Things You Should Consider Before Going on Birth Control – Sarah Kim

I remember when I was considering going on birth control a few years ago, I wanted to find out how, if at all, my cerebral palsy would cause certain side effects. As a naturally anxious person, I was paranoid about getting pregnant, although I always used protection. So, I wanted to have ease of mind by having an extra level of prevention. However, to my dismay, there weren’t any resources available that addressed the complexities a woman with cerebral palsy might encounter when going on any form of birth control.

While there was plenty of research about how birth control affects women in general, no information existed on its effects on women with physical disabilities, let alone CP. The lack of research and resources stems from the entrenched misconception that women with disabilities are asexual and therefore don’t need to go on birth control. Just like other women, we are entitled to make our own decisions about our bodies. To do so, we deserve to have medical professionals who are well informed on the differential effects of procedures and pills on differently-abled women.

A common theme that appeared in my research on this matter was the practice of coerced sterilization for eugenic and prevention purposes. While women with physical disabilities are more vulnerable to sexual abuse than nondisabled women, this sends multiple negative messages. First, existing research focuses on women with cognitive disabilities, but lumps it together under the umbrella of all disability, which dangerously reinforces the misconception of physical disabilities equating to cognitive deficits. Second, it shows that there is a presumption that exists in the medical field that women with disabilities are not interested in or are incapable of engaging in sexual activities.

Reproductive health justice for women with disabilities is behind, but slowly emerging. The following is an incomplete list of the precautions a woman with CP might want to take into consideration before going on birth control. CP has a wide spectrum, and there is no one-size-fits-all solution for contraception.

As in other medical practices, doctors prescribing birth control options might not have prior experience with patients with disabilities. As a result, medical professionals may or may not ask you the appropriate or necessary questions associated with contraception. Therefore, it is exceptionally important for you to do your due diligence by advocating for yourself and demanding for all your questions to be answered.

1. Based on your level of mobility, you might be prone to blood clots.

Hormonal birth control — like the pill, patch, and ring — contains estrogen, which causes blood clots in some women. The combination of increased risk from limited mobility plus increased risk of estrogen may increase the chances of blood clots developing. If you are typically not physically active, consider staying away from hormonal birth control.

Even if you are physically active, consult your family to see if there’s a genetic history of blood clots. Too often, doctors only ask about the physical disability the patient has, forgoing screening for unrelated conditions that they might have or that run in the family. True story: a dear friend who was a college athlete, was on the same pill as me. I experienced no issues with being on it, although I was not as physically active as her, and after a few months, she was hospitalized for a major blood clot. It turned out there’s a history of a blood disorder in her family, and that wasn’t taken into consideration before the doctor prescribed her the pill.

2. If your CP presents low bone density, certain contraception can increase the chances of bone breaking.

Sometimes in people with CP, bone density is significantly decreased and causes osteoporosis, a condition in which the person is at risk of fractures because of low bone strength. The Depo-Provera birth control shot reduces minerals in bones, causing weakened bone strength. So, if you already have osteoporosis, then the shot could further increase the chances of bone fractures.

3. Consider the state of your mental wellbeing.

The rate of depression and anxiety prevalence in people with disabilities is two to three times greater than the rate in the general population. Since it is only in the recent decade that society has become more accepting of mental illness, it is likely that some people don’t get diagnosed until adulthood. For me, it was when I got to college that I realized I had depression and anxiety, which was around the same time I went on birth control.

If you have symptoms of mental illness and go untreated before going on hormonal birth control, then the synthetic hormones in the contraception can magnify those symptoms, which can lead to grave consequences. So, it is crucial to be transparent with your doctor about the state of your mental health. Depending on how certain birth control affects mood, your doctor might advise you to go with a non-hormonal option.

4. For intrauterine device (IUD) insertions, consider the level of your spasticity and/or pelvic sensitivity.

IUDs are shaped like a “T” and slightly bigger than a quarter. They are inserted into your uterus and prevents pregnancy by stopping sperm from reaching and fertilizing eggs. Some women with CP have heightened sensitivity in their pelvic area or have uncontrollable spasms or contractures. These factors can make IUD insertions especially hard and may require the use of anesthesia. If an IUD is your desired type of contraception, then you should discuss foreseeable complications that might arise during the insertion procedure with your doctors.

Remember, finding the right birth control method is different for each woman and can sometimes require trial and error. There isn’t an exact science to finding the right contraception, as each woman is different and each case of disability varies. It is normal to try a few options before you find the one that works for you. It requires patience and good communication between you and your doctor.

For me, the pill didn’t work for reasons not involving my CP. Certain pills are effective only if you take it at the same time every day, and my daily schedule in college was unpredictable. On top of that, I had never taken a prescription before this, so having to do so at a specific time each day was asking too much from my college-aged self. Therefore, with the consultation of my gynecologist, I went the IUD route and almost three years later, I couldn’t be happier.

People with CP spend most of our lives having to think outside the box to find alternative ways to achieve our goals. The same principle applies to when diligently determining the right birth control for you. If you’ve decided to go on birth control, then you deserve to explore all options to do so!