Disparities in Access to Sexual and Reproductive Health Care for Women with Physical, Intellectual, and/or Developmental Disabilities in the United States

Human Rights Research Center
1 hour ago
11 min read

April 30, 2026

A woman with transverse myelitis gets an ultrasound while in her wheelchair at the Accessible Care Pregnancy Clinic at Sunnybrook, a clinic for pregnant women with physical disabilities. [Image credit: Doug Nicholson]

Introduction

Considering that almost 25% of the United States (U.S.) population has some sort of disability, it is alarming that the presence of a disability is tied to barriers in seeking health care.¹ Compared with the general population, people with disabilities:

Are 1.75 times more likely to have unmet medical needs
Have almost 3 times the risk of death from avoidable causes
Have higher medical costs than the general population; about 5 times higher for people with intellectual and developmental disabilities and about 4 times higher for people with physical disabilities²

When disability intersects with another marginalized category (racial or ethnic minority, lower socioeconomic class, etc.) these disparities are multiplied.

For decades, people with disabilities, their caregivers, and their advocates have wanted the world to understand the hurdles that they face, not only in their everyday lives, but especially as they access health care.

Finally, in 2023, the National Institute on Minority Health and Health Disparities designated people with disabilities as a population that faces health disparities.

Health inequities for people with disabilities are prevalent throughout the lifespan, but are particularly critical in sexual and reproductive health care.

Sexual and reproductive health care services are an essential part of routine medical care for all women. The American College of Obstetricians and Gynecologists (ACOG) recommends a yearly well visit for all women over the age of 18 and those under 18 who are sexually active. This visit includes a physical exam, screenings for breast and cervical cancer, sexually transmitted infection testing, menstruation management, and general counseling. These visits are also an opportune time to screen for intimate partner violence and signs of sexual abuse.

Despite the passage of the Americans with Disabilities Act (ADA) in 1990, which requires equal access to all services for people with disabilities, including healthcare systems, disparities persist.

Although disability prevalence can be hard to quantify due to different definitions and varying self-identification, approximately 12% of women aged 18-44 have a disability affecting cognition (self-reported and ranging from mild autism to significant intellectual disability), and 5.5% have impaired mobility (defined as difficulty walking or climbing stairs).³ These estimates suggest that a large number of women of reproductive age are at risk of barriers to obstetric and gynecologic care. As discussed below, this results in women with disabilities being less likely to be up to date on screenings or exams like mammograms, Pap tests, and pelvic exams and less likely to receive counseling on contraceptive usage and family planning.⁴

Poor Health Outcomes

A recently published systematic review of the experiences of women with intellectual and developmental disabilities (IDD) accessing reproductive health services found mounting evidence that they experience lower rates of utilization and worse outcomes than women without IDD.⁵

While there is not a consensus on the extent of the discrepancy between Pap test rates of women with and without disability, there is agreement across many studies that women with disabilities are less likely to receive screening. One study found a gap as large as 93% of women with no physical limitations screened versus just 68% of women who were not ambulatory screened.⁶ The same is true of discrepancies in mammography rates.

Women with IDD had lower rates of contraception use and higher rates of unwanted pregnancy despite reporting similar rates of sexual activity as women without disabilities.⁷ Obstetrician-gynecologists (OB-GYNs) reported that when it comes to women with disabilities, they only initiate conversations about contraceptives about 50% of the time, however, when counseling women without disabilities, they initiate the conversation about 70% of the time.⁴

An important study published in the Journal of the American Medical Association reviewed maternal outcomes of over 200,000 women. After controlling for unrelated factors (social determinants and other health conditions), they found that women with disabilities had a higher risk of all adverse outcomes, including:

2 times higher risk of severe preeclampsia (prenatal high blood pressure)
11 times higher risk of maternal mortality (death)
23 times higher risk of sepsis (infection)

While these outcomes were not attributed to any specific factors, experts have called for more research into whether changes to medical training would improve these outcomes by increasing provider knowledge and comfort.

