Many people with mobility and physical disabilities lack basic reproductive health care. People with disabilities are less likely to receive cervical cancer screenings, prenatal care, and family planning services than those without disabilities. Estimates of contraceptive use vary across studies, but some studies indicate that those with disabilities use a narrower set of contraceptive methods and are more likely to use sterilization than those without disabilities, raising concerns about the history of involuntary sterilization. Those with disabilities have similar rates of sexual activity as those without disabilities, are as likely to experience pregnancy, and have similar fertility desires. This is all to say that needs are similar among these groups.

Barriers to accessing reproductive health care include office inaccessibility, clinician biases, and lack of clinician training. Clinicians should go beyond compliance with the Americans with Disabilities Act towards full accessibility for patients with impaired mobility.

Making the exam room fully accessible:

Ideally, health centers should have at least one accessible exam table. The best table lowers to around 20 inches for easy transfers, has side rails for extra security, and has adjustable padded boots in place of stirrups. If your office lacks an accessible exam table, you should help a patient transfer safely and comfortably from a wheelchair or other mobility device. Train staff in transfer techniques and make a plan with the patient for a preferred transfer method. Your patient knows what works best.

Check your biases:

People with disabilities are often considered asexual and assumed not to have the ability, desire, or right to express their sexuality or to have children and function as parents. This is inaccurate and stigmatizing.

• Always take a sexual history.
• In prenatal genetic and structural screening, don’t assume that your patient would want to terminate a pregnancy with any particular anomaly.
• Recognize that most people with physical disabilities can make their own medical decisions, give informed consent, and parent a child.

Always ask!

By asking a patient with a physical disability about their abilities, preferences, and accommodation needs, you can avoid making false assumptions and provide the best possible care.

Helpful Resources

ACOG Interactive Site for Clinicians Serving Women with Disabilities

ICSNY A Blueprint for Improving Access to Primary Care for Adults with Physical Disabilities

NACCHO Including People with Disabilities in Reproductive Health Programs and Services

Take Charge Reproductive Health Guide for Women with Disabilities

Sources

Bloom TL, Mosher W, Alhusen J, Lantos H, Hughes RB. Fertility desires and intentions among U.S. women by disability status: Findings from the 2011-13 National Survey of Family Growth. Matern Child Health J. 2017;21(8): 1606-1615.

Cox RL, Signore C, Quint E. Interactive site for clinicians serving women with disabilities. The American Congress of Obstetricians and Gynecologists.

Haynes RM, Boulet SL, Fox MH, Carroll DD, Courtney-Long E, Warner L. Contraceptive use at last intercourse among reproductive-aged women with disabilities: An analysis of population-based data from seven states. Contraception. 2018;97(6):538-545

Horner-Johnson W, Kulkarni-Rajasekhara S, Darney BG, Dissanayake M, Caughey AB. Live birth, miscarriage, and abortion among U.S. women with disabilities. Disabil Health J. 2017;10(3):382-386.

Horner-Johnson W, Moe EL, Stoner RC, et al. Contraceptive knowledge and use among women with intellectual, physical, or sensory disabilities: A systematic review. Disabil Health J. 2019;12(2):139-154.

Li H, Mitra M, Wu JP, Parish SL, Valentine A, Dembo RS. Female sterilization and cognitive disability in the United States, 2011-2015. Obstet Gynecol. 2018;132(3):559-564.

Mitra M, Clements KM, Zhang J, Iezzoni LI, Smeltzer SC, Long-Bellil LM. Maternal characteristics, pregnancy complications, and adverse birth outcomes among women with disabilities. Med Care. 2015;53(12):1027-1032.

Mosher W, Bloom T, Hughes R, Horton L, Mojtabai R, Alhusen JL. Disparities in receipt of family planning services by disability status: New estimates from the National Survey of Family Growth. Disabil Health J. 2017;10(3):394-399.

Quint E, Signore C, Mahoney J. Reproductive health care for women with disabilities. Association of University Centers on Disabilities.

Ramjan L, Cotton A, Algoso M, Peters K. Barriers to breast and cervical cancer screening for women with physical disabilitiy: A review. Women Health. 2016;56(2):141-56.

Wu JP, McKee MM, McKee KS, Meade MA, Plegue M, Sen A. Female sterilization is more common among women with physical and/or sensory disabilities than women without disabilities in the United States. Disabil Health J. 2017;10(3):400-405.

Pharma-free

The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.