How Restricting Reproductive Rights Hurts People with Disabilities: A Review of Research Findings

Photo by Stephen Melkisethian. CC BY-NC-ND 2.0.

08/17/2022 10:00am

Key Findings 

  • In almost every state likely to ban abortion (“abortion-ban states”), a majority of women with disabilities of reproductive age have very low or low incomes (below 200 percent of the official poverty line). Nationwide, about 55 percent of low-income disabled women of reproductive age live in abortion-ban states. 
  • Access to adequate reproductive health care was more severely restricted for people with disabilities even before Dobbs. One survey found that 40.3 percent of women with disabilities thought their prenatal care provider knew little to nothing about how their disability would affect their pregnancy.
  • Health risks associated with pregnancy can be greater for people with disabilities. Women with disability risk are more likely to have pregnancy risks and adverse infant and maternal outcomes relative to those who did not show disability risk.
  • Unintended pregnancy, though an imperfect classification of pregnancy decision-making, may be more common for people with disabilities. One study reports that over half (53 percent) of disabled women described their pregnancies as unintended, compared to just over a third (36 percent) of women without disabilities.
  • Households containing a disabled adult need substantially more income on average—28 percent more income according to one recent study—than households with no disabled members to achieve the same standard of living. Costs associated with having children would add substantially to this financial strain.

Introduction

After the recent Supreme Court decision in Dobbs v. Jackson Women’s Health Organization, women around the country are reminded daily of their status as second-class citizens. In many states, abortion policies are already restrictive, and a handful have completely banned the practice. In other states, the jury is still out on the legality of various restrictions. Upcoming midterm elections will also play a role in determining where state abortion policies land. Recently, Kansas voters decisively struck down an amendment to the state constitution that would have paved the way for an abortion ban. 

On July 26th, amidst the backlash to Dobbs, the US celebrated the 32nd anniversary of the Americans with Disabilities Act. A week later, the Department of Justice sued Idaho to protect the reproductive rights of women who have the right to emergency treatment, including abortion as a necessary stabilizing treatment for an emergency medical condition, under federal law. The ADA anniversary and the DOJ lawsuit are reminders that people with disabilities who can become pregnant are among those most negatively impacted by state abortion bans and restrictions.

This article documents the prevalence of disability among women of reproductive age by state, disability status, type of disability, and income. It then chronicles findings from scholarly research that suggest women and people with disabilities who can become pregnant are at risk of greater harm if denied access to safe abortion services. Restricting access to those services could have dire consequences for disabled people for several reasons. 

First, people with disabilities already experienced increased difficulty accessing adequate reproductive health services before Dobbs. Second, health risks associated with pregnancy can be more severe for people with disabilities. Lastly, people with disabilities are more likely to experience unintended pregnancy and uncertainty about becoming pregnant. 

While this piece focuses on academic research, we should not lose sight of the fact that, as Kendall Ciesmier writes, “What chronically ill and disabled people need is autonomy to make the health care choices right for them. It’s what we all deserve.”

Disability and Economic Insecurity Among Women of Reproductive Age 

Of the nearly 74 million women of reproductive age (15–49) in the US, about 7 percent (5.2 million) have one or more disabilities. Just over half of disabled women of reproductive age (53 percent) live in the 26 states that have banned or are likely to ban abortion (see Table 1). In addition, about 55 percent of all disabled women of reproductive age in the US have very low or low incomes (below 200 percent of the official poverty line, or $26,600 in pre-tax income for a single adult living alone in 2019). The same is true in the 26 abortion-ban states.

Table 1: Women of Reproductive Age (15-49) in States Likely to Ban and States Not Likely to Ban by Income Level and Number of Disability Types
  United States States Likely to Ban States Not Likely to Ban
Number Percent Number Percent
All Income Levels 74,341,946 35,717,936 48.1% 38,624,010 52.0%
Have One Type of Disability 2,959,040 1,556,822 52.6% 1,402,218 47.4%
Have Two or More Types of Disability 2,236,135 1,189,969 53.2% 1,046,166 46.8%
Low Income 26,311,858 13,783,745 52.4% 12,528,113 47.6%
Have One Type of Disability 1,537,078 852,561 55.5% 684,517 44.5%
Have Two or More Types of Disability 1,333,498 733,446 55.0% 600,052 45.0%

Source: Author’s analysis of 2015–2019 American Community Survey 5-Year Estimates downloaded from IPUMS USA, University of Minnesota, www.ipums.org.

