Racial and ethnic minority women with disabilities may have a higher likelihood of unintended pregnancy, compared to White women without disabilities and other women of their own racial or ethnic group, suggests a study funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The study authors called for efforts to improve access to comprehensive sexual and reproductive health care for minority women and minority women with disabilities.
The study was conduced by Anne Valentine, Ph.D., and Monika Mitra, Ph.D., of Brandeis University and their colleagues. It appears in the Journal of Women’s Health. Funding also was provided by the National Institute on Disability, Independent Living, and Rehabilitation Research.
Background
Unintended pregnancy refers to a pregnancy that is unwanted or occurs earlier than desired. According to the U.S. Centers for Disease Control and Prevention, the rate of unintended pregnancy in 2019 among females aged 15 to 44 years was 35.7 per 1,000. Women with unintended pregnancies are more likely to experience depression around the time of birth, as well as adverse outcomes such as pre-eclampsia, preterm birth, and low birthweight. Previous studies have found that women with disabilities have higher rates of unintended pregnancy than women without disabilities.
Results
For the current study, researchers sought to determine how disability status combined with race and ethnicity might influence unintended pregnancy risk.
The study authors analyzed data from the National Survey of Family Growth, which gathers information on pregnancy and births, marriage and cohabitation, infertility, contraception use, family life, and general and reproductive health. Their analysis included responses from 12,833 women with 34,463 pregnancies who were interviewed from 2011 to 2019. Participants were 15 to 44 years old and provided information on disability status, age, race, number of pregnancies, and the intendedness of those pregnancies. Measures of disability included limitations in hearing, vision, cognition, mobility, self-care, and independent living. The authors statistically compensated for factors other than disability, race, or ethnicity that could influence the risk of unintended pregnancies, such as income, younger age, and single parenthood.
When compared to non-disabled, non-Hispanic White women:
- Non-Hispanic White women with disabilities were 49% more likely to have unintended pregnancies.
- Non-disabled, non-Hispanic Black women were 66% more likely to have unintended pregnancies.
- Disabled, non-Hispanic Black women were more than twice as likely (218%) to have unintended pregnancies.
Non-disabled Hispanic women (9%), disabled Hispanic women (40%), and disabled women who listed their race or ethnicity as other than white, black, or Hispanic (53%) were also more likely to have unintended pregnancies when compared to non-disabled, non-Hispanic White women. Non-disabled women of other race/ethnicities were no more likely to have unintended pregnancies.
Significance
The authors concluded that being disabled appears to increase the risk of unintended pregnancy in people of minority racial or ethnic status.
Next Steps
The authors called for health policies that eliminate barriers to reproductive care for people with disabilities, such as lack of accessible family planning facilities, interpreter services, transportation, and suitable contraceptive methods. They also called for policies that eliminate differences in out-of-pocket costs for contraception for reproductive-age women covered by Medicaid or Medicare.
Reference
Valentine, A, et al. Pregnancy intendedness among racial and ethnically minoritized women with disabilities. Journal of Women’s Health. 2024. DOI: 10.1089/jwh.2023.0494
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