Reproductive Rights and Access to Reproductive Services for Women with Disabilities

Abstract

Are women with disabilities owed equitable access to reproductive health services, including family planning, contraception, screening for sexually transmitted infections, maternal health services, and fertility services? Or are there circumstances in which disability is a reason to deny access to such services? Conversely, should women with certain disabilities have access to procedures such as caesarean section or sterilization? May these procedures be recommended just because a woman has a disability or imposed on her if she appears reluctant or unable to consent? Treating People with Disabilities: Equitable Access is Key Legal and professional answers to the questions posed above have been strongly in favor of equitable access to treatment and autonomous decision making for patients with disabilities. Physicians' offices, clinics, hospitals, and other medical facilities are required by the Americans with Disabilities Act (ADA) of 1990 to provide meaningful access to the services they provide for people with disabilities who meet essential eligibility requirements, with or without accommodations. These providers may also be covered by state antidiscrimination laws. Meaningful access is a legal standard that calls for a fact-specific inquiry into whether individuals with disabilities are afforded equitable opportunity to benefit from the provider's services [1, 2]. The focus is on whether the individual's disability has occasioned loss of equitable opportunity to receive the same quality of medical services, rather than the same resulting benefit, as that afforded to other people. A site that dispenses medical treatment would not meet this access standard if, for example, a speech-output version of the usual printed directions for taking medications was not provided to visually impaired patients, or if deaf patients could not participate with their physician in conversations about treatment choices for lack of an ASL interpreter. To use another illustration, inaccessible examination equipment continues to be a problem despite the ADA [3]. A common example is the absence of examination tables that lower to facilitate transferring from a wheelchair to the table, preventing wheelchair users from being properly examined. This subjects them to limited, substandard, noncomprehensive care [4]. As a general matter, data indicate that adults with disabilities, especially women, receive less access to needed health care even when controlling for variables such as socioeconomic status [5].

Contraceptive Provision to Women With Intellectual and Developmental Disabilities Enrolled in Medicaid

“…[3][4][5][6] Contrary to misconceptions that people with intellectual and developmental disabilities are sexually inactive, young women with and without intellectual and developmental disabilities have similar agespecific fertility rates. 7,8 Young people with mild or moderate intellectual disabilities are also more likely to engage in sex without precautions or contraception. 9 Intellectual and developmental disabilityrelated concerns exist around contraceptive use (eg, prescription adherence, consent); analysis of the 2012 Massachusetts All-Payer Claims Database identified provision disparities by intellectual and developmental disability status.…”

The Use of Self-Reported Functional Limitation to Examine Pregnancy and Reproductive Health Experiences in a National Sample of Women

“…Among other protections, the ADA requires all doctors' offices provide meaningful access to their services for people with disability, regardless of whether the disability requires accommodations. 1 The implementation of this policy, along with the growing momentum of the disability and reproductive rights movements, has led to increased reproductive autonomy for women with disability (WWD).…”