A collaborative agenda for the disability and reproductive justice communities in 2023

AUTHORS’ NOTE: The disability community is rapidly evolving to use identity first language rather than first person language. This is because disability is seen as a core component of identity, as are race and gender. Some members of society, such as people with intellectual and developmental disabilities, prefer first-person language. In this fact sheet, the terms are used interchangeably.

On November 29, 2022, the Center for American Progress called on more than 20 reproductive rights and disability advocates and justice communities to discuss their agendas for 2023 and beyond. After categorizing the meeting notes, the authors compiled a list of the top five issues highlighted by attendance. Although these priorities do not sum up every issue that needs to be addressed, they provide important opportunities for collaboration in the coming years.

1. Increasing access to reproductive health care for people with disabilities

Persons with disabilities face barriers to accessing high-quality reproductive health care, whether due to lack or restricted access to accessible medications, transportation, or medical examination equipment. Federal legislative action can help ensure access to medicines, including methotrexate;which are used to treat a variety of conditions and may have side effects that lead to miscarriage.

Policymakers at the federal administrative level also have a great deal of opportunity to address barriers:

• The Department of Health and Human Services can accredit the 2017 Access Board Standards for accessible medical diagnostic equipment by merging it in Section 510 of the Rehabilitation Act. This would ensure the availability of this equipment.
• To boost access to telehealth, the Biden administration could prioritize reproductive health care deserts when allocating money to expand broadband access through the Infrastructure Investments and Jobs Act.

2. Addressing barriers to coverage and financing of reproductive health care for persons with disabilities

Congress should repeal Hyde Amendment, an annual appropriation contestant that prohibits federal insurance programs like Medicaid and Medicare from covering abortion services except in extremely narrow circumstances. Further state and federal reforms will also be critical to ensuring universal coverage of reproductive health services.

At the federal level, policy makers should:

• Handling administrative burdens and eligibility requirements that act as barriers to Medicaid coverage. Simplifying paperwork procedures can significantly reduce burdens for people with disabilities. And Congress must require all 50 states to automatically enroll SSI recipients in Medicaid.
• Require Medicare to offer all forms of birth control through Part A, Part B, and Part D programs, regardless of the beneficiaries’ disability status.

At the state level, policy makers should:

• Adopt legislation to increase access to reproductive health care in general, incl Medicaid Expansion under the ACA. This will permanently eliminate the coverage gap for individuals in non-expansion states who do not qualify for Medicaid but whose household income is too low to qualify for health insurance market benefits from the ACA. It will also provide funding for rural clinics and hospitals.

3. Increasing the right of persons with disabilities to reproductive independence

Although the increases in coverage and financing are important, more than a million People with disabilities are in guardianship arrangements that legally prevent them from making critical decisions about their reproductive lives. Because Guardianship is currently very much a state law issue:

• States must ensure this guardianship Laws encourage the independence of persons with disabilities and their ability to make their own decisions regarding their health. States should remove guardianship laws that prevent reproductive decision-making, as well as those that automatically remove children when one parent is in custody.

At the same time, federal policymakers can work to improve and reform the US guardianship system:

• Congress should pass legislation that includes a national bill of rights for people in custody or at risk of guardianship and allocate grants to establish a court improvement program. This program can be modeled Child Welfare Court Improvement Program and educate judges about guardianship and supported decision-making.
• The Department of Justice should recognize through guidance or a list of frequently asked questions that supported decision-making is a less restrictive environment than guardianship that must be protected under the Americans with Disabilities Act by the Supreme Court’s decision in Olmsted.

4. Increase education and training in the field of reproductive health for service providers and others who work directly with persons with disabilities

There are a variety of opportunities to improve how the health care workforce serves people with disabilities. Federal action, in particular, could help advance a national standard of care. Policy makers should consider the following:

• Pass federal legislation that provides for management in community living Grants to help give providers professional education and sensitivity training that reduces their reliance on able metaphors and encourages self-determination for people with disabilities, for example by increasing provider recognition of supported decision-making.
• Invest in expanding and improving training in sexual and reproductive health (SRH) care so that providers can better serve people with disabilities. This includes maternal and pregnancy health care, abortion services, and preventive care. In particular, legislators should prioritize passing legislation such as Reproductive Health Care Accessibility Actoriginally introduced in Congress in 2022. This bill would establish a grant program to train sexual and reproductive health providers and educators who serve individuals with disabilities.

5. Increase sexual and reproductive education for the disabled

Even with the above improvements, far too many people with disabilities are prevented from obtaining the necessary education and information about their reproductive choices. While Seven states It requires that sex education in public schools be evidence-based only Three states Require sex education to be accessible to the disability community. Thirty-six countries No sex education programs are tailored to the disability community. Ultimately, all school and health programs funded by state or federal dollars should be needed to provide sex education accessible to the disability community. This is especially necessary for individuals with intellectual disabilities, due to the high rates of sexual assault. Lessons must be adjusted for disability; For example, lessons involving an intellectually disabled person should include clear language that is appropriate for their communication style. The US Department of Education can begin this work by:

• Publication of a list, in partnership with the Department of Health and Human Services, of frequently asked questions about sex education for students with disabilities.
• Encourage states to request Title X grants to help fund more evidence-based reproductive education programs for youth with disabilities.

conclusion

The issue areas and policy actions explored in this fact sheet are non-exhaustive and represent starting points for change at the local, state, and federal levels. As policymakers work to remove barriers to comprehensive and accessible reproductive health care, they must collaborate directly with the disability, reproductive rights, and justice communities.

Especially when it comes to federal administrative opportunities, the disability and reproductive rights communities can work with policymakers to increase access, correct regressive policies, and ensure reproductive freedom and autonomy for people with disabilities.