Reproductive Health

Optimal reproductive health demands equal access to inclusive, competent, and medically appropriate reproductive health services and information. Three important aspects of women’s reproductive health are:

• Contraception
• Pregnancy and Childbirth
• Well Woman Exam

The reproductive health of women with disabilities relies on the freedom to exercise their rights to decide whether to become pregnant and give birth, as well as the number, spacing, and timing of their children. It also involves the right to prevent unplanned pregnancies by having access to effective, affordable, and accessible methods of contraception. Research suggests that women with disabilities may receive sterilization at higher rates and certain types of birth control at lower rates than other women.¹ Women with disabilities also report experiencing both negative attitudes and misguided assumptions from clinicians when seeking contraceptive information, and inaccessible facilities and exam tables.^2,3 To learn more, visit our page on Contraception.

Women with disabilities are increasingly choosing pregnancy and childbirth.⁴ The abilities to conceive, carry a pregnancy to term, and have favorable pregnancy outcomes are generally not affected by physical disability⁵ although some women with disabilities experience more pregnancy and delivery complications than women in general.^5-8 However, with knowledgeable health care providers who focus more on the woman’s ability than her disability, most women with disabilities can give birth to healthy babies.⁹ To learn about pregnancy and childbirth risks related to specific disability types as well as  experiences of women with disabilities related to changes in body and mobility during pregnancy, pregnancy care, labor and delivery, breastfeeding, and maternal and infant health outcomes, visit our page on Pregnancy and Childbirth. We also offer information on LGBTQ Women and Pregnancy and Assisted Reproduction options for women who cannot or decide not to become pregnant.

A well woman exam, or annual visit to an obstetrician/gynecologist (OBGYN) or other healthcare provider for examination of the reproductive system, is central to maintaining reproductive health, identifying risk factors for disease, promoting prevention practices, and detecting problems requiring medical treatment or self-management. This exam usually includes an updated health history, an assessment of overall health, a pelvic exam, a clinical breast exam, orders for laboratory and other tests, and a discussion on ways to improve and maintain overall health. To learn more, visit our page on the Well Woman Exam.

Reproductive health is essential to the overall health and well-being of women with disabilities. Until recently, their reproductive health was a taboo topic because sexuality, conception, and parenting capabilities were not as well recognized in women with disabilities. Now, we see in the media, policy decisions, and the literature that there is growing respect and calls-to-action for women with disabilities’ reproductive health. There is recognition that women with disabilities are sexual beings with the same reproductive rights,¹⁰ desires¹¹ and needs for services as other women.⁵ Women with disabilities have the right to equitable access to reproductive health services including family planning/birth control, well woman exams, and pregnancy and maternal health services.

Reproductive health is essential to the overall health and well-being of women with disabilities. Until recently, their reproductive health was a taboo topic because sexuality, conception, and parenting capabilities were not as well recognized in women with disabilities. Now, we see in the media, policy decisions, and the literature that there is growing respect and calls-to-action for women with disabilities’ reproductive health. There is recognition that women with disabilities are sexual beings with the same reproductive rights,¹⁰ desires¹¹ and needs for services as other women.⁵ Women with disabilities have the right to equitable access to reproductive health services including family planning/birth control, well woman exams, and pregnancy and maternal health services.

Barriers to Services

When women with disabilities seek reproductive health services, they often face many complex barriers. Physically, many facilities and equipment are often inaccessible. Additionally, providers may lack information about a woman’s specific disability and the knowledge needed to accurately inform her about reproductive health issues and decisions. ^3,12

Attitudes and Assumptions

Families, medical providers, and the public often hold negative, paternalistic attitudes and judgments regarding the rights and abilities of a disabled woman to become pregnant and parent children.^13-15 People often falsely assume that women with disabilities are not sexually active and, therefore, not in need of the same reproductive health services as other women.

Disparities 

Despite the fact that decades have passed since the ADA was signed into law, women with disabilities continue to lack access to equitable reproductive health care, including prenatal care, preventive services, treatment, accurate information, and family planning services.^16-20 For more information, visit our page Pregnancy Disparities.

Lack of Information

A woman with a disability is the best source of information about her own body and its functioning. Nevertheless, women with disabilities need and deserve up-to-date and accurate reproductive health support and information throughout their lifetime — whether they are dealing with issues related to cancer screenings, menstruation, contraception, sexuality, sexually transmitted infections, pregnancy, breastfeeding, or menopause.^{13, 21-22}

Videos:

• Hillary Brown: Forgotten Reproductive Health in Women with Disabilities l TED Talk

Articles/ Blog Posts:

• Affirming Disability Rights in Sexual and Reproductive Health Care | International Women's Health Coalition 
• "We need to talk about disability as a reproductive justice issue" [Blog Post]
• Disability and Health Information for Women with Disabilities | CDC
• Girls with Disabilities Kept in Dark about Sexual and Reproductive Rights | Plan International

Fact Sheets/ Info Summaries:

• Sexual and Reproductive Health and Rights of Women and Girls with Disabilities (Easy Read Format) | Women Enabled
• Sexual and Reproductive Health and Rights of Women and Girls with Disabilities (Shorter Fact Sheet) | Women Enabled
• UN Policy brief for WWD reproductive health
• UN Infographic for accessing equal reproductive rights

