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Research

Pregnancy Disparities

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Women with disabilities face multiple barriers that can negatively affect their pregnancy-related experiences and outcomes.1 For example, they often lack access to information and care during preconception and pregnancy.2-5 As a result, they may experience elevated rates of pregnancy- and childbirth-related risks and negative experiences including:

  • Risk of poor preconception health, or poor health during the reproductive years, due to smoking, lack of exercise and other unhealthy behaviors during the preconception period.6-7
  • Risk for unplanned pregnancy, medically unnecessary cesarean (C-section) delivery, less emotional support and increased depression after delivery, and intimate partner violence around the time of pregnancy.4,5,8-13
  • Risk for pregnancy complications and unfavorable birth outcomes such as prematurity and low birth weight.1,4,14-17
  • Possibly at greater risk for physical abuse before pregnancy, during pregnancy, or during either time, compared to women without disabilities.13
  • Women with disabilities and women without disabilities are equally likely to want to have a baby; however, women with disabilities are less likely to intend to have a baby in the future.19 Future research is needed to determine the perceived risks, concerns, and barriers influencing a woman with a disability to desire pregnancy but not intend to get pregnant.
  • Racial and ethnic disparities in women’s reproductive health are well-documented20-21 including in the context of disability.22 For example, non-Hispanic black women with disabilities have been shown to be less likely to receive family planning services than other women.23

Women with disabilities also continue to face substantial barriers to equal access to health care for pregnancy and childbirth including:

  • Inaccessible facilities and exam rooms, and lack of adjustable examination tables and  platform scales to weigh women in their wheelchairs to document weight gain during pregnancy.4,24
  • Lack of trained staff available to assist with services such as undressing and dressing per the woman’s request, getting on or off the exam table as needed, or getting into an appropriate position for the examination.25
  • Encounters with providers who:
    • Do not provide adequate time for a thorough exam, the necessary patient education, or experience based on disability-specific training.4, 24, 26-30,
    • Do not provide appropriate pain relief during labor and delivery28
    • Demonstrate discriminatory attitudes about disabled women’s childbearing desire and intentions.5,30

Women with disabilities have the right to seek legal assistance and call attention to reproductive health services that are not accessible, do not provide reasonable accommodation, or are not acceptable for other reasons. To learn about filing a disability discrimination claim, see Legal Resources below.

