CENTER FOR RESEARCH ON WOMEN WITH DISABILITIES
CROWD Mission Research Team - Current Research Information Services
Recent Research Findings
Findings on Reproductive Health and Access to Health Care National Survey of
Women with Physical Disabilities
From 1992 through 1995, the Center for Research on Women with Disabilities at Baylor College of
Medicine conducted a national study of women with physical disabilities with funding from the
National Institutes of Health. Following are some of the key findings on health and access to
health care. Data were gathered through in-depth interviews with 31 women who had a variety of
physical disabilities, and a survey of 950 women nationally, 506 with physical disabilities
(including 120 with spinal cord injuries) and 444 women without disabilities. The survey included
more than 1,000 variables covering demographics, culture, sexuality, relationships, developmental
experiences, reproductive health conditions, and access to health care services.
REPRODUCTIVE FUNCTIONING
Women with physical disabilities are sexually active, but to a lesser degree than women without
disabilities.
Seventy-one percent (71%) of women with disabilities with live-in partners were sexually active,
compared to 96% of the comparison group. Ninety-four percent (94%) of women with disabilities and
97% of women in the comparison group had experienced sexual intercourse. Among women with
disabilities there were lower levels regular of sexual activity (45% overall, including women
without partners compared to 70%) and sexual satisfaction, but no differences were detected in
sexual desire. Differences in sexual response were in part associated with type of
disability.
Many women with physical disabilities are married and have children, but at a lower rate than
women without disabilities.
Thirty-four percent (34%) of the women with physical disabilities were single, as compared to 23%
of the able-bodied women. Of the women with disabilities in the survey, 32% were married compared
to 36% of the able-bodied women. Age at first marriage was not significantly different. Nineteen
percent (19%) of the women with disabilities were divorced as compared to 22% of the able-bodied
women.
Thirty-eight percent (38%) of the women with disabilities had natural children as compared to 51%
of the able-bodied comparison group. Twenty-five percent (25%) of the women with disabilities in
our sample currently care for children in their home, compared to 42% of the able-bodied women.
There was no significant difference between groups in rates of pregnancy losses or
terminations.
Women with physical disabilities have limited options for contraception.
Women with limited use of their hands have difficulty using barrier method contraceptives.
Barrier methods were found to be used only by a small portion of women with and without
disabilities (1.5% compared to 4%). In the national survey, women of child bearing age with
disabilities were much less likely to take oral contraceptives than the able-bodied comparison
group. Women with and without disabilities used surgical means of birth control, such as tubal
ligation and partner vasectomy at similar rates. However, women with disabilities were
significantly more likely to have had a hysterectomy.
CHRONIC HEALTH CONDITIONS
Disability is a risk factor for acquiring chronic diseases.
Significantly more women with disabilities reported having arthritis (29%), chronic urinary tract
infections (19%), major depression (18%), osteoporosis (15%), restrictive lung disorders (7%),
inflammatory bowel disorders (7%), heart disease (6%) obstructive lung disease (5%), and kidney
disease (3%) than the ablebodied comparison group. Women with disabilities reported chronic
conditions significantly more often than the comparison group without disabilities.
Chronic health conditions occur in women with physical disabilities at an earlier age than other
women.
Women with disabilities reported chronic health problems at a much higher rate than the
comparison group without a primary disabling condition. When a trend analysis was completed
examining groups of women 40+, 50+ and 60+ years of age, the frequency of chronic health
conditions in women with disabilities increased 11% between age groups while increasing only 5%
among women without disabilities.
Women with physical disabilities reported having sexually transmitted diseases (STDs) at about
the same rate as women without disabilities.
Twenty-two (22%) of the women with disabilities and 24% of ablebodied women reported having cases
of gonorrhea, syphilis, chlamydia, or trichomonas. Ablebodied women reported a significantly
higher number of cases of herpes infections (7%) as compared to 3% for women with disabilities.
Ablebodied women also reported significantly higher numbers of nonspecific STDs (5% vs 3%). There
is the potential that women with spinal cord injury may have undiagnosed STDs due to lack of
sensation in the pelvic area.
Younger women with severe disabilities are significantly more likely to have hysterectomies.
Women with disabilities in our sample had a significantly higher rate of hysterectomy (22% vs
12%) than ablebodied women. Twentyfour (24%) percent of the young women with severe functional
limitations had hysterectomies which is a significantly higher rate than ablebodied women of
child bearing age in our study.
HEALTH CARE UTILIZATION
Women with physical disabilities have a different pattern of using health care services than
women without disabilities.
Women with physical disabilities are significantly more likely than women without disabilities to
use public health clinics, emergency rooms, and to see medical specialists. Forty percent (40%)
of women with disabilities, including women with spinal cord injuries, and 39% of women without
disabilities reported receiving services from chiropractors or other alternative medical
services.
