Sexual and reproductive health (SRH) equity means that all people have access to the high-quality health care and health-related social needs, legal rights, and power they need to attain their highest attainable standard of SRH and wellbeing. Unfortunately, people with disabilities face numerous barriers to experiencing this aim. Over the last year, new federal and state opportunities and threats have emerged in the fight to advance equitable SRH care access for people with disabilities. This blog post addresses developments in three key realms: nondiscrimination rights, contraceptive equity, and telehealth medication abortion.
Nondiscrimination Rights
Last year, the Biden administration’s Department of Health and Human Services (HHS) addressed disability discrimination in SRH care in its final rules on § 1557 of the Affordable Care Act (the law’s nondiscrimination provision), and § 504 of the Rehabilitation Act (the first federal disability nondiscrimination law). The § 1557 rule affirmed that health care providers cannot deny abortions based on disability, race, or other protected characteristics. Further, HHS acknowledged for the first time that subjecting individuals to obstetric violence (the mistreatment, disrespect, and abuse of pregnant people) based on protected characteristics or denying pain medications based on sex stereotypes about women exaggerating our pain — both issues that disproportionately affect disabled people, and particularly disabled people of color — may violate § 1557. HHS also affirmed that denying or delaying access to prescription drugs for chronic conditions on the basis of sex, a concerning trend in the post-Dobbs landscape, may violate the law.
The § 504 rule included numerous firsts, including new regulations on discrimination in medical treatment and discrimination against people with disabilities in the child welfare system, a pervasive reproductive justice issue. It also affirmed that discriminatory denials or limits on access to SRH care, reproductive coercion, denying comprehensive information regarding assisted reproduction, or denying accessible mammograms based on an individual’s disability, all pervasive issues, may violate the law.
We expect to have to defend these rules against the Trump administration which, consistent with Project 2025’s recommendations, will likely attempt to revise or rescind them. Barring acts of Congress, however, § 1557 and § 504 are the law of the land. Advocates should continue to enforce these laws, such as through complaints to their state attorneys general or state insurance commissioner. Where feasible, state advocates should also push for state-level nondiscrimination laws that are at least as generous as § 1557 (which incorporates § 504).
Contraceptive Equity
From coverage gaps to accessibility issues and civil rights violations in the forms of reproductive coercion, infantilization, and pain dismissal, disabled people face numerous barriers to contraceptive equity. In the last year, state and federal policymakers have attempted to address these barriers through a number of reforms.
Closing the Contraceptive Coverage Gap for Medicare Beneficiaries
Medicare is the federal program that serves people ages 65 and older and younger people with long-term disabilities. It covers over one million women with disabilities and many trans, nonbinary, and intersex people of reproductive age (20 to 49 years). While Medicare covers many forms of contraception, coverage is more limited than in Medicaid and private insurance and can entail cost-sharing. In December 2024, Senators Hassan, Murkowski, Duckworth, and Collins introduced a bipartisan bill, the Closing the Contraception Coverage Gap Act, to ensure no-cost contraceptive coverage for Medicare beneficiaries. Because Medicaid is generally the payer of last resort, the bill includes a provision to ensure that dual-eligible beneficiaries — individuals with both Medicaid and Medicare coverage — receive contraceptive coverage that is at least as comprehensive as Medicaid provides.
Improving Access to Pain Management for Intrauterine Device (IUD) Insertion and Removal
The last year has brought historic federal wins in the fight for appropriate pain management for IUD insertion and removal — wins that are especially critical to people with disabilities, who may be more likely to experience severe pain from these procedures. For example, a history of painful menstruation — often a symptom of disabilities such as endometriosis, pelvic inflammatory disease, and Ehlers-Danlos Syndrome — can increase the risk of severe pain during insertion. As the Centers for Disease Control and Prevention (CDC) affirmed in its U.S. Selected Practice Recommendations for Contraceptive Use, 2024, trauma and mental health conditions are also risk factors. Building on the § 1557 final rule’s groundbreaking recognition of sex discrimination in pain management as a potential civil rights violation, CDC’s guidance indicated that “before IUD placement, all patients should be counseled on potential pain during placement as well as the risks, benefits, and alternatives of different options for pain management.” While the Trump administration has since pulled down this guidance in its blitz of reproductive health information on agency websites, it remains a meaningful stepping stone toward addressing a barrier to contraceptive care that disproportionately affects disabled people.
While the federal landscape is precarious in 2025, states have a number of options to build on this momentum. First, states with their own protections against sex discrimination in health care should consider issuing guidance clarifying that failing to provide pain management counseling based on a belief that women and people assigned female at birth exaggerate their pain could violate the law. Further, a number of states have contraceptive equity laws that, consistent with NHeLP’s Model Contraceptive Equity Act, cover “clinical services related to the provision or use of contraception.” This should include pain management for IUD insertion and removal. Moreover, a number of state legislatures are considering reforms to address barriers to IUD-related pain management. These proposals include requirements to notify patients seeking IUD placement or removal of their pain management options (Washington) and requiring health insurers to cover IUD pain management methods (Texas) — some with cost-sharing prohibitions (Massachusetts).
Telehealth Medication Abortion (TMAB)
Abortion access is critical for people with disabilities. We are less likely to have adequate travel accommodations, accessible medical equipment and physical spaces, and providers who understand their unique needs. TMAB — the use of telehealth for some or all of the interactions between a patient and provider for abortion care — can help reduce some of these barriers. As of early last year, TMAB comprised 20% of all abortions in the U.S. Decades of research demonstrate that medication abortion is exceptionally safe.
Comprehensive Medicaid coverage of all telehealth modalities is key to achieving an equitable abortion access landscape, including for people with disabilities. Reforms such as California Assembly Bill 260 would make TMAB more accessible by allowing asynchronous delivery for Medi-Cal beneficiaries While positive steps are taking place at the state level, anti-abortion politicians and judges are doing everything they can to ban medication abortion nationwide. Most recently, the Trump administration installed Dr. Martin Markalay — who has spread abortion disinformation and refused to say that he would protect medication abortion during his Senate confirmation hearing. This would have disastrous effects on abortion access, including for disabled people.
Conclusion
This blog post outlines threatening landmines and promising pathways in the fight for equitable SRH care access for people with disabilities. The enclosed opportunities stand to alleviate barriers to equitable access and delivery. Meanwhile, amid relentless democratic backsliding in the U.S. and overarching federal attempts to cut Medicaid, threats to disabled SRH care equity will likely continue to swell. NHeLP’s SRH team is here to provide legal, policy, and advocacy technical assistance on related issues. For additional resources related to disabled SRH care equity, visit our SRH Equity webpage.