When women with disabilities do not get regular well-women visits or their provider focuses too much on their disability, they can also miss out on screening for violence or abuse. This is a real problem because women with disabilities are twice as likely as women without to experience sexual violence in their lifetime.⁸

The causes of these disparities are multifaceted, ranging from interpersonal to structural factors. Next, we explore the physical and philosophical barriers that women with disabilities experience as they seek sexual and reproductive health care services.

Inaccessible Clinic Spaces

Some of the routine testing that takes place during a visit with an OB-GYN or other women’s health provider typically requires specific patient positioning on an exam table. Not all women who use wheelchairs can transfer themselves from their chairs to an exam table, and not all offices have the staff capacity to assist.⁹

There are two pieces of medical equipment that can help with the transfer. A Hoyer lift is an electric or hydraulic device that uses a sling to transfer someone from one surface to another. Additionally, an exam table with adjustable height settings can significantly increase the ease and safety of the transfer. However, an audit of primary care offices in California found that just 6% had a lift to assist with transfers, and 20% had height-adjustable exam tables.¹⁰

Women with disabilities have some concerning experiences in accessing care, including being dropped while pregnant during a transfer to an exam table due to inadequate equipment. ¹¹ Some women reported that they missed out on prenatal exams altogether because they could not get onto an exam table. Others had to ensure they came with a partner or friend, as it was the only way they could be examined.¹¹

An important metric to monitor in pregnant women is weight, as sudden changes can indicate the onset of potentially life-threatening conditions.¹² A qualitative study published in the Journal of Women’s Health exploring the experiences of 22 women with mobility impairments as they navigated prenatal care revealed that none of them had regularly been weighed during their pregnancy.¹¹ Wheelchair scales allow people to remain seated and be weighed, but not all offices have them. The same audit mentioned above found that just 11% of offices had wheelchair scales.¹⁰ These inaccessible spaces prevent women with disabilities from receiving the same standard of care as women without disabilities.

Inaccessible spaces can also be dehumanizing. One woman who uses a wheelchair shared with a researcher that her OB-GYN insisted that she be weighed, even though the office did not have a wheelchair scale. When she pointed that out, the doctor suggested she go to the post office and use the cargo scale.¹¹ This suggestion placed responsibility on the patient rather than on the inadequacies of the clinical setting, an all too common experience for people with disabilities.

Insufficient Training

For providers to deliver quality health care, they must be properly trained and feel confident in their abilities. Historically, medical school curricula have either failed to include disability–specific training or have presented it from an ableist perspective.^13,14 Disability advocates have denounced the medical model of disability, as it views disability as a deficit that a person needs to overcome. The preferred social model of disability recognizes that it is societal structures that cause barriers for people with disabilities and not the disability itself. ¹⁴

Increased training can help to improve providers’ confidence. A survey of over 700 practicing physicians in the U.S. found that just 41% felt confident in their ability to provide the same quality of care to their patients with disabilities as their patients without disabilities.¹⁵ For OB-GYNs specifically, another survey found that only about 17% had received training on how to best provide care for women with disabilities, and only 20% responded that they definitely felt adequately equipped to care for their patients with disabilities.⁴

When providers are not prepared to care for their patients, the quality of patients’ care suffers. In a study of OB-GYNs, about 80% believed that women with disabilities were less likely “to receive comprehensive reproductive healthcare.” ⁴Women with disabilities who were interviewed about their sexual and reproductive healthcare shared that they could sense fear, negativity, and uncertainty from their providers, which made them uncomfortable.⁹ They also felt that their doctors were uneducated on the unique complexities that their disability contributed to their care affecting their safety, as well as diagnosis and treatment.¹¹

Providers’ Personal Biases and Misconceptions

Ableism is defined by the American Psychological Association as “prejudice and discrimination aimed at disabled people,” and it can be a conscious or unconscious bias.¹⁶ In the same survey of physicians mentioned above, over 80% believed that people with significant disabilities have a worse quality of life than people without disabilities; however, people with disabilities argue that that is not the case.¹⁵ When it comes to sexuality and intimate relationships, personal biases and misconceptions on the part of medical providers can affect the way they counsel their patients. Women with disabilities have reported that their providers have assumed that because of their disability, they are not sexually active or cannot become pregnant.⁹ There have also been instances of providers assuming that people with disabilities will not make good parents, partially due to the infantilization that often occurs with people with intellectual disabilities.⁹

