I recently read a story in which a woman named H. Lee, who has muscular dystrophy, details a decade-long struggle to receive adequate cervical cancer screening. Providers have been unable to find her cervix due to the curvature of her spine, examined her in her wheelchair because there were no height-adjustable examination tables, and outright turned her away for “liability reasons.”
By the time she finds an accessible provider, she has not had a pap smear in four years. She is eventually diagnosed with a form of precancer called carcinoma in situ and must have her uterus removed. She writes, “I never wanted to have children. But, not to have a child was my choice, but now it was being taken away from me.”
Lee’s experience is not unique. In a study of more than 60,000 women in the United States, women with disabilities had lower odds of being up to date on pap smears and were more likely to be diagnosed with cervical cancer. These disparities pervade other areas of women’s health. Women with disabilities are also less likely to be up to date on breast cancer screening. They are more likely to undergo female sterilization and less likely to be on the pill than non-disabled women.
One of the many barriers to accessing gynecological care is the lack of height-adjustable examination tables. This leaves many women with mobility disabilities vulnerable to potential injury from unsafe transfers to and from their wheelchairs or unable to receive adequate examinations.
Several pieces of legislation exist to protect individuals with disabilities from experiencing discrimination in health care. These include Title II and Title III of the Americans with Disabilities Act, Section 504 of the Rehabilitation Act of 1973, and Section 1557 of the Patient Protection and Affordable Care Act.
Though the disability rights law within the US is arguably robust, the means of enforcing these protections are not. Currently, if an individual experiences discrimination based on disability status, they must file a report with the Department of Justice. This protocol places the burden on the individual. It can be time-consuming and financially burdensome.
We need a policy that is not reactive but rather prevents these injustices from occurring in the first place. It should incentivize clinics to be accessible and comply with the ADA. A tax credit in which women’s health clinics are evaluated based on the presence of height-adjustable examination tables as well as providing disability-focused training to staff may help to reduce inaccessibility of the physical environment. Both the Disabled Access Credit, which offers a tax credit to employers for expenditures related to accessibility, and the Architectural Barrier Removal Tax Deduction, which allows small businesses to receive a deduction of up to $15,000 per year for expenditures related to barrier removal, may serve as a model for this proposal. One potential weakness of this policy is that complying with the ADA can be expensive; it may not be financially worth it to many smaller clinics. Thus, the credit must outweigh the cost of examination tables and training.
Inaccessible examination tables are just one of many systemic and discriminatory factors impacting health access and outcomes for people with disabilities. Addressing them is important to ensure health equity and reproductive justice for all.
Geffen Treiman is a medical student.