Examining Barriers to Reproductive Care for Women with Disabilities

There are significant disparities relating to reproductive health (RH) services among women with disabilities in the United States, according to a recent study published in JAMA Network Open.¹

Disability is, “physical or mental impairment that substantially limits 1 or more major life activity,” according to the Americans with Disability Act. The severity of difficulty functioning can significantly differ across individuals, with unique accommodations to access adequate health care necessary between different people, including RH services.

The risks of poor health, more health care needs, and gynecological cancer are significantly increased in patients with disabilities. However, this population is less likely to receive gynecological cancer screenings than the general population, despite similar rates of pregnancy.

Small studies have reported barriers to contraceptive access among patients with disabilities, including lack of insurance, lack of privacy, and lack of resources and information. However, these studies have not determined the extent to which people with disabilities experience barriers to RH services.

To evaluate barriers to RH services experienced by people with disabilities, investigators conducted a cross-sectional study. Participants included English- and Spanish-speaking people assigned female at birth (AFAB) aged 15 to 49 years between December 2021 and January 2022 who completed a large national survey.

Barriers to RH services, abortion attitudes, health care experiences, and sociodemographic characteristics were evaluated in the survey. The number and types of barriers when trying to access RH services in the past 3 years were the primary outcomes of the study. RH services included a Pap smear and family planning.

There were 10 barriers included in the analysis: getting time off work or school, finding transportation, finding a location offering RH services, finding childcare, finding services that speak one’s language, finding a place that feels comfortable, finding a place that accepts one’s insurance, paying for services, privacy, and a partner or family member not wanting one to go.

The number of barriers experienced were categorized as none, 1, 2, or 3 and more. Conceptual themes for barriers included logistical, access, cost, privacy, and interpersonal relationship.

There were 6956 AFAB individuals included in the final analysis, aged a mean 36 years. Of participants, 46.4% had never been pregnant and 8.5% met the Washington Group Short Set criteria for disability, 73.2% of whom had ever tried to access RH services.

Participants with disabilities were more often Black, Hispanic, with non–US nativity, living below the federal poverty level, members of the LGBTQIA community, had ever considered self-managed abortion, and had ever experienced medical mistreatment.

People with disabilities were more likely to experience barriers to RH services than those without disabilities, at 69% and 43% respectively. Of barriers experienced, 50.7% were logistical, followed by 49.9% being access barriers.

Participants with activities of daily living, communication, and multiple disabilities most often experienced 3 or more barriers, at 75.3%, 65.1%, and 59.9%, respectively. Barriers were significantly more common in patients with overall disability status, some difficulty functioning, and multiple disabilities.

These results indicated significant disparities in access to RH care among AFAB people with disabilities. Investigators recommended further research to address unmet RH needs among patients with disabilities.

This article originally appeared on Contemporary OB/GYN.

Reference

1. Biggs MA, Schroeder R, Casebolt MT, et al. Access to reproductive health services among people with disabilities. JAMA Netw Open. 2023;6(11):e2344877. doi:10.1001/jamanetworkopen.2023.44877