Ilhom Akobirshoev

Background: Women with disabilities face systematic barriers to reproductive autonomy, yet physician bias in pregnancy counseling has not been quantified using nationally representative data. Methods: We analyzed pooled data from 4 waves of the National Survey of Family Growth (2011–2019), including 8018 US women aged 15–25. Disability status was defined using the American Community Survey’s 6-item measure. The primary outcome was self-reported physician recommendation against pregnancy. Among women who received such recommendations (n=122), we examined physician-reported reasons using categories: “dangerous for you,” “dangerous for your baby,” and “some other reason.” Poisson regression was used to estimate adjusted prevalence ratios (aPRs). Results: Disabled women comprised 21.2% of the sample and were significantly more likely to report receiving physician recommendations against pregnancy compared with nondisabled women (2.6% vs. 1.1%; aPR:1.91, 95% CI: 1.10–3.29). The disparity was highest among women with physical disabilities (aPR:5.73, 95% CI: 1.79–18.29), followed by those with hearing (aPR: 4.24, 95% CI: 1.49–12.07) and vision disabilities (aPR:3.99, 95% CI: 1.60–9.99). A substantial proportion of recommendations were attributed to “some other reason” (disabled women: 44%; nondisabled women: 40%). Conclusions: Young disabled women face systematic bias during reproductive health care counseling, with nearly double the likelihood of receiving recommendations against pregnancy. The high proportion of recommendations under “some other reasons,” beyond maternal or fetal health concerns, suggests potential subjective biases may influence clinical recommendations. These findings underscore the need for evidence-based clinical guidelines and monitoring to ensure respectful, individualized, and medically appropriate reproductive health care regardless of disability status.

This study extends the growing literature on adolescent and young adult females with disabilities’ sexual experiences by using nationally representative survey data. We analyzed the 2011–2019 National Survey of Family Growth to examine disability’s association with sexual experiences among females aged 15–25 ( n = 7884). Chi-square and modified Poisson regression analysis compared sexual experiences, debut, and number of partners of females with and without disability by status and type. After adjustment, females with any, cognitive, or physical/sensory disability were more likely than those without disability to have had an opposite-sex sexual debut before age 15 and 10 or more opposite-sex sex partners. Those with any or cognitive disability were more likely than those without disability to have given oral sex to a male, receive oral sex from a male, had anal sex with a male, had any sexual experience with a female, and had 10 or more same-sex partners. Our analyses provide detailed population-level data on disabled adolescent and young adult females’ sexual experiences, debut, and partners and demonstrate that young disabled females have active sexual lives, highlighting the need for comprehensive sexual education and health care addressing relationships with all genders, STI testing and prevention, and sexual rights and consent.

Physical assault of women at the intersection of race/ethnicity and physical disability is not well studied. This study seeks to assess the prevalence of physical assault-related emergency department or hospital visits among women with physical disabilities during different stages of the perinatal period, stratified by racial/ethnic background. This study used 1998–2020 data from the Massachusetts Pregnancy to Early Life Longitudinal Data System. Unique singleton deliveries were classified into 10 cohorts by combining maternal physical disability status (yes/no) and racial/ethnic background (White, Black, Latinx, Asian/Pacific Islander [API], and American Indian/Alaska Native [AIAN]); nondisabled White mothers served as referent. Outcomes assessed were the presence of assaults up to 1 year before conception, during pregnancy, and up to 1 year postpartum. Compared to nondisabled White mothers, Black, Latinx, and AIAN mothers with physical disabilities were at the highest risk and experienced 16.0, 12.0, and 12.0 times the risk, respectively, of preconception assault; 15.3, 12.7, and 11.6 times the risk of prenatal assault; and 9.0, 8.2, and 9.3 times the risk of postpartum assault ( p < .001 for all risk ratios). Adjusting for sociodemographic differences between groups reduced the magnitude of disparities, but Black, Latinx, and AIAN mothers with physical disabilities remained at greatest risk among all cohorts. Women with physical disabilities from minoritized racial/ethnic backgrounds experienced compounded risk of perinatal violence, with risks exceeding those of nondisabled women in the same racial/ethnic groups as well as White women with physical disabilities. Violence against women with physical disabilities, especially during pregnancy, is a major and ongoing public health crisis. Urgent needs include screening and outreach efforts to Black, Latinx, and AIAN mothers with physical disabilities.