Resources for Health Care Providers

• Reproductive Health Care for Women with Disabilities | AUCD
• Promoting Sexual and Reproductive Health for Persons with Disabilities | WHO                 
• Reproductive Health in WWD [Fact Sheet] | NACCHO

1. Mosher W, Hughes RB, Bloom TL, Horton L, Mojtabai R, Alhusen J.Contraceptive use by disability status: New national estimates from the National Survey of Family Growth. Contraception. 2018;97(6):552-558. doi: 10.1016/j
2. Nosek MA, Young ME, Rintala DH, Howland CA, Foley CC, Bennett JL. Barriers to reproductive health maintenance among women with physical disabilities. J Women's Health, 1995;4:505–518.
3. Becker H, Stuifbergen A, Tinkle M. Reproductive health care experiences of women with physical disabilities. Arch Phys Med Rehabil. 1997;78(12):S26–S33.
4. Iezzoni LI, Yu J, Wint AJ, Smeltzer SC, Ecker JL. Prevalence of current pregnancy among US women with and without chronic physical disabilities. Med Care. 2013;51(6):555-562. doi:10.1097/MLR.0b013e318290218d
5. Signore C, Spong CY, Krotosk D, Shinowara NL, Blackwell SC. Pregnancy in women with physical disabilities. J Obstet Gynecol. 2011;117(4):935–947. doi:10.1097/AOG.0b013e3182118d59
6. Darney BG, Biel FM, Quigley BP, Caughey AB, Horner-Johnson W. Primary cesarean delivery patterns among women with physical, sensory, or intellectual disabilities. Women's Health Issues. 2017;27:336–344.
7. Houtchens MK, Edwards NC, Schneider G, Stern K, Phillips AL. Pregnancy rates and outcomes in women with and without MS in the United States. Neurology. 2018;91: e1559–e1569.
8. Morton C, Le JT, Shahbandar L, Hammond C, Murphy EA, Kirschner KL. Pregnancy outcomes of women with physical disabilities: A matched cohort study. PM R. 2013;5: 90–98.
9. Smeltzer SC. Pregnancy in women with physical disabilities. J Obstet Gynecol Neonatal Nurs. 2007;36(1):88-96.
10. Silvers A, Francis L, Badesch B. Reproductive rights and access to reproductive services for women with disabilities. AMA J Ethics. 2016;18(4):430-437. doi: 10.1001/journalofethics.2016.18.4.msoc1-1604
11. Bloom TL, Mosher W, Alhusen J, Lantos H, Hughes RB. Fertility desires and intentions among U.S. women by disability status: Findings from the 2011-2013 National Survey of Family Growth.  Matern Child Health J. 2017;21(8):1606-1615. doi:10.1007/s10995-016-2250-3.
12. Nosek MA, Hughes RB, Howland CA, Young ME, Mullen PD, Shelton ML. The meaning of health for women with physical disabilities: A qualitative analysis. Fam Community Health. 2004;27:6 –21.
13. Andrews EE. Pregnancy with a physical disability: One psychologist’s journey. Spotlight on Disability Newsletter. Updated December 2011.
14. Nguyen TTA, Liamputtong P, Monfries M. Reproductive and sexual health of people with physical disabilities: A Metasynthesis. Sex Disabil. 2016;34:3–26. doi:10.1007/s11195-015-9425-5 
15. 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. doi:10.1016/j.dhjo.2016.12.020
16. Armour BS, Thierry JM, Wolf LA. State-level differences in breast and cervical cancer screening by disability status: United States, 2008. Women's Health Issues. 2009;19(6): 406-14. doi: 10.1016/j.whi.2009.08.006
17. Gavin NI, Benedict MB, Adams EK. Health service use and outcomes among disabled Medicaid pregnant women. Women's Health Issues. 2006;16(6):313-22. doi: 10.1016/j.whi.2009.08.006
18. Iezzoni LI, McCarthy EP, Davis RB, Siebens, H. Mobility problems and perceptions of disability by self- respondents and proxy respondents. Med Care. 2000;38(10):1051-1057.
19. Mosher W, Bloom TL, Hughes RB, Lantos H, Mojtabai R, Alhusen J.Disparities in receipt of family planning services by disability status: New estimates from the National Survey of Family Growth. Disabil Health J. 2017;10:394-399.
20. Nosek MA, Simmons DK. People with disabilities as a health disparities population: The case of sexual and reproductive health disparities. Calif J Health Promot. 2007;5:68-81.
21. Smeltzer SC, Mitra M, Long-Bellil L, Iezzoni LI, Smith LD. Obstetric clinicians' experiences and educational preparation for caring for pregnant women with physical disabilities: A qualitative study. Disabil Health J. 2018;11(1):8-13. doi:10.1016/j.dhjo.2017.07.004
22. Nosek MA, Hughes RB, Howland CA, Young ME, Mullen PD, Shelton ML.The meaning of health for women with physical disabilities: A qualitative analysis. Fam Community Health. 2004;27:6-21.