Disability and women's health

History of disabled women's healthcare

Women with physical and or intellectual disabilities often face a medical bias within their communities. Factors can include unconscious bias, symptoms, negative perceptions, and even harsh assessments that can contribute to such discrimination.

Women with disabilities, especially individuals who belong to minority groups or who live in rural settings, are often underserved in their healthcare needs. In addition, women with disabilities are more likely to live in poverty, which puts them at a greater health risk. In general, because of a lack of social connectedness that many disabled women experience, they often become disconnected from sources of support which can include healthcare providers. In Brazil, women with disabilities are also less likely to seek out gynecological health care due to various reasons, including cultural attitudes and cost.

When disabled women need routine services for anything other than their main impairment(s), they can be perceived as "problematic patients" by healthcare providers. Women with disabilities have reported that they are seen through the lens of their disability first and as a person second by healthcare providers.

Women with intellectual disabilities have been advised to become sterilized to possibly prevent sexual assault or because doctors may consider them unfit to become mothers. In the United States, a 1927 Supreme Court case, Buck v. Bell, allowed the forced sterilization of women with intellectual disabilities. In Singapore, the Voluntary Sterlisation Act (VSA) was passed in 1970 and which allowed any spouse, parent or guardian of persons who are "afflicted with any hereditary form of illness that is recurrent, mental illness, mental deficiency or epilepsy" to consent to the sterilization on their behalf. In Brazil, many healthcare providers and individuals with disabilities both see sterilization as the only option for contraception.

Accessibility of annual women's wellness visits

Healthcare professionals are less likely to refer women with disabilities for various gynecological screenings. This could be due to the healthcare provider's unfamiliarity with disability or the assumption that women with disabilities are asexual in nature. Women who have a spinal cord injury above the T6 vertebra can have autonomic dysreflexia during a pelvic exam which can be life-threatening. Women with intellectual disabilities are less likely to receive Pap smears because the process may be upsetting to the patient.

In the case that the examination table cannot be lowered during a Pap smear, women with physical disabilities can use alternative examination positions during the procedure, such as knee-chest position, diamond-shaped position, M-shaped position and V-shaped position. These alternative procedures can accommodate women who are unable to position their feet into stirrups or need greater body support. In addition, lithotomy stirrups can be used for additional comfort.

The Welner table, designed by American obstetrician-gynecologist and disability rights activist Sandra Welner, is an examination table designed with a wider range of adjustments and positions to facilitate accessibility for both patients and doctors with physical disabilities. Welner also compiled the handbook, Welner's Guide to the care of women with disabilities.

Accessing reproductive healthcare

Here are some places where women with disabilities can look for healthcare resources. An important first place to look is the CDC's Disability and Health Information for Women. This site discusses has flyers advocating for breast cancer screenings and cervical cancer screenings. Additionally, this site links to the Center for Research on Women with Disabilities. This site has a reproductive care section that links to information on accessing contraception, pregnancy and childbirth Q&As, the "well-woman" exams, as well as links out to additional information, flyers, and videos.

Contraception

Contraceptives are used by women with intellectual disabilities for various reasons, including pregnancy prevention, menstrual suppression, and management of teratogenic medications. Women with intellectual disabilities may be more likely to use contraceptives or undergo a hysterectomy to manage menstruation. Different types of contraception are available to women with disabilities, but the prescription of a specific type of birth control is based on the type of disability and the associated side-effects.

Menstrual cycles are sometimes affected by different types of disabilities, such as rheumatoid arthritis. In addition, women who become disabled later in life sometimes experience transient menstrual disorders.

A study conducted in 1989 found that 19% of women with physical disabilities had been counseled on sexuality in a medical setting and were rarely offered information about contraceptives. Women with intellectual disabilities often lack both education about sexual health and the ability to learn about it informally. In addition, their medical providers are less likely to discuss contraception with them. Women with intellectual disabilities are often encouraged to use supported decision-making with family members or other support persons to determine their preferred contraceptive option.

Attitudes regarding disabled women accessing contraception range globally. For example, Zimbabwean women with disabilities faced negative attitudes about their reproductive health, such as those of female nurses who expressed the idea that "sex was not meant for the disabled."

Maternity care

Some studies have highlighted potential obstacles for pregnant women with disability. For example, a 1996 study discovered that over 50% of United States hospitals lacked the necessary infrastructure to cater to the needs of physically disabled pregnant women, which rendered their facilities inaccessible. These barriers may include lack of adjustable examination tables, wheelchair compatible features, and accessible weight scales.

More recent research has continued to demonstrate disparities that disabled pregnant women experience in accessing their maternity care. A 2017 study grouped barriers that physically-disabled pregnant women face into four main categories, or "levels." These levels include the practitioner level, in which medical professionals are unwilling to provide care, the clinical practice level, where there is a lack of accessible examination equipment, the system level, where there are specific time limits and coverage issues, and finally the barriers to research, specifically for disability-specific clinical data.

Expectant mothers with intellectual disabilities may need more specialized training and guidance in regards to childcare after they give birth. Important themes in training may include consistent formal obstetric training and education for both providers and mothers.

Breast health

Many women with a disability do not regularly receive or are not regularly referred for breast cancer screenings. These women are still at risk of developing breast cancer. Therefore, access to breast health resources is crucial for women with disabilities.

Some women with disabilities may be unable to receive breast cancer screening due to financial concerns. It can also be difficult to access these screenings. For example, women with some physical disabilities may need to be referred to special mammography centers because most equipment is not designed to accommodate individuals who are unable to stand.

Menopause and later life

In some instances, women with disabilities may experience menopause more severely. Specifically, women with intellectual disabilities have been found to be at risk for a broader range and more severe menopausal symptoms, especially when there are other underlying health issues at play.

Women with physical disabilities are at a greater risk of having lower bone mass and are at risk for osteoporosis. Women with ID and Down syndrome often go through menopause at an earlier age than other women. Women with various disabilities sometimes show different symptoms from decreased estrogen levels during menopause.

Loss of estrogen after menopause can also lead to a greater likelihood of urinary incontinence. Treatment and therapy interventions for incontinence have not been tested or modified for women with disabilities.