Sometimes, a “routine” medical appointment is anything but.
A wheelchair-bound patient arrives for their annual mammogram, only to discover she must stand to complete the exam. A patient in a larger body makes an appointment with their gynecologist and is told the exam table is too small for them to sit on.
These are just some of the issues that disabled and bigger-bodied patients can have at medical appointments.
“I think [people without disabilities] would be shocked to see what we go through in … health-care spaces,” said Syanne Centeno-Bloom, a disability rights activist, adding, “That leads to a lot of people not seeking care.”
The updated Department of Justice guidelines—issued in August 2024—requiring accessible medical diagnostic equipment to be available in all government-funded health facilities; the deadline to fix these problems is August 9, 2026.
In practice, however, accessibility compliance is not heavily enforced at the federal level. Americans with Disabilities Act requirements often rely on private lawsuits or complaints filed by patients to enact, rather than on federal oversight. State governments are also tasked with enforcement.
Now, as the August deadline approaches, advocates say implementation is lagging. Some reproductive and sexual health clinics nationwide are adopting more inclusive equipment, if slowly. But weak enforcement mechanisms mean progress is uneven across states, and that could present a long-term problem for disabled patients’ reproductive health.
‘There’s a dignity issue’
According to a 2024 academic study published before the new accessibility rules were issued, fewer than 40 percent of medical offices had disability-accessible examination tables or weight scales.
Centeno-Bloom, a model and disability rights activist with Ehlers-Danlos syndrome (EDS), endometriosis, osteoporosis, and several immunodeficiencies, has experienced the results firsthand.
“Most places don’t have the exam tables that you can be weighed on,” she told RNG, referring to dual-use tables that allow patients to be weighed and examined in the same place.
They eliminate the need for multiple transfers between different medical equipment, reducing patients’ potential for injury and embarrassment. Inaccessible equipment that does not cater to wheelchair patients can result in incorrect positioning during operations and positioning injuries that affect the skin, joints, ligaments, and bones.
In some instances, Centeno-Bloom said, staff have elevated adjustable exam tables for prior appointments and then