Equitable Care for Patients With Disabilities: Considerations for the Gynecologic Health Care Professional

The recent article by Barbera et al1 in the April 2024 issue offers important practical guidance for clinicians to provide more competent gynecologic care for patients with disabilities. We are pleased to see Obstetrics & Gynecology highlighting this issue and offering a practical framework for clinicians to address the health disparities that people with disabilities experience in gynecology. Additionally, recent research about the biases generally held by clinicians regarding people with disabilities2,3—and research about disability bias conveyed by obstetrician–gynecologists during prenatal screening4—suggests that clinical guidelines and training also must address the systemic ableism in obstetrics and gynecology that undergirds those biases to achieve true health equity for people with disabilities. Otherwise, we are bandaging the wound without medicating the infection. Ableism involves “stereotyping, prejudice, discrimination, and social oppression toward people with disabilities—the largest minority group in the US.”5 Currently, people with disabilities are not substantively included in the American College of Obstetricians and Gynecologists' (ACOG) health equity initiatives, despite being officially designated as a minority underserved population by the National Institutes of Health. Therefore, we invite ACOG to specifically address disability in clinical guidelines as well as policy and position statements, to expand the inclusion of disability in training and education programs, and to address obstetric care given the higher rates of maternal morbidity and mortality among people with disabilities.6 Beyond improving competent care for patients with disabilities at the clinical level as rightfully articulated by Barbera et al, ACOG and hospital systems can contribute tremendously to addressing health equity for people with disabilities at a systems level. This can be done by intentionally including people with a range of physical and cognitive disabilities and their families and caregivers on the DEIE Workgroup and Team (as the American College of Medical Genetics and Genomics has done), giving people with disabilities a platform at the ACOG annual meeting, and working alongside the disability community to develop obstetrics and gynecology student and fellow training on the history of disability rights and avoiding disability bias as key components of providing equitable health care.