Context: Over 40% of pregnancies in the United States are unintended. Women with unintended pregnancies may be less likely to receive timely prenatal care and engage in healthy behaviors immediately before and during pregnancy. Limited research suggests that women with disabilities are more likely to have an unintended pregnancy, but to date no studies have assessed whether intendedness varies by extent of disability.Methods: We analyzed 2019–2020 PRAMS data from 22 sites that included the Washington Group Short Set of Questions on Disability (n = 37,832). We examined associations of extent of disability (none, some difficulty, or a lot of difficulty) with pregnancy intendedness (classified as intended, mistimed, unwanted, or unsure). We used multinomial logistic regression to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) while controlling for sociodemographic characteristics.Results: Overall, 60.1% of pregnancies were intended, 18.2% mistimed, 6.4% unwanted, and 15.3% unsure. Compared to respondents with no difficulty, respondents with some difficulty or a lot of difficulty were more likely to report a mistimed pregnancy (aOR = 1.55, 95%CI 1.40,1.71; aOR = 1.62, 95%CI 1.34,1.95), an unwanted pregnancy (aOR = 1.92, 95%CI 1.66,2.24; aOR = 2.20; 95%CI 1.72,2.82), and unsure intendedness (aOR = 1.61, 95%CI 1.45,1.79; aOR = 1.75, 95%CI 1.45,2.11), respectively.Conclusions: People with disabilities who give birth, regardless of extent of disability, had elevated odds of mistimed and unwanted pregnancy and of being unsure of their pregnancy intendedness. Our findings support the use of more inclusive measures of disability and emphasize the need for equitable reproductive healthcare that respects the childbearing potential and choices of individuals with disabilities.

OBJECTIVE: To estimate the risk of severe maternal morbidity (SMM) among women with disabilities compared with those without disabilities in a nationally representative sample of U.S. delivery hospitalizations. METHODS: We conducted a retrospective cohort analysis using the 2016–2021 Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. We identified delivery hospitalizations and disability status using International Classification of Diseases, Tenth Revision diagnosis codes. The primary outcome was SMM, which was determined using 21 indicators specified by the Centers for Disease Control and Prevention. We used Poisson regression to estimate unadjusted and adjusted relative risks (aRRs) and 95% CIs for the association between disability status and type with SMM outcomes. RESULTS: Among 4,331,457 delivery hospitalizations, 128,413 (3.0%) were to women with disabilities. Women with disabilities had significantly higher rates of SMM compared with those without disabilities (396/10,000 deliveries vs 177/10,000 deliveries). In fully adjusted models, women with disabilities had an aRR of 1.86 (95% CI, 1.80–1.91) for one or more SMM indicators. The risk of SMM varied by disability type, with the highest risks observed for women who had vision disabilities (aRR 3.02, 95% CI, 2.70–3.38) or had physical disabilities (aRR 2.44, 95% CI, 2.34–2.55). Women with disabilities had the highest risk for other medical complications (puerperal cerebrovascular disorders and sickle cell disease with crisis), followed by other obstetric complications, respiratory complications, cardiovascular complications, acute renal failure, sepsis, and bleeding complications compared with women without disabilities. CONCLUSION: Women with disabilities have a significantly higher risk of SMM during delivery compared with those without disabilities, with the magnitude of risk varying by disability type. Efforts to reduce SMM and maternal mortality in the United States must prioritize the unique needs of this population and ensure equitable, disability-competent care for all women.