Women with severe physical disabilities are significantly less likely to receive regular pelvic
exams.
Women with severe disabilities were significantly less likely to receive annual pelvic exams than
women with less severe disabilities. Women with spinal cord injuries reported that pelvic
examinations were impossible because getting on to the exam table was too difficult (43%),
knowledgeable physicians were not available (26%), doctor's offices are inaccessible (21%), exams
were too costly (21%), and they had transportation problems (11%). Eleven percent of women with
spinal cord injury reported that they felt that there was no need for routine pelvic examinations
because of their disability.
INDIVIDUAL BARRIERS TO HEALTH CARE
Some women with physical disabilities lack basic knowledge about their reproductive health.
Women who attended special education classes in primary and secondary school may not have had the
opportunity to learn basic facts about reproductive health. Women with disabilities in our study
relied more on the media for information about sexuality than able-bodied women.
Women with disabilities face extraordinary barriers in accessing health insurance.
More than 55% of women with physical disabilities, including 50% of the women with spinal cord
injuries, reported that they did not have adequate health insurance to cover required medical
services. However, this finding was not significantly different from the 60% of women without
disabilities also reported having inadequate health insurance.
Abuse experienced in medical settings can have a lifelong traumatic impact.
Many women with disabilities reported sexual and emotional abuse in medical facilities,
especially during childhood. Some women in the interviews reported that numerous surgeries and
lack of emotional support in hospitals as children made them feel dissociated from their bodies
and contributed to a negative body image. Almost 10% of the women with physical disabilities
reported abuse by health care providers, while less than 3% of the able-bodied women reported
abuse of this type.
SYSTEMS BARRIERS TO HEALTH CARE
Physicians are not well informed about the effect of disability on the reproductive health of
women.
Thirty seven percent (37%) of all women with disabilities believed that their physicians were not
well informed about the effect of their disability on reproductive health. Thirty percent (30%)
believed they had been given inaccurate information about birth control by their physicians, in
contrast to only 9% of the able-bodied comparison group. Fourteen (14 /26) women with spinal cord
injuries, who had children after their injury, reported that it was difficult to find a physician
to manage their pregnancy.
Characteristics of medical systems sometimes constitute barriers to women with physical
disabilities.
Some medical facilities operate under policies that exclude women with physical disabilities from
receiving services. An example is a policy that prohibits staff from lifting patients onto
examination tables. Some women under managed care programs experienced problems accessing
specialists for health conditions related to their disability.
Most medical facilities have numerous architectural barriers.
While most modern medical offices have accessible entrances and restrooms, it is very rare to
find elevating exam tables or platform scales. Most women with severe physical disabilities are
unable to monitor their weight, an especially critical problem during pregnancy. Forty percent to
45% of women over 35 years of age in our national survey reported having had a mammogram. Twenty
-three percent (23%) of women with spinal cord injury reported that it was impossible to position
mammography equipment for them and 11% had no accessible examination room for mammograms.
Twenty-six women with spinal cord injury had natural children after their injury and 14 (more
than 50%) reported that the hospital could not accommodate their disability during
childbirth.
Some physicians harbor negative, stereotypic attitudes toward women with physical
disabilities.
In the interviews, many women reported that their physicians regarded them as asexual and did not
acknowledge their need for reproductive health care. Twenty-nine percent (29%) of women with
disabilities, including 33% of the women with spinal cord injury, reported that a physician had
refused to see them for health care.
Some physicians do not talk directly to women with physical disabilities.
In the interviews, many women complained that their physicians were more likely to talk to
someone accompanying them than directly to them. This was a problem especially for women with
speech impairments and women from non-English-speaking backgrounds. Thirty-eight percent (38%) of
women with disabilities reported that physicians do not speak directly to them if someone is
accompanying them.
Demographic Description of the Sample:
The 506 women with disabilities had a median age of 42 years, 18% were minorities, 32% were
married, with high educational level, 62% had a bachelor's or higher college degree; 57% were
employed earning a median personal income of 14,600, median household income of $25,000. The 444
women without physical disabilities had a median age of 39 years, 19% were minorities, 36% were
married, with 40% had a bachelor's or higher college degree; 82% were employed, earning median
personal income of $19,000 and $31,000 median household income.
RESEARCH TEAM
Principle Investigator - Margaret A. Nosek, Ph.D.
Co-Principle Investigators
Diana Rintala, Ph.D.
Mary Ellen Young, Ph.D.
Catherine Clubb Foley, Ph.D.
Kay Dunn, PhD
Other Faculty and Staff
Carol Howland, M.P.H. (in progress)
Donald Rossi, M.S.
Gail Chanpong, M.S.
Kathy Meroney, B.A.
(Modified: Aug-24-1996)
- copyright )1996-97 BCM
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