Sexuality and Reproduction
This chapter reviews the benefits and drawbacks of common birth control methods, including sterilization, for MR individuals. Concerns of care providers in protecting clients from sexually transmitted diseases (STDs) and the disability status of HIV-positive individuals are addressed. Barriers preventing unconstrained decisions for MR women are identified. Finally, the chapter includes findings about positive aspects of sexual expression for MR individuals as well as their vulnerability to sexual abuse.
It is important to review common forms of sterilization as well as contraceptive alternatives to sterilization. 1 In the interest of voluntarism and free choice, MR people should have the opportunity to select from the widest variety of contraceptive options ( Shelton & Speidel, 1983). For those too cognitively limited to choose independently, others should make decisions based on what best suits MR individuals' needs.
Choosing contraception depends on effectiveness, safety, convenience, need for protection from STDs, reversibility, and cost. When considering effectiveness, there is a difference between the lowest expected failure rate, which is based on consistent and correct use of the method, and the higher typical user failure rate, which is based on records of actual use over time. User failure rates include instances of forgetting to take pills, failing to use condoms correctly, and removing diaphragms too soon after intercourse; they also reflect frequency of intercourse. Because effectiveness depends on correct usage, methods will be evaluated in terms of their use by MR persons.