We explore the unique considerations surrounding menopause, periods and contraception for people with intellectual disability (ID), the barriers they face and how to achieve ‘equal outcomes of care’. A complex interplay of communication differences, societal assumptions and stigma, diagnostic overshadowing, physical accessibility challenges, and gaps in healthcare providers’ understanding of ID, create these barriers. Aspiring to achieve equal outcomes of care requires early and adapted communication about menopause, periods and sexual health. Clinicians need to adapt clinical care to embed enquiry about menstruation and menopause and use systematic tracking tools to understand a woman’s periods and associated psychological and behavioural changes and then offer the whole range of treatment options. The responsibility lies with professionals to be aware of the barriers, provide reasonable adjustments to overcome them, and to advocate for equal outcomes around menopause, periods and contraceptive health for people with ID. The chapter includes insight from ‘experts by experience’, and each section provides practical suggestions for professionals working with people with ID.

The menstrual history is a key feature of a psychiatric assessment and must be approached with sensitivity, recognising that cultural beliefs surrounding menstruation and menopause may pose barriers to open discussion. A structured framework is outlined, including suggested questions, designed to simplify the process and support identification of links between hormonal fluctuations and psychiatric symptoms and to glean information about the practical management of menstruation. We suggest a culturally sensitive, trauma-informed approach to enquiring about female genital mutilation (FGM) and its psychological impact. By adopting a life-course approach and routinely incorporating menstrual history into psychiatric assessment, clinicians can provide more holistic, personalised care.

Trans and non-binary people face many barriers to accessing healthcare. There is also a lack of research and guidance focusing on the health of transgender and non-binary people. Many clinicians also do not feel confident in their knowledge of specialist care for trans and non-binary people. As part of gender-affirming care, trans and non-binary people may start gender-affirming hormone therapy to provide masculinising or feminising changes that are more congruent with their gender identity. This has shown to a positive impact on the mental health and quality of life of trans and non-binary people. Over the life course, trans and non-binary people may also access other hormonal medications such as contraceptives and hormone replacement therapy for menopause. There are unique considerations for prescribing these medications for trans and non-binary people, especially if they are on gender-affirming hormones. In this chapter, we summarise evidence around the care for trans and non-binary people with specific considerations for the intersection between gender-affirming hormones, mental health, and sexual and reproductive healthcare.

Sexual and reproductive health needs are often overlooked in psychiatric care; people with severe mental illness are at risk of unintended pregnancy and may struggle to access sexual health services. The link between psychological symptoms and contraceptive use is complex and the impact of hormonal contraceptives on mental health is poorly understood. There can be interactions between hormonal contraceptives and psychotropic medication, and where psychotropics with potential teratogenic effects are considered, good contraceptive counselling is imperative. The chapter explores mechanisms, risks and benefits of different types of contraceptives and explores their use beyond pregnancy prevention, including alternative therapeutic indications. Contraception choices are considered in specific groups including perimenopause, trans and non-binary people, and other marginalised groups. We aim to empower mental health professionals to engage collaboratively with their patients in discussing contraception as part of assessment and formulation. Where relevant, we encourage consideration of how contraceptive choices may interact with mental health conditions and influence management plans

Discussions of the family and sexual orientation, the topics of Chapters 8 and 9, would not be complete without a consideration and review of contraception and birth control. Most married and unmarried sexually active women and men in the United States and in the countries of the developed world endeavor to limit their family size and/or to control the timing and spacing of their births.

In this chapter I address the killing of human embryos under three different kinds of circumstance. First are embryos in vitro; second, embryos that are a result of sexual intercourse but which have not yet implanted in a woman’s uterus; and third, embryos that have implanted in the wrong location, typically in the fallopian tube, and which thus cause a significant danger to the mother’s life if the pregnancy continues.

Chapter 6, Branding Birth Control, examines how birth-controllers used claims about medical works’ vulnerability to destruction under the Hicklin test to distance contraception from immorality, frame its advocacy as a free speech issue, and generate publicity for the cause. Contraception pamphlets first published by radicals in the 1820s and 1830s had long been sold by both social reformers and pornographers. In 1876, a figure with feet in both domains was arrested for selling Charles Knowlton’s Fruits of Philosophy (1832). The following year, Annie Besant and Charles Bradlaugh engineered their own arrest for selling it. The chapter examines the selective publication history that Bradlaugh and Besant constructed to divorce Fruits from its associations with promoscuity and promote contraception advocacy as a respectable, progressive cause, and shows that birth-controllers went on to sell huge volumes of literature on contraception. Although they encountered relatively little legal opposition, they often claimed that selling such works was very risky. These claims operated as a way of generating further publicity for the cause, and branding it as brave, modern, and progressive.

Chapter 1, Holywell Street Medicine, traces the pornography trade’s birth out of the collapse of revolutionary politics in the 1820s, and shows how early agents in the trade scavenged for content to fill lists of sexual material. This fostered a vibrant mid-century traffic in cheap reprints and reworkings of works on contraception, venereal disease, fertility, and midwifery alongside pornographic novels and prints, bawdy songbooks, and other sexual material, operating out of London’s Holywell Street and other thoroughfares near the Strand. While showing how these agents harnessed the expanding infrastructures of the press and the post to sell their wares works across the nation, this chapter demonstrates that they framed medical works through two different, but compatible, lenses. Following a long line of disreputable publishers, Holywell Street publishers framed medical works as titillating reading material. However, they also adapted earlier radical arguments for sex education and female sexual pleasure, marketing medical works as containers of practical information about the body that readers could apply to support safe, active, and pleasurable sex lives.

This chapter claims that in the new millennium, religious conservatives succeed in their struggles to control women’s bodies and to turn their private prejudices into public policy through the misappropriation of human rights and by gaining unwarranted religious exemptions. By allegedly demanding the protection of their own rights to religious liberty, conscientious objection, equality, and multicultural accommodations, religious conservatives are reversing the progress in women’s rights and using liberal rights and concepts as a weapon against women. The chapter argues that, contrary to popular belief, the separation between religion and the state cannot protect women’s rights against the religious conservative attack. It compares the religious conservative attack on women’s rights in the USA, where religion is separated from the state, to the religious conservative attack on women’s rights in Israel, where there is no separation between religion and the state, and shows that despite the very different religion–state relations, the religious conservative attack in the USA and Israel is similar in both method and success.

Compared with Britain, industrial transformation occurred more slowly in nineteenth-century France and Italy, forcing two early marginalists from the Lausanne school to pay continued attention to family poverty among the agrarian masses. Although Léon Walras and Vilfredo Pareto wanted to explain and resolve family impoverishment by securing a market whose outcomes correlated with what families deserved, the two economists diverged on the causes of family impoverishment, and on the best ways to respond. Walras’s ‘social economics’ rejected a popular view that family ‘immorality’ was the cause of family impoverishment, instead identifying badly designed government policy as the key factor. Pareto’s studies of population suggested the opposite position. Assuming government corruption and protective policies had been dismantled, Pareto assigned primary responsibility for poverty to egoistical parents, who should have anticipated cyclical economic decline before having children. Describing Malthus’s rejection of contraception as ‘not very scientific’, Pareto studied ‘people as they are’, finding families to be already limiting fertility through delayed sexual union or contraceptive knowledge. This suggested to Pareto that poverty would disappear spontaneously. Neither Walras nor Pareto explained how to manage existing family destitution or unanticipated economic crisis, and they did not problematise the many structural impediments to escaping one’s class.

The papacy played a central role in the development of Roman Catholic teaching about bioethics. Pope Pius XI’s Casti connubii (1930) condemned contraception, sterilization, and abortion. Papal teaching was broadly accepted by Catholics before the 1960s. Widespread dissent in the Church greatly increased after the publication of Pope Paul VI’s Humanae vitae (1968). The first successful IVF procedure in 1978 raised new bioethical issues relating to the status of human embryos outside the womb.

The Catholic hierarchy was more successful in lobbying politicians to enact restrictive laws, or obstruct liberal reforms, than in persuading the laity to accept its teaching on birth control and assisted human reproduction. A rift emerged between mainstream Catholic culture and the institutional Church. The Church is now circumscribed in meeting the challenges presented by complex ethical issues, such as surrogacy and assisted dying, because of the papacy’s inflexible stance on these matters.

Enzyme-inducing antiepileptic drugs (EI-ASMs) such as phenytoin, carbamazepine, oxcarbazepine, and phenobarbital may decrease contraceptive efficacy. When considering contraception for women with epilepsy (WWE), the intrauterine device (IUD) is a first line choice. It is important to keep in mind that hormonal contraception with estrogenic components induces the metabolism of lamotriginePreconception counseling should be started early and revisited frequently for WWE of childbearing age. Pre-partum optimization of ASMs ideally should be done 9−12 months before a planned pregnancy. The majority of WWE are likely to have a safe pregnancy and a healthy newborn.