Disability, Equipment Barriers, and Women's Health: Using the ADA to Provide Meaningful Access

It is well-known that people with disabilities face multiple barriers to adequate health care, including lower average incomes, disproportionate poverty, and issues with insurance coverage. This article focuses on a more fundamental barrier - one that has not been discussed in the legal literature - inaccessible medical equipment and its effect on the delivery of women’s health care to millions of women with disabilities. The problem of physical barriers to the delivery of health care for people with disabilities is a surprisingly under-examined subject. Early writing after the passage of the Americans with Disabilities Act (ADA), primarily in the medical literature, noted lack of access as a problem, but predicted or appeared to assume that the ADA’s requirement of removal of architectural barriers where readily achievable would quickly remedy the problem. Most legal scholars since then have focused on the problems of the role of disability in medical decision-making and insurance coverage. Although the Rehabilitation Act and the ADA require that health care programs, institutions, and offices be accessible, few actually are: over fifteen years after the passage of the ADA, women with mobility impairments cannot get on examination tables, cannot be weighed, and cannot use mammography equipment. This pervasive and unequal treatment has serious consequences for the health and well-being of millions of women. The continuing failure to ameliorate this seemingly simple problem points to larger questions. What does it mean to have a disability? And how does the answer to that question inform our understanding of the social, political, and economic consequences of disability? Even a cursory review of law and practice in this area reveals a deep conflict in our understanding of disability and the justness of its social, political, and economic consequences. I have explored these questions elsewhere, arguing that disability is under-theorized, and offering an alternative model of disability in the context of employment discrimination claims under Title I of the ADA. These same questions are present here in a different context. What does it mean to be a woman with a disability? And what if anything should we do to ameliorate disparities in access to health care for women with disabilities? This article seeks a solution to the problem of inaccessible medical equipment informed by these larger questions. Part I establishes the scope of the problem through a review of the medical literature and the first national survey of women with disabilities on their experiences with women’s health care. Disturbingly, the literature reveals significant equipment-related barriers to women’s health care for women with mobility disabilities. Part II provides an overview of disability-based civil rights law, specifically the Rehabilitation Act and the ADA, and the requirements regarding equal access to health care programs and services. Part III explores possible explanations for the discrepancy between the requirements of the law and the experience of women with disabilities. The section first addresses possible objections to enforcement of the duty to acquire accessible equipment, including claims that there is no consensus on the definition of accessible equipment, that accessible equipment is not available, and that accessible equipment is not necessary because patients can be lifted onto existing equipment. It then argues that the continuing stigmatization of sexuality, reproduction, and parenting in connection with women with disabilities plays a key role in the continuing invisibility of the problem among people without disabilities, including physicians. Finally, Part IV discusses ways to increase equitable access to women’s health care for women with disabilities in light of the physical and societal barriers identified above, and suggests addressing the responsibility of states to ensure meaningful access to the Medicaid program for women with disabilities as a promising place to start.