Note: Estimates of the prevalence of disability vary by the survey used and the disability questions asked. The American Community Survey likely provides a conservative estimate of disability prevalence but is used in this article because it has a large sample size that allows for reliable state-level estimates in all 50 states. A person is classified as having very low or low income if their pre-tax family income is below 200 percent of the official poverty line. The official poverty measure (OPM) is outmoded in many respects, but using 200 percent of the OPM line reasonably captures people who are economically insecure.

Economic insecurity is highest in West Virginia (68 percent), Mississippi (65 percent), and Kentucky (65 percent), but in almost every one of these 26 states (except Utah) a majority of women with disabilities of reproductive age live below 200 percent of the poverty line (see Figure 1). Texas, Florida, and Ohio are the three abortion-ban states with the highest number of disabled women of reproductive age. In these states, 53 percent, 54 percent, and 61 percent of disabled women of reproductive age, respectively, have very low or low incomes. Notably, these shares are lowest in Maryland, New Jersey, and Hawaii, where abortion bans are not being considered.

Figure 1

Access

Access to reproductive health care was more severely restricted for people with disabilities even before the Supreme Court reversed its Roe v. Wade ruling. For example, disabled women may be denied care by clinics due to their disabilities. Interviews conducted by Mitra and others in “Pregnancy among women with physical disabilities: Unmet needs and recommendations on navigating pregnancy” reveal that clinicians’ limited understanding of disabilities and their potential impacts on pregnancy is a major concern for disabled pregnant people. One mother in their study said, “You have to advocate, you have to do your homework, you have to know…what you need so that you can explain it to them [clinicians] and know when they’re off base.” Another study by Mitra and others, “Access to and Satisfaction with Prenatal Care Among Pregnant Women with Physical Disabilities: Findings from a National Survey,” found that 40.3 percent of women with disabilities surveyed thought their prenatal care provider knew little to nothing about how their disability would affect their pregnancy. 

Clinics themselves also pose barriers to reproductive care for people with disabilities. For example, facilities may have narrow doorways or use equipment that require patients to stand (e.g., scales, mammography machines). In “Experiences of Women With Disabilities in Accessing and Receiving Contraceptive Care,” Horner-Johnson and others find that patients with physical disabilities often struggle to mount examination tables when lifts are not provided, while people with sensory disabilities have difficulty with paperwork and obtaining American Sign Language interpreters. Mitra and others also found that physical accessibility ranked highly among disabled women’s top unmet needs during pregnancy. Some with physical disabilities reported that their spouses were expected to transfer them to the examination table. Others described the arduous process of being weighed on scales that required the patient to stand. 

Reproductive health information and education is also often inaccessible to people with disabilities. “Health knowledge and the impact of social exclusion on young people with intellectual disabilities,” by Pownall and others, found that a group of young people with mild intellectual disabilities and another with physical disabilities had more limited understanding of personal health issues like pregnancy and contraception than their peers without disabilities. McCabe reinforces these findings. When asked about 11 different topics related to sex and sexuality, people with intellectual and physical disabilities demonstrated less knowledge across the board. In addition, while the general population was more likely to report learning about sexuality through friends and family, disabled respondents’ primary source of sex education was through media and formal classes where asking questions might not be possible or comfortable. A study of deaf and hearing college students found that hearing students were significantly more knowledgeable about sexuality (although neither group was highly informed). Many studies suggest that societal views that characterize disabled people as asexual or incapable of sexual activity may contribute to this dearth of reproductive health education.  

Health Risks

The potential health risks associated with pregnancy can be greater for people with disabilities. A meta-analysis, conducted by Tarasoff and others, to examine the relationship between maternal disability and pregnancy complications found that women with disabilities had an increased risk of hypertensive disorders and cesarean delivery. In “The Intersection of Disability and Pregnancy: Risks for Maternal Morbidity and Mortality,” Signore and others review evidence of specific health conditions arising for women with disabilities, such as infection, hemorrhage, cardiomyopathy, thromboembolic disease, and other cardiovascular diseases. They note, however, that more studies are needed on associations between specific disabilities and health conditions before, during, and after pregnancy. 

