contraceptive options for people with physical disabilities are influenced by many factors, including: quality of blood circulation, abnormal clotting associated with the condition, degree of physical sensation, manual dexterity, whether the condition is stable, whether a contraceptive can worsen a condition, possible drug interactions with medications a person is taking, whether the person is depressed, and any problem the person has with menstrual hygiene.

The choice of a method may also involve how easy it is to obtain. Physical barriers and lack of transportation may discourage disabled people from using methods that require routine supplies or services, says Eileen Giron, executive director of the Cooperative Association of the Independent Group for Rehabilitation (ACOGIPRI) in El Salvador. Disabled men and women who attend the group's workshops say they have wanted to learn more about contraception, but did not know where to obtain information.

For psychiatric disabilities, important factors include how the hormonal components in some contraceptives can affect the mental disturbance or interact with drug therapy. For intellectually handicapped people, the ability to use a method correctly is important. Some mentally retarded people, for example, have trouble swallowing pills, or may need supervision to help them take pills daily.

Given the potential interactions of methods with conditions, people with chronic diseases or disabilities generally require more family planning counseling than do healthy people. In addition to health risks and benefits, counseling should consider the couple's unique situation, including a woman's ability to conceive, the appropriate timing for a pregnancy if desired, and ability of the woman or man to use a method correctly.

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Chronic Medical Conditions Influence Contraceptive Choices -- April 3, 1999