Authors’ note: The disability community is rapidly evolving to use identity-first language in place of person-first language. This is because it views disability as being a core component of identity, much like race and gender. Some members of the community, such as people with intellectual and developmental disabilities, prefer person-first language. In this fact sheet, the terms are used interchangeably.
On November 29, 2022, the Center for American Progress invited more than 20 advocates from the reproductive and disability rights and justice communities to discuss their agendas for 2023 and beyond. After categorizing the meeting notes, the authors compiled a list of the top five issues that attendees highlighted. Although these priorities do not encapsulate every issue that needs to be addressed, they present important opportunities for collaboration in the coming years.
1. Increase disabled people’s access to reproductive health care
Disabled people face barriers to accessing high-quality reproductive health care, whether due to a lack of or restricted access to medications, transportation, or accessible medical examination equipment. Federal legislative action could help guarantee access to medications, including methotrexate, that are used to treat a variety of conditions and may have side effects that cause abortion.
Policymakers at the federal administrative level also have a great deal of opportunity to address barriers:
- The Department of Health and Human Services could adopt the Access Board’s 2017 standards for accessible medical diagnostic equipment by incorporating them into Section 510 of the Rehabilitation Act. This would ensure the availability of such equipment.
- In order to bolster access to telehealth services, the Biden administration could prioritize reproductive health care deserts when allocating funds to expand broadband access through the Infrastructure Investment and Jobs Act.
2. Address barriers to covering and funding reproductive health care for disabled people
Congress must permanently repeal the Hyde Amendment, the annual appropriations rider that prohibits federal insurance programs such as Medicaid and Medicare from covering abortion services except in extremely narrow circumstances. Further federal and state reforms will also be critical to ensuring comprehensive coverage of reproductive health services.
At the federal level, policymakers must:
- Address administrative burdens and eligibility requirements that act as barriers to Medicaid coverage. Simplifying the paperwork process could greatly reduce the burdens on disabled people. And Congress should require all 50 states to automatically enroll Supplemental Security Income (SSI) recipients in Medicaid.
- Require Medicare to offer all forms of birth control through its Part A, Part B, and Part D programs, regardless of recipients’ disability status.
At the state level, policymakers should:
- Adopt legislation to increase access to reproductive health care overall, including expanding Medicaid under the ACA. This would permanently eliminate the coverage gap for individuals in nonexpansion states who are not eligible for Medicaid but have family incomes too low to qualify for the ACA’s health insurance marketplace subsidies. It would also provide funding to rural clinics and hospitals.
3. Increase disabled people’s right to reproductive autonomy
Although increases in coverage and funding are critical, more than 1 million disabled people are in guardianship arrangements that often legally prevent them from making critical decisions about their reproductive lives. Because guardianship is currently largely a state law issue:
- States must ensure that guardianship statutes encourage disabled people’s autonomy and ability to make their own decisions regarding their health. States must remove guardianship statutes that inhibit reproductive decision-making, as well as those that automatically remove children when a parent is under guardianship.
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At the same time, federal policymakers can act to improve and reform the U.S. guardianship system:
- Congress must pass legislation that includes a national bill of rights for people under or at risk for guardianship and allocate grants to create a court improvement program. This program could be modeled on the Child Welfare Court Improvement Program and educate justices on guardianships and supported decision-making.
- The Department of Justice should recognize through guidance or a list of frequently asked questions that supported decision-making is a less restrictive environment than guardianship that should be protected under the Americans with Disabilities Act through the Supreme Court’s decision in Olmstead.
4. Increase reproductive health education and training for providers and others who work directly with disabled people
A variety of opportunities exist to improve how the health care workforce serves disabled people. Federal action, in particular, could help promote a national standard of care. Policymakers should consider:
- Passing federal legislation that provides Administration on Community Living grants to help give providers professional education and sensitivity training that reduces their reliance on ableist tropes and encourages the self-determination of disabled people, such as through increased provider recognition of supported decision-making.
- Investing in expanding and improving sexual and reproductive health (SRH) care training so that providers can better serve disabled people. This includes pregnancy and maternal health care, abortion services, and preventive care. In particular, lawmakers should prioritize the passage of legislation such as the Reproductive Health Care Accessibility Act, which was originally introduced in Congress in 2022. This bill would establish a grant program to train SRH providers and educators who serve individuals with disabilities.
5. Increase sexual and reproductive education for disabled people
Even with the improvements above, far too many disabled people are blocked from acquiring necessary education and information on their reproductive options. While seven states require sex education in public schools to be evidence-based, only three states require sex education to be accessible to the disability community. Thirty-six states do not tailor any sex education programs to the disability community. Ultimately, all school and health programs funded by state or federal dollars should be required to provide sex education that is accessible for the disability community. This is particularly necessary for individuals with intellectual disabilities, due to high rates of sexual assault. Lessons should be adjusted depending on disability; for example, lessons that include someone with an intellectual disability should include plain language that fits their communication style. The U.S. Department of Education can start this work by:
- Releasing, in partnership with the Department of Health and Human Services, a list of frequently asked questions on sexual education for disabled students.
- Encouraging states to request Title X grants to help fund more evidence-based reproductive education programs for disabled youth.
Conclusion
The issue areas and policy actions this fact sheet explores are nonexhaustive and represent starting points for change at the local, state, and federal levels. As policymakers work to eliminate barriers to comprehensive and accessible reproductive health care, they must collaborate directly with disability and reproductive rights and justice communities.
Particularly when it comes to federal administrative opportunities, the disability and reproductive rights communities can work with policymakers to increase access, rectify regressive policies, and ensure reproductive freedom and autonomy for disabled people.