A study by Clements and others, used hospital records to identify associations between disability risk (i.e., risk of developing a disability due to a preexisting health condition) and maternal and infant outcomes. They found that women with disability risk were more likely to have pregnancy risks and adverse infant and maternal outcomes relative to those who did not show disability risk. For example, women at risk for disability were almost twice as likely to have a preterm birth and more than three times as likely to experience extended hospitalization. Another study found similar results for women with intellectual and developmental disabilities, who were more likely to have a preterm birth, low birth weight, and stillbirth. 

Notably, pregnancy may also worsen existing disabilities or cause new ones to arise. Italian researchers found that women with multiple sclerosis who experienced a relapse in the year leading up to conception were more likely to see their disability worsen in the longer term. A study in Norway found that positive posterior pelvic pain provocation test results early in pregnancy were associated with disability in later stages. Others have documented that lupus, thrombophilia, migraines, heart disease, sickle cell disease, hypertension, and thrombocytopenia are strongly associated with pregnancy-related stroke resulting in disability.

Unintended Pregnancy

Unintended pregnancy is a common reason for seeking an abortion. Several studies report that people with disabilities may be more likely to experience unintended pregnancy than those without disabilities. Research, conducted by Horner-Johnson and others, found that over half (53 percent) of disabled women described their pregnancies as unintended, compared to just over a third (36 percent) of women without disabilities. Among the different types of disabilities identified by the researchers, those with independent living, hearing, and cognitive disabilities were most likely to report unintended pregnancy. It is important to note that viewing pregnancy decision-making as binary—that is, as either intended or unintended—may fail to capture the nuance and complexity involved in the pregnancy planning process. Gomez and others propose acceptability as a useful alternative.

A study by Shandra and others found that women with disabilities who did not yet have children were more likely to express uncertainty about their intentions to have children when compared to nondisabled women. They were also more likely to want additional children but not plan on having them. Another study by Wu and others explored unplanned pregnancy and contraceptive use among reproductive-age women with physical and sensory disabilities. The authors found that 27 percent of women with disabilities at risk of unplanned pregnancy did not use contraceptives. Disability was also associated with reduced use of highly and moderately effective contraceptives versus less effective ones. 

People with disabilities may also be more likely to experience intimate partner violence, in some cases leading to unintended pregnancy. A study by Barrett and others found that women with disabilities were over 10 percentage points more likely to experience intimate partner violence than women without disabilities. Another study by Casteel and others found that women with disabilities that severely limited daily activities were four times as likely to experience sexual assault, compared to women without disabilities. The Bureau of Justice Statistics has reported that disabled individuals are over three times more likely than those without disabilities to experience rape or sexual assault, among other types of serious violent crime. 

Economic Consequences

People with disabilities likely face a greater financial burden during pregnancy. Research by Peterson and others have shown that expecting parents are more likely than other reproductive-age adults to experience catastrophic health expenditures. Parents with low incomes were even more affected and often relied on public insurance to ease the financial strain. 

Pregnancy-related expenses could be crushing for the nearly one-fourth of people with disabilities living below the poverty line. Many must already contend with a higher cost of living, magnified by out-of-pocket expenses that health insurance will not cover, such as home modifications and personal care assistants. A study by Goodman and others estimated that households containing one disabled adult need 28 percent more income on average than households with no disabled members to achieve the same standard of living. 

Conclusion

Inadequate reproductive care, heightened health risks, and increased likelihood of unintended pregnancy make access to safe, legal abortion vital for people with disabilities. While even states with total bans allow exceptions when the life of the person giving birth is at risk, the same cannot be said for threats to physical health. In theory, these exceptions should make abortion procedures widely available. In practice, they may do little to protect women who experience life-threatening pregnancy complications and create confusion for health care professionals about when abortion is legal. In the wake of Dobbs, the best hope for women with disabilities and anyone who may become pregnant is federal legislation that protects their reproductive freedom. Without it, states led by conservative lawmakers will continue to restrict essential abortion services until little, if anything, is left.

It is important to point out that even in states that will continue to protect parents’ right to choose, providing robust reproductive health and abortion services, health care providers must do more to respond to the needs of people with disabilities. All components of clinic visits should be made accessible, and targeted educational materials made available. In addition, society must change its inaccurate and stigmatizing views of disabled people’s sexuality. Only when these harmful beliefs change will reproductive health care be truly inclusive. 

Finally, many of the studies reviewed for this article call for better data collection on the pregnancy experiences of women and people with disabilities. Future research should explore how specific disabilities might influence the experiences of access, health risks, and intendedness described above. 

