Provision of Reproductive Healthcare to Women with Disabilities: A Survey of Obstetrician–Gynecologists' Training, Practices, and Perceived Barriers

Abstract

Purpose: The purpose of this study was to document current awareness, attitudes, and training regarding the care of women with disabilities by obstetrician–gynecologists (ob-gyns) and explore barriers that may explain observed discrepancies in care.Methods: One thousand ob-gyns, including 500 members of the Collaborative Ambulatory Research Network (CARN), were surveyed on practice accessibility, training, awareness, barriers, beliefs, comfort, challenges, practices, contraceptive counseling, and preconception/pregnancy counseling.Results: CARN, 49.0%, and non-CARN, 19.4%, members completed the survey for an overall response rate of 33.9%. Most respondents indicated feeling “somewhat” (57.5%) or “very” (21.9%) aware of the special healthcare needs of women with disabilities. Only 17.2%, however, received any information or training on the provision of healthcare to women with disabilities. Eighty-one percent agreed somewhat or strongly that women with disabilities are less likely to receive comprehensive reproductive healthcare. Respondents who provided contraceptive counseling (94.3%) initiated it with women of reproductive age who did not have a disability more frequently than those who had a disability. Finally, only 19.3% felt “definitely” adequately equipped to manage the pregnancies of women with disabilities.Conclusion: Women with disabilities require reproductive healthcare no less than women without disabilities; however, the evidence consistently identifies disparities. This study suggests that while ob-gyn providers are aware of these issues, they lack adequate training and resources to provide equal care.

Preconception Health Risks Among U.S. Women: Disparities at the Intersection of Disability and Race or Ethnicity

“…Unfortunately, few clinicians receive instruction in addressing biases or knowledge gaps about disability. A recent survey of U.S. obstetrician-gynecologists found that only 17% had received any information or training on provision of care to women with disabilities (Taouk, Fialkow, & Schulkin, 2018). The Alliance for Disability in Health Care Education (2019) has developed a minimum set of disability competencies clinicians should be expected to demonstrate.…”

Associations between Disability and Infertility among U.S. Reproductive-Aged Women

“…The lack of adequate medical training with respect to patients with disabilities have contributed to increased negative medical encounters for WWD and, ultimately, inadequate preconception care even among those with medical insurance. A survey sent to a random sample of 1000 OBGYN physicians across the US reported that while most respondents indicated feeling “somewhat” (57.5%) or “very” (21.9%) aware of the special healthcare needs of WWD, only 17.2% received any information or training on the provision of healthcare to WWD [ 40 ]. A large survey of medical school deans suggested that medical students receive limited training in the care of people with disabilities and therefore may not be able to adequately meet the competencies [ 41 ].…”

Perceived Barriers to Gynecologic Care by Women Who Use Wheelchairs

“…Many hypotheses exist as to why women with mobility impairments face barriers in achieving adequate healthcare. From the patient’s perspective, these barriers include inaccessible facilities, improper scheduling techniques, inadequate appointment length, lack of training for transferring the patient, and prior unpleasant healthcare experiences [ 3 , 4 ]. Fewer than a quarter of obstetrician-gynecologists (OB/GYNs) received any training on providing healthcare to women with disabilities, resulting in deficits in knowledge, skills, and attitudes in caring for this population [ 4 ].…”

“…From the patient’s perspective, these barriers include inaccessible facilities, improper scheduling techniques, inadequate appointment length, lack of training for transferring the patient, and prior unpleasant healthcare experiences [ 3 , 4 ]. Fewer than a quarter of obstetrician-gynecologists (OB/GYNs) received any training on providing healthcare to women with disabilities, resulting in deficits in knowledge, skills, and attitudes in caring for this population [ 4 ]. Providers often assume women with disabilities are less sexually active, leading to improper counseling on reproductive healthcare [ 4 ].…”

“…Fewer than a quarter of obstetrician-gynecologists (OB/GYNs) received any training on providing healthcare to women with disabilities, resulting in deficits in knowledge, skills, and attitudes in caring for this population [ 4 ]. Providers often assume women with disabilities are less sexually active, leading to improper counseling on reproductive healthcare [ 4 ]. Physicians who provide contraceptive counseling do so less often with patients with a physical disability than those with typical mobility [ 4 ].…”