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Reference List

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  1. Signore C, Spong CY, Krotoski D, Shinowara NL, Blackwell SC. Pregnancy in women with physical disabilities. Obstet Gynecol. 2011;117(4):935–947. doi:10.1097/AOG.0b013e3182118d59
  2. Blackford K, Richardson H, Grieve S. Prenatal education for mothers with disabilities. J Adv Nurs. 200;32:898–904.
  3. Gavin NI, Benedict MB, Adams EK. Health service use and outcomes among disabled Medicaid pregnant women. Womens Health Issues. 2006;16(6):313–322.
  4. Mitra M, Long-Bellil LM, Iezzoni LI, Smeltzer SC, Smith LD. Pregnancy among women with physical disabilities: Unmet needs and recommendations on navigating pregnancy. Disabil Health J. 2016;9(3):457-463. doi:10.1016/j.dhjo.2015.12.007
  5. Streur SC, Schafer CL, Garcia VP. “He told me it would be extremely selfish to even consider [having kids]”: The importance of reproductive health to women with spina bifida and the lack of support from their providers. Disabil Health J. 2020;13. doi:10.1016/j.dhjo.2019.06.004
  6. Mitra M, Lu E, Diop H. Smoking among pregnant women with disabilities. Womens Health Issues. 2012;22(2):e233-9.
  7. Mitra M, Clements KM, Zhang Y, Smith LD. Disparities in adverse preconception risk factors between women with and without disabilities. Matern Child Health J. 2015; doi: 10.1007/s10995-015-1848-1.
  8. Abati E, Stefani C. Pregnancy outcomes in women with spinal muscular atrophy: A review. J Neurol Sci. 2018;388:50-60. doi:10.1016/j.jns.2018.03.001
  9. Alhusen JL, Bloom T, Anderson J, Hughes RB. Intimate partner violence, reproductive coercion, and unintended pregnancy in women with disabilities. Disabil Health J. 2020;13(2);100849. doi:10.1016/j.dhjo.2019.100849
  10. Biel F, Darney B, Caughey A, Horner-Johnso W. Medical indications for primary cesarean delivery in women with and without disabilities. J Matern Fetal Neonatal Med. 2019; doi:10.1080/14767058.2019.1572740
  11. Darney BG, Biel FM, Quigley BP, Caughey AB, Horner-Johnson W. Primary cesarean delivery patterns among women with physical, sensory, or intellectual disabilities. Womens Health Issues. 2017;27:336–344.
  12. Horner-Johnson W, Dissanayake M, Wu JP, Caughey AB, Darney BG. Pregnancy intendedness by maternal disability status and type in the United States. Perspect Sex Reprod Health. 2020;52(1):31-38. doi:10.1363/psrh.12130
  13. Mitra M, Manning SE, Lu E. Physical abuse around the time of pregnancy among women with disabilities. Matern Child Health J. 2012;16(4):802-806. doi:10.1007/s10995-011-0784-y
  14. 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.
  15. 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
  16. Mitra M, Clements KM, Zhang J, Iezzoni LI, Smeltzer S, Long-Bellil L. Maternal characteristics, pregnancy complications and adverse birth outcomes among women with disabilities. Med Care. 2015;53(12):1027-1032. doi: 10.1097/MLR.0000000000000427
  17. 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.
  18. 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.
  19. Crawford S, Joshi N, Boulet SL, et al. Maternal Racial and Ethnic Disparities in Neonatal Birth Outcomes With and Without Assisted Reproduction. Obstet Gynecol. 2017;129(6):1022-1030. doi:10.1097/AOG.0000000000002031
  20. Murray Horwitz ME, Pace LE, Ross-Degnan D. Trends and disparities in sexual and reproductive health behaviors and service use among young adult women (Aged 18–25 Years) in the United States, 2002–2015. Am J Public Health. 2018;108(S4): S336-S343. doi:10.2105/AJPH.2018.304556
  21. Akobirshoev I, Mitra M, Parish SL, Moore Simas TA, Dembo R, Ncube CN. Racial and ethnic disparities in birth outcomes and labour and delivery-related charges among women with intellectual and developmental disabilities. J Intellect Disabil Res. 2019;63(4):313-326. doi:10.1111/jir.12577
  22. 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.
  23. Mitra M, Smith L, Smeltzer SC, Long-Bellil LM, Moring NS, Iezzoni LI. Barriers to providing maternity care to women with physical disabilities: Perspectives from health care practitioners. Disabil Health J. 2017; doi: 10.1016/j.dhjo.2016.12.021.
  24. U. S. Department of Health and Human Services [HHS], & U. S. Department of Justice [DOJ]. (2010). Americans with Disabilities Act: Access to medical care for individuals with mobility disabilities. Updated July 22, 2010. Accessed August 31, 2020.
  25. Becker H, Stuifbergen A, Tinkle M. Reproductive health care experiences of women with physical disabilities: A qualitative study. Arch Phys Med Rehabil. 1997;78:S26-S33.
  26. Clowse MEB, Eudy AM, Revels J, Sanders GD, Criscione-Schreiber L.Rheumatologists’ knowledge of contraception, teratogens, and pregnancy risks. Obstetric Medicine. 2018;11(4):182-185. doi: 10.1177/1753495X18771266
  27. Long-Bellil L, Mitra M, Iezzoni LI, Smeltzer SC, Smith LD. Experiences and unmet needs of women with physical disabilities for pain relief during labor and delivery. Disabil Health J. 2017;10(3):440-444. doi:10.1016/j.dhjo.2017.02.007
  28. 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(1):6-22. PMID: 14724499
  29. Smeltzer SC. Pregnancy in women with physical disabilities. J Obstet Gynecol Neonatal Nurs. 2007;36(1):88-96.

Funded by the National Institutes of Health, National Library of Medicine (Grant #G08 LM012702) and Paralyzed Veterans of America Educational Foundation (Grant #848).

Page updated October 2020