On May 2, 1927, the Supreme Court decided that the state-sanctioned forced sterilization of people with disabilities in public institutions is constitutional. Ninety-seven years later, the horrific precedent set in Buck v. Bell remains the law of the land. Due to ableism, sexism, racism, and other mutually reinforcing systems of oppression, people with disabilities face innumerable barriers to sexual and reproductive health equity. These include refusals of care and other health care discrimination, Medicaid eligibility and service gaps, reproductive coercion, and accessibility barriers. In this blog post series, the National Health Law Program highlights current barriers and opportunities for change.
Contraception’s Impact on Health Equity
It is not hyperbole to say that contraception can be life-saving, especially for people with disabilities. Contraception allows people with disabilities to safely choose pregnancy prevention. It also gives them the ability to time and space pregnancies, which improves maternal and infant health outcomes. Although contraception cannot replace abortion, contraceptive access is crucial in the post-Dobbs landscape.
Contraceptives also help people with chronic health conditions such as polycystic ovary syndrome, endometriosis, and adenomyosis manage symptoms like debilitating cramps and excessive bleeding. Contraception enables some individuals with these conditions to live without constant pain. Hormonal contraception can also slow the growth of adenomyosis and endometriomas. Additionally, hormonal contraception can be used to control menstruation and hormonal fluctuations, which can exacerbate a number of health conditions including postural orthostatic tachycardia syndrome, Ehlers-Danlos syndrome, multiple sclerosis, and rheumatoid arthritis.
Contraception Improves Economic Security
Contraceptive access is linked to greater economic security. Studies show that by being able to delay and decide when to have children, women[1] achieved higher educational attainment, greater labor force participation, and increased wages. Research also demonstrates that access to subsidized contraception reduces childhood poverty and adult poverty a generation later. This is incredibly important for people with disabilities, who are twice as likely to live in poverty and even more so if they are BIPOC individuals. Although access to contraception alone is not enough to ensure economic security for people with disabilities, it is a necessary step to creating an equitable society because it gives people the power to make the reproductive decisions that are best for themselves and their families.
Contraception Allows for Greater Bodily Autonomy
Contraceptive access is intrinsically linked to asserting autonomy over one’s body and sexual relationships, something often stigmatized for people with disabilities and which they are frequently denied as courts, medical providers, or family members make those decisions for them. Therefore, contraceptive access is vital for people with disabilities to be able to assert bodily autonomy.
Barriers to Contraception
Despite all the known benefits of contraception, barriers to access remain. Contraceptive access often requires a prescription, which necessitates travel to a provider and generally requires time off work as well as paying for transportation and possibly childcare. People with disabilities suffer these costs most acutely. One study found that fifty percent of women with disabilities have experienced logistical barriers to accessing reproductive health care.
Additionally, people with disabilities face further barriers to access like provider refusals, coverage prohibitions, cost, lack of adequate infrastructure, and a lack of qualified providers.
Contraceptive Equity
Barriers to contraception have significantly increased since the Dobbs decision. Despite the first ever over-the-counter (OTC) contraceptive pill recently hitting U.S. markets, contraception remains under threat. In these hostile times, ensuring that contraception remains legal is not enough. We must work towards contraceptive equity, which means that all people have easy access to the contraception of their choice (if they so choose to utilize it) and that it is covered at no-cost in all health programs.
A key component of contraceptive equity is ensuring coverage of OTC contraceptives without cost-sharing and without a prescription requirement. Unfortunately, Medicaid requires a prescription for federal coverage of drugs, even when they are available OTC. As described above, this requires enrollees to make unnecessary and time-consuming trips to the doctor to obtain a prescription. This especially hurts people who are disabled because over ten million people qualify for Medicaid based on a disability. The federal government should take steps to remove this barrier, including issuing a federal standing order for OTC contraceptives applying to all Medicaid beneficiaries. And states need to pass contraceptive equity laws that apply all provisions to their Medicaid programs.
Contraceptive equity addresses the historically inadequate coverage of contraceptive services especially among underserved populations. Therefore, true contraceptive equity must center the needs and vision of underserved groups like people with disabilities.
[1] Note: We employ “women” in limited instances when necessary to accurately reference legal terms or cisgender women-centered research. More inclusive policy language and research is needed to better service the needs of all people who need equitable access to reproductive and sexual health care.
