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Patients with disabilities are much more likely than nondisabled patients to experience barriers to reproductive healthcare, including barriers in the clinic.¹ Common forms of inaccessibility for disabled patients include information barriers (inaccessible websites, information in inaccessible formats), communication barriers (lack of interpreters, inaccessible forms and printed materials), physical barriers (inaccessible spaces and medical equipment), and programmatic barriers (failure to provide accommodations and lack of disability competent care). One contributing factor may be a lack of knowledge and training among clinicians regarding standards of care and legal responsibilities when serving disabled people.² 

Disability rights laws prohibit discrimination against people with disabilities and require clinicians to make their services and programs available in an accessible manner.³ Among other things, these laws require clinicians to make reasonable accommodations, communicate effectively, and ensure their facilities and equipment are accessible to disabled people.^4,5 

Reasonable accommodations are changes to the usual way of doing things to include disabled people and provide equal opportunity for them to access and benefit from services. An accommodation is reasonable unless it would “fundamentally alter” the nature of a service.⁶  Accommodations must be individualized to meet the patient’s needs and will be different for each person–even for people with the same disability. People with disabilities are experts in what supports will work best for them. Follow their lead.

Some examples of common reasonable accommodations are: 

• Reserving additional time for an appointment to allow for:
  • Interpreting
  • Physical transferring on and off the exam table
  • Using the teach-back method to confirm understanding
• Facilitating supported decision-making
• Allowing a support person to be present
• Delivering information in multiple ways
• Moving items that might block the path of travel
• Reserving a room that has accessible equipment
• Adjusting the brightness of the exam room lights
• Performing a pelvic exam in an alternative position
• Providing forms and materials in alternative formats  (larger text, braille, plain language)
• Wearing a mask

To understand the needs of the patient and allow as much time as possible for arranging accommodations because of the time-sensitive nature of reproductive health care, clinics should ask patients at the first point of contact: “Do you have any access needs or communication needs? Is there any way we can make this appointment more accessible to you?” Stated needs should be noted in their file, and the requested arrangements should be made as soon as possible. Clinicians may not charge patients for any cost associated with arranging an accommodation. Providing reasonable accommodations is often intertwined with the responsibility to communicate effectively and ensure your spaces and equipment are usable by and accessible to people with disabilities. 

In the context of abortion care, removal of accessibility barriers is imperative to ensure access for all patients. To reduce disability-related barriers to care, clinicians should consider ways to streamline their reasonable accommodation procedures and commit to instituting readily accessible practices to ensure quality care.

The Pelvic Exam: Multiple Positions for Patient-Centered Care