Patient Experiences in Accessing Reproductive Health Services for Women With Cognitive, Intellectual, and...

Individuals with disabilities face barriers to care. Using a life-course and socio-ecological perspective, we reviewed studies on the experiences of individuals with cognitive, intellectual, and developmental disabilities (CIDD) in accessing sexual and reproductive health (SRH) services.

We systematically searched six online databases and gray literature, selecting studies published from January 2010 to June 2024 written in English. Narrative synthesis was used to identify key themes using the socio-ecological framework. Data were collected by using a standardized extraction form following the Population, Intervention, Comparator, and Outcome format. We conducted assessments of risk of bias and certainty of evidence using standardized tools. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for quantitative studies and Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) for qualitative studies.

Of 5,595 studies screened, 26 were included in the final analysis, with almost perfect inter-rater reliability (kappa = .87). SRH service categories included preventive care, puberty/menarche, family planning, pregnancy and fertility, reproductive cancer treatment, and general SRH services. We found lower receipt of preventive care services, lower use of contraception, higher rates of sterilization, and worse obstetric outcomes for individuals with CIDD compared with those without CIDD. Caregiver support was an interpersonal factor well represented in the literature, whereas the patient perspective was underrepresented.

Future research and policy efforts should prioritize the perspectives of individuals with CIDD, particularly during puberty/menarche and menopause. Studies indicate a need for patient-centered approaches, caregiver support, provider training in disability-inclusive care, and accessible healthcare infrastructure to reduce barriers to care.