Physician Recommendations Against Pregnancy Among Young Women With Disabilities in the United States

BACKGROUND: Women with disabilities face systematic barriers to reproductive autonomy, yet physician bias in pregnancy counseling has not been quantified using nationally representative data. METHODS: We analyzed pooled data from 4 waves of the National Survey of Family Growth (2011-2019), including 8018 US women aged 15-25. Disability status was defined using the American Community Survey's 6-item measure. The primary outcome was self-reported physician recommendation against pregnancy. Among women who received such recommendations (n=122), we examined physician-reported reasons using categories: "dangerous for you," "dangerous for your baby," and "some other reason." Poisson regression was used to estimate adjusted prevalence ratios (aPRs). RESULTS: Disabled women comprised 21.2% of the sample and were significantly more likely to report receiving physician recommendations against pregnancy compared with nondisabled women (2.6% vs. 1.1%; aPR:1.91, 95% CI: 1.10-3.29). The disparity was highest among women with physical disabilities (aPR:5.73, 95% CI: 1.79-18.29), followed by those with hearing (aPR: 4.24, 95% CI: 1.49-12.07) and vision disabilities (aPR:3.99, 95% CI: 1.60-9.99). A substantial proportion of recommendations were attributed to "some other reason" (disabled women: 44%; nondisabled women: 40%). CONCLUSIONS: Young disabled women face systematic bias during reproductive health care counseling, with nearly double the likelihood of receiving recommendations against pregnancy. The high proportion of recommendations under "some other reasons," beyond maternal or fetal health concerns, suggests potential subjective biases may influence clinical recommendations. These findings underscore the need for evidence-based clinical guidelines and monitoring to ensure respectful, individualized, and medically appropriate reproductive health care regardless of disability status.