Note: This article uses person-first and identity-first language interchangeably following reasoning provided by the Center for American Progress in their recent report addressing similar topics.

Appendix

Appendix Table 1: Disabled Women of Reproductive Age by State and Disability Type
State Has Only One Disability Type Has Multiple Disability Types Total State Ban or Likely to Ban
Hearing Vision Cognition Ambulation Independent Living Personal Care
Alabama 6,048 10,968 19,888 15,190 4,169 497 47,664 104,424 Yes
Alaska 1,132 1,218 3,020 1,085 666 0 5,473 12,594 No
Arizona 8,924 12,893 21,629 12,679 6,813 631 45,561 109,130 Yes
Arkansas 4,581 7,157 13,177 8,722 3,194 364 31,573 68,768 Yes
California 39,668 58,991 97,423 49,798 29,860 3,875 204,184 483,799 No
Colorado 7,210 9,491 17,896 6,889 5,587 463 33,263 80,799 No
Connecticut 3,266 4,746 12,228 4,299 2,970 210 20,836 48,555 No
Delaware 1,174 1,392 3,861 1,729 773 97 5,449 14,475 No
District of Columbia 923 2,554 2,969 2,012 433 77 4,582 13,550 No
Florida 20,296 32,038 58,932 31,504 14,041 1,911 125,948 284,670 Yes
Georgia 11,996 22,159 36,283 23,083 9,275 1,099 70,156 174,051 Yes
Hawaii 1,192 1,674 2,628 1,715 976 138 6,018 14,341 No
Idaho 2,234 2,880 6,991 2,679 2,233 310 14,903 32,230 Yes
Illinois 12,081 17,843 33,619 19,277 9,977 896 71,027 164,720 No
Indiana 8,431 11,069 27,798 13,840 6,831 414 55,776 124,159 Yes
Iowa 3,369 4,572 11,165 3,522 2,881 270 19,226 45,005 Yes
Kansas 4,261 5,578 11,912 4,401 3,262 199 22,752 52,365 No
Kentucky 7,249 10,701 22,357 12,140 5,663 294 50,497 108,901 Yes
Louisiana 6,566 14,638 21,315 9,890 4,245 425 39,908 96,987 Yes
Maine 1,586 1,600 6,921 2,163 2,301 234 14,115 28,920 No
Maryland 6,671 8,465 21,646 8,763 4,587 654 33,847 84,633 No
Massachusetts 7,152 9,550 28,072 9,460 6,917 614 42,654 104,419 No
Michigan 12,604 16,120 44,523 20,724 10,692 771 85,209 190,643 Yes
Minnesota 6,646 6,434 21,344 6,063 4,998 529 32,614 78,628 No
Mississippi 3,090 7,506 12,405 8,436 4,168 266 29,899 65,770 Yes
Missouri 7,112 10,256 26,241 12,800 6,009 417 51,739 114,574 Yes
Montana 1,481 1,292 4,276 1,551 999 63 7,317 16,979 Yes
Nebraska 2,414 3,378 7,113 2,582 1,455 131 11,289 28,362 Yes
Nevada 3,472 7,089 8,016 5,291 2,238 196 20,922 47,224 No
New Hampshire 1,617 1,588 5,896 1,802 1,593 50 9,782 22,328 No
New Jersey 6,620 11,758 20,302 10,076 5,790 1,074 41,930 97,550 No
New Mexico 2,498 4,643 7,575 3,815 2,648 295 18,284 39,758 No
New York 17,725 28,920 59,819 32,929 16,145 2,144 119,450 277,132 No
North Carolina 12,906 19,198 35,459 20,219 8,555 1,134 76,019 173,490 No
North Dakota 810 999 3,344 483 731 42 3,970 10,379 Yes
Ohio 14,695 19,393 53,311 23,697 11,686 1,263 96,949 220,994 Yes
Oklahoma 5,961 10,586 17,249 9,950 4,344 397 37,139 85,626 Yes
Oregon 6,600 6,125 20,727 6,058 5,903 374 34,783 80,570 No
Pennsylvania 15,837 20,491 59,440 21,698 14,460 1,637 105,562 239,125 No
Rhode Island 1,546 1,564 5,084 2,016 1,090 108 9,161 20,569 No
South Carolina 6,030 11,392 17,580 10,316 4,380 445 38,013 88,156 Yes
South Dakota 1,346 1,422 3,269 1,012 568 66 4,808 12,491 Yes
Tennessee 9,478 14,251 27,523 16,305 7,452 895 62,598 138,502 Yes
Texas 36,579 61,289 88,976 45,176 21,857 2,450 179,924 436,251 Yes
Utah 3,874 5,427 12,616 4,536 3,415 204 19,353 49,425 Yes
Vermont 1,257 839 2,689 1,191 811 5 5,156 11,948 No
Virginia 8,725 14,222 30,708 13,140 8,101 794 53,787 129,477 No
Washington 10,183 11,657 28,632 13,133 8,661 633 54,516 127,415 No
West Virginia 2,871 3,653 8,234 5,299 2,182 74 21,158 43,471 Yes
Wisconsin 6,395 7,223 23,438 8,368 5,311 357 35,287 86,379 Yes
Wyoming 1,290 974 2,344 1,177 519 55 4,105 10,464 Yes
Total 377,672 561,866 1,139,863 554,683 294,415 30,541 2,236,135 5,195,175  

