Written by Julia Wang, MD and Jillian MacLeod, Esq.

As we experience ongoing attacks on abortion access and provision, it is important to highlight the numerous barriers to equitable care that disabled patients face. These barriers include inaccessible online information about abortion services (for example, websites that lack straightforward language or are incompatible with screen readers), providers and staff who are unfamiliar with caring for or accommodating certain disabled patient populations, widespread provider bias against disabled patients¹ and physical barriers such as inaccessible facilities and medical equipment. Notably, the Department of Health and Human Services is currently updating its regulations to incorporate the U.S. Access Board’s Medical Diagnostic Equipment (MDE) Accessibility Standards.² This would require medical practices that take federal funds (like Medicare or Medicaid) to acquire accessible MDE in the future. If your practice takes any federal funds, you will be subject to these new rules once they are
published.

Below are some suggestions that can help to make clinics that provide abortion care more physically accessible for disabled patients:

• Remember that the patients with disabilities are experts in their own bodies and accessibility needs. Ask patients what they need for a successful exam to take place and follow their suggestions carefully.
• Review the relevant ADA regulations (28 CFR §36 for private practices and 28 CFR §35 for public entities) to ensure that your clinic is following the law. Keep in mind, these requirements are meant to act as the bare minimum and do not necessarily create an accessible environment.³
• Ensure that hallways, clinic rooms, bathrooms, and doorways are wide enough to accommodate mobility devices such as wheelchairs and walkers. Additionally, ramps and elevators are a vital alternative to stairs.
• Acquire at least one adjustable height exam table with movable armrests or side bars. These tables allow for safe, independent transfer for patients who use mobility devices. If your practice has a Hoyer lift, ensure that all staff are aware of its location and are trained on how to safely use it.⁴
• For pelvic exams, acquire an exam table with adjustable leg rests that patients can rest the backs of their knees on. These are oftentimes more supportive for patients with muscle paralysis or spasticity. Most importantly, having options for patients with varying disabilities is critical to safe and inclusive care. See RHAP’s previous Contraceptive Pearls Alternative Positions for Pelvic Exams for more details.

These are just a few recommendations for clinics to provide more physically accessible abortion care, as well as comprehensive gynecological care.

RHAP Resources:

Early Abortion Options

Contraceptive Pearl: Alternative Positions for Pelvic Exams

Sources:

1. Lagu T, Haywood C, Reimold K, DeJong C, Walker Sterling R, Iezzoni LI. ‘I Am Not The Doctor For You’: Physicians’ Attitudes About Caring For People With Disabilities. Health Aff (Millwood). 2022;41(10):1387-1395. doi:10.1377/hlthaff.2022.00475

2. 1. U.S. Access Board – About MDE. www.access-board.gov. Accessed January 10, 2024. https://www.access-board.gov/mde/

3. Health Care and the Americans With Disabilities Act | ADA National Network. adata.org. Published 2020. https://adata.org/factsheet/health-care-and-ada

4. Accessible Medical Diagnostic Equipment | ADA National Network. Adata.org. Published 2019. https://adata.org/factsheet/accessible-medical-diagnostic-equipment

Pharma-free: The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or products. The information in the Insights is unbiased, based on science alone.

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