There are significant disparities in reproductive health (RH) services among women with disabilities in the United States, according to a recent study published in Open JAMA Network.1
Disability is “a physical or mental impairment that substantially limits one or more major life activities,” according to the Americans with Disability Act. The severity of functional difficulties can vary considerably among individuals, with unique accommodations for accessing adequate health care needed between different people, including RH services.
The risks of poor health, increased health care needs and gynecological cancer are significantly increased in patients with disabilities. However, this population is less likely to benefit from gynecological cancer screening than the general population, despite similar pregnancy rates.
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 face barriers to accessing RH services.
To assess the barriers to RH services faced by people with disabilities, the investigators conducted a cross-sectional study. Participants included English- and Spanish-speaking individuals assigned at birth (AFAB) ages 15 to 49 between December 2021 and January 2022 who responded to a large national survey.
Barriers to RH services, abortion attitudes, health care experiences, and sociodemographic characteristics were assessed in the survey. The number and types of barriers encountered when trying to access RH services over the past 3 years were the main findings of the study. RH services included Pap smear and family planning.
Ten obstacles were included in the analysis: missing work or school, finding transportation, finding a place offering RH services, finding daycare, finding services that speak your language, finding a comfortable place, find a place that accepts his insurance. , payment for services, confidentiality and a partner or family member who does not want to go.
The number of obstacles encountered was categorized as none, 1, 2, or 3 and above. Conceptual themes of barriers included logistics, access, cost, privacy, and interpersonal relationships.
The final analysis included 6,956 AFAB individuals, with a mean age of 36 years. Among participants, 46.4% had never been pregnant and 8.5% met Washington Group Short Set disability criteria, of whom 73.2% had previously attempted to access RH services.
Participants with disabilities were more likely to be Black, Hispanic, non-U.S. born, living below the federal poverty line, members of the LGBTQIA community, had ever considered self-managed abortion, and had previously 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 the barriers encountered, 50.7% were logistical, followed by 49.9% 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 general disability, functional difficulties and multiple disabilities.
These findings indicated significant disparities in access to reproductive health care among AFAB people with disabilities. The investigators recommended further research to address unmet needs for SR among patients with disabilities.
This article was originally published on Contemporary OB/GYN.