Source: Author’s analysis of 2015–2019 American Community Survey 5-Year Estimates downloaded from IPUMS USA, University of Minnesota, www.ipums.org. 

Note: The American Community Survey does not provide detail on respondents’ specific disabilities. Many different disabilities are represented in each of the categories presented here.

 

Appendix Table 2: Disabled Women of Reproductive Age by State and Income Level
State Women of Reproductive Age State Ban or Likely to Ban
Number with Any Disability Number Low Income Percent Low Income
Alabama 104,424                       63,007 60.3% Yes
Alaska 12,594                         5,894 46.8% No
Arizona 109,130                       58,545 53.6% Yes
Arkansas 68,768                       44,231 64.3% Yes
California 483,799                     239,296 49.5% No
Colorado 80,799                       39,001 48.3% No
Connecticut 48,555                       24,573 50.6% No
Delaware 14,475                         7,059 48.8% No
District of Columbia 13,550                         7,921 58.5% No
Florida 284,670                     154,060 54.1% Yes
Georgia 174,051                       97,014 55.7% Yes
Hawaii 14,341                         6,538 45.6% No
Idaho 32,230                       18,009 55.9% Yes
Illinois 164,720                       86,695 52.6% No
Indiana 124,159                       73,452 59.2% Yes
Iowa 45,005                       25,972 57.7% Yes
Kansas 52,365                       28,694 54.8% No
Kentucky 108,901                       70,646 64.9% Yes
Louisiana 96,987                       58,765 60.6% Yes
Maine 28,920                       18,509 64.0% No
Maryland 84,633                       35,974 42.5% No
Massachusetts 104,419                       54,826 52.5% No
Michigan 190,643                     111,656 58.6% Yes
Minnesota 78,628                       41,153 52.3% No
Mississippi 65,770                       42,832 65.1% Yes
Missouri 114,574                       70,413 61.5% Yes
Montana 16,979                         9,408 55.4% Yes
Nebraska 28,362                       16,297 57.5% Yes
Nevada 47,224                       25,135 53.2% No
New Hampshire 22,328                       11,736 52.6% No
New Jersey 97,550                       42,908 44.0% No
New Mexico 39,758                       24,753 62.3% No
New York 277,132                     158,253 57.1% No
North Carolina 173,490                       99,144 57.1% No
North Dakota 10,379                         5,685 54.8% Yes
Ohio 220,994                     135,430 61.3% Yes
Oklahoma 85,626                       50,650 59.2% Yes
Oregon 80,570                       46,126 57.2% No
Pennsylvania 239,125                     136,623 57.1% No
Rhode Island 20,569                       11,910 57.9% No
South Carolina 88,156                       49,736 56.4% Yes
South Dakota 12,491                         7,317 58.6% Yes
Tennessee 138,502                       85,600 61.8% Yes
Texas 436,251                     229,773 52.7% Yes
Utah 49,425                       22,968 46.5% Yes
Vermont 11,948                         6,644 55.6% No
Virginia 129,477                       62,670 48.4% No
Washington 127,415                       62,534 49.1% No
West Virginia 43,471                       29,470 67.8% Yes
Wisconsin 86,379                       49,471 57.3% Yes
Wyoming 10,464                         5,600 53.5% Yes
Total 5,195,175                  2,870,576 55.3%  

Source: Author’s analysis of 2015–2019 American Community Survey 5-Year Estimates downloaded from IPUMS USA, University of Minnesota, www.ipums.org.

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