Disability is common in Canada, with the prevalence of disability rising from 10 per cent in 15- to 24-year-olds to 42 per cent in those 75 years and older. Women, trans and non-binary people with disabilities, including those who identify as disabled and/or d/Deaf, can experience intersecting forms of discrimination that impact their sexual and reproductive health.
Research has documented that women with disabilities are at heightened risk of experiencing poverty, unstable housing, food insecurity, violence and other health disparities. This is compounded by ableism in the Canadian health-care system, such as physically inaccessible spaces, communication barriers, discriminatory provider attitudes and practices and the inadequate provision of sexual and reproductive health services. Furthermore, experiences of ableism and discrimination in health care are amplified by systemic heterosexism, homophobia and racism, creating additional barriers for 2SLGBTQI+ and BIPOC people with disabilities in Canada.
We know that the COVID-19 pandemic has detrimentally impacted sexual and reproductive health services around the world. In Canada, access to contraception and abortion has been restricted; there have been fewer prenatal, breastfeeding and parenting resources; rates of anxiety and depression in mothers have increased; routine vaccinations for children have been missed; in-person family access for children in the care of the child welfare system was suspended; and rates of intimate partner violence increased.
Although we know that marginalized groups have been disproportionately impacted by the pandemic, to date there has been no published research on its impact on the sexual and reproductive health of disabled women, trans and non-binary people. Before the pandemic, research on women with disabilities illustrated they were already more likely than women without disabilities to experience limited access to health information and family planning services, and experience higher rates of perinatal complications, child custody loss and intimate partner violence.
To better understand the impact of the COVID-19 pandemic on the reproductive health of women, trans and non-binary people with disabilities, our team of researchers based at the University of Toronto has partnered with the DisAbled Women’s Network (DAWN) of Canada to conduct the Disability and Reproductive Health during COVID-19 Study. The study consists of a national survey and one-to-one interviews with disabled women, trans and non-binary people across Canada. The goal is to produce evidence that will ensure pandemic response and recovery plans include equitable, inclusive approaches to sexual and reproductive health.
People with disabilities have a right to accessible health care.
So far, we have learned that the COVID-19 pandemic has created disruptions in access to sexual and reproductive health-care services for women, trans and non-binary people with disabilities, and these disruptions are compounded by disability-related life experiences and ableism. For example, people like Jamie, an autistic person with severe anxiety, experienced panic attacks accessing contraception when the pharmacy was rationing supplies (ed. note: all names of study participants have been changed). Disabled women, trans and non-binary people also reported delays in accessing sexual and reproductive health care such as cervical and breast cancer screenings, delays made longer because of disability-related health-care needs. Sexual and reproductive health needs often were deprioritized for people like Winona, an older woman with multiple chronic illnesses who said she wouldn’t get a mammogram during the pandemic unless she was told she “really” needed it. Anika, a woman with vision loss, missed regular cervical screening-related appointments because providers did not offer necessary accommodations, such as assistance in finding the clinic within the hospital. Similarly, another hospital failed to provide the necessary accommodation of ASL interpretation for Shannon, a Deaf woman, when she was seeking care during the pandemic.
People with disabilities have a right to accessible health care. While virtual appointments have the potential to expand access to care, the shift to virtual services during the pandemic has not always been accessible for disabled people. Nicole, a woman with cerebral palsy, found virtual prenatal classes inaccessible and was struggling to find in-person options. Amy, a woman with amputations, had to self-advocate for in-person postpartum breastfeeding support and pediatric care for her newborn. Despite national guidelines that state essential support persons should be permitted to accompany disabled persons to health care appointments during the pandemic, many study participants have reported difficulties in bringing support persons to sexual and reproductive health care appointments.
The Disability and Reproductive Health during COVID-19 Study is ongoing. We are recruiting women, trans and non-binary people who are 18 years or older and living with disabilities, including those who self-identify as disabled and/or d/Deaf and who live and receive health care in Canada.
So far, the majority of study participants have been 25 to 44 years old; identify as straight, white, cisgender women; live in Ontario; and have a physical disability. In the coming weeks, we are aiming to recruit a more diverse sample of participants to better reflect the population of women, trans, and non-binary people with disabilities living in Canada. Specifically, we are seeking younger and older participants; 2SLGBTQI+ participants; BIPOC participants; residents of Atlantic Canada (Newfoundland, Nova Scotia, New Brunswick, Prince Edward Island), Quebec, Western Canada (Manitoba, Saskatchewan, Alberta, British Columbia), and Northern Canada (Yukon, Northwest Territories, Nunavut); and participants with sensory and intellectual and developmental disabilities.
If you are interested in participating in this study, email us at firstname.lastname@example.org or call 647-601-4519. Follow us on Twitter @DisabilitySRH and visit our website for more information: https://www.utsc.utoronto.ca/projects/disabilitysrh/