The (dis)ability to be pregnant: how sensory, developmental, and reproductive disabilities among women of reproductive age influence pregnancy outcomes using 2017-2019 NSFG data. Público

Abstract

Women with disabilities (WWD) in the U.S. are a vulnerable population with disproportionate lack of access to healthcare. Pregnancy outcomes for this population are understudied in public health research, both due to stigma from healthcare providers and low quantity and quality of consistent data. Existing literature suggests higher rates of miscarriage and negative maternal health outcomes among WWD compared to women without disabilities (WWOD). Using a biopsychosocial framework of disability, this secondary, cross-sectional analysis uses data from the 2017-2019 U.S. National Survey of Family Growth to examine miscarriage, abortion, and livebirth outcomes among WWD compared to WWOD (n = 9,794), and women with one of three disease categories (sensory (SD), developmental (DD), or reproductive-related non-communicable (RRD)) compared to women with one of the remaining two disease categories (n = 2,681). After adjusting for sociodemographic factors, binomial logistic regressions found increased odds of miscarriage among WWD compared to WWOD (OR: 1.58, p < 0.0001, 95% CI: 1.28 – 1.95) and in women with RRD compared to women with SD or DD (OR: 1.35, p = 0.04, 95% CI: 1.01 - 1.81). These results add to the growing body of literature calling for increased and improved data collection and research about women with disabilities in the U.S., including standard definitions of different types of disability, and improved, consistent data collection questions. The results also help to contextualize the disparity that WWD face in accessing appropriate reproductive healthcare. Lastly, they signal the need for consideration of vulnerable populations in changing U.S. healthcare policy and in reproductive and family planning resources.

Table of Contents

Positionality Statements I  

Abbreviations ii  

I. Introduction 1  

II. Literature Review 3  

A. Pregnancy among women with disabilities 3  

B. Potential confounders on birth outcomes 12  

C. Significance of the problem 19  

D. Theoretical frameworks 19  

E. Measurement of disability in the U.S. 23  

F. Summary 25  

III. Methods 26  

A. Data source 26  

B. Data preparation and variable selection 27  

C. Analysis 29  

IV. Results 31  

A. Descriptive 31  

B. Regression 34  

C. Patterns and trends 35  

V. Discussion 35  

A. Significant findings 35  

B. Strengths 38  

C. Limitations 39  

D. Future research 41  

VI. Conclusion 43  

VII. Public Health Implications 43  

Tables and Figures 46  

Appendix A 53  

References 55 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palavra-chave	reproductive health developmental sensory pregnancy disability
Committee Chair / Thesis Advisor	Subasri Narasimhan, Emory University
Committee Members	Johnathan Edwards, Emory University

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