Despite its controversial history, new guidance to the nation’s pediatricians recommends that permanent contraception should be an option for individuals with intellectual disability.

In a clinical report out this week, the American Academy of Pediatrics says that sterilization should be one of many considerations when treating those with intellectual developmental disorder.

“Permanent contraception may be considered as part of a continuum of treatment options that support every individual’s well-being and, thus, considered after all other options have been exhausted,” reads the guidance crafted by the group’s Committee on Bioethics Council on Children with Disabilities.

The report details the legal, ethical and medical considerations that pediatricians should factor when considering the reproductive health needs of young people with intellectual disability.

Providers should work with families to address concerns about emerging sexuality, fertility, managing menstrual hygiene and the risk of sexual abuse and sexually transmitted infections, all of which can prompt conversations about permanent contraception, the pediatrics group says.

The guidance also addresses the history of involuntary sterilization of individuals with disabilities, which was supported by the eugenics movement. As a result, the pediatrics group notes that states and courts have moved to severely limit access to permanent contraception for minors with intellectual developmental disorder given that they are a “vulnerable population still at risk for mistreatment, abuse and marginalization.”

The American Academy of Pediatrics acknowledges in the report that it is diverging from some other professional and patient advocacy organizations that oppose permanent contraception for those who are not able to give consent.

The guidance indicates that permanent contraception should only be considered for those with intellectual developmental disorder if other reversible methods of contraception have been tried and deemed unsatisfactory. Such a decision should be rooted in careful discussion over a period of time with the surrogate decision-maker and potentially other family members, caregivers, health and social support providers and it should be based on what is in the best interest of the individual, the pediatrics group said.