Sexual and reproductive health in female adolescents and young adults with disabilities: a population-based study

Purpose — To compare sexual and reproductive health (SRH) outcomes and care in female adolescents and young adults (AYA) with and without disabilities.

Methods — We undertook a population-based cohort study in Ontario, Canada, of females aged 12–24 years as of April 1, 2021, and followed them to March 31, 2023, for contraceptive prescriptions or procedures, recognized pregnancy, management of sexually transmitted infections (STIs), and violence resulting in acute care. AYA with physical (n = 95,474), sensory (n = 29,638), intellectual/developmental (n = 7,762), and multiple disabilities (n = 12,304) were compared to those without a disability (n = 814,127; referent) using modified Poisson regression, with relative risks (aRR) adjusted for sociodemographic and clinical factors.

Results — Compared to AYA without a disability, those with physical disabilities were more likely to have contraception (aRR 1.05, 95% CI 1.03–1.07), pregnancy (1.26, 1.22–1.29), management of an STI (1.17, 1.13–1.20), and violence (1.82, 1.70–1.93). AYA with intellectual/developmental disabilities were less likely than AYA without disabilities to have a pregnancy (0.86, 0.77–0.96) and management of an STI (0.65, 0.57–0.74), but more likely to experience violence (1.99, 1.69–2.35). Those with multiple disabilities were less likely to have management of an STI (0.81, 0.74–0.88), but more likely to experience violence (2.16, 1.88–2.47). There were few differences between AYA with sensory disabilities compared to AYA without a disability after adjustment.

Discussion — Female AYA with disabilities experience significant SRH disparities, including higher risk of violence and, for some, reduced access to SRH care. Findings suggest the need for accessible SRH services, supported by provider training and guidelines, to ensure equitable SRH for AYA with disabilities.