A study of OB-GYNs revealed that, when discussing contraceptive options, they are more likely to recommend sterilization to women with disabilities than those without.⁴ When a woman decides that she does not want to have children or has finished having children, she can make the choice to be sterilized to prevent the possibility of future pregnancy. There are a few surgical options available which include either blocking or removing the fallopian tubes or removing the uterus entirely. A study published in 2018 found that women with disabilities were more likely to have undergone a sterilization procedure than women without disabilities and that they were having the procedures at younger ages.¹⁷ As mentioned above, there are providers with misguided beliefs that women with disabilities do not engage in sexual activity, should not engage in sexual activity, and are not fit to be parents. These misconceptions may contribute to higher rates of hysterectomy among women with disabilities, including procedures that are not medically indicated beyond contraception.¹⁸ Historically, there has been an issue of forced or coerced sterilization among marginalized populations, including those with disabilities.¹⁹

Additionally, because it is common for caregivers to make decisions for people with disabilities, many young women miss out on contraceptive counseling and sexually transmitted infection testing because, like many providers, their caregiver or parent does not think it is relevant to them.⁵ Overall, women reported that it is important for their providers and caregivers to have the proper training and equipment available and to trust them to be involved in their own care.

The infantilization of people with disabilities leads to overprotection: while this is usually done by well-meaning people, it can affect their autonomy. “Dignity of risk” is a philosophy that calls on others to respect the right of a person with disabilities to make their own informed decisions about their lives, experiences, and even medical care, even if those around them disagree due to perceived risk.²⁰ People with disabilities deserve the right to choose to do everything from snowboarding to dating despite the risk of physical or emotional harm, just as anyone else does.

Human Rights Implications

Disparities in accessing sexual and reproductive health care violate many of the human rights that women with disabilities should enjoy. Many of the barriers to care discussed here are legal violations related to noncompliance with the ADA. More than that though, they are personal violations of the dignity and rights of women with disabilities to access the same standard of care as others and to be treated as people and not just as their diagnosed disability.

Women with disabilities should have the same autonomy to make choices about their sexuality and intimate relationships. People with disabilities are capable of and very often actually are dating, falling in love, engaging in sexual activity, and choosing to marry or have a family. Medical providers, and society at large, must recognize and respect that and create a space where people with disabilities can feel supported in reaching their full potential.

This is an important topic for everyone to be aware of, but especially those who provide care for people with disabilities as a caregiver or medical professional. Below are some helpful resources to ensure the best health care for people with disabilities:

Sexual Health and IDD Resources from the Maryland Center for Developmental Disabilities at Kennedy Krieger Institute

Supporting people with intellectual disabilities with sexuality and relationships - Article in the Journal of Applied Research on Intellectual Disabilities

Supporting HPV Self Swab - An option for women with disabilities from Thomas Jefferson University and the Pennsylvania Developmental Disabilities Council

Glossary

Ableism - Prejudice and discrimination aimed at disabled people, often with a patronizing desire to “cure” their disability and make them “normal.”
Hoyer lift - A type of assistive device powered electrically or hydraulically used to transfer a person with limited mobility from one surface to another, often from a chair or wheelchair to a bed or exam table.
Intellectual and Developmental Disabilities (IDDs) - The collective term used to describe the presence of an intellectual and/or developmental disability in a person. An intellectual disability is one which is present before age 18 and can affect the ability to learn, reason, or problem solve and impact social skills. A developmental disability can be intellectual, physical, or both and also cause daily challenges. These disabilities can be present at birth or acquired.
Mammogram - An X-ray that can show abnormal areas of breast tissue and is used to screen for and help diagnose breast cancer.
Obstetrician-Gynecologist (OB-GYN) - A medical professional dedicated to the broad, integrated medical and surgical care of women's health throughout the lifespan.
Pap Smear/Pap Test - A cervical cancer screening test that involves removing cells from the cervix to examine them for infection, inflammation, or signs of cancer.

References/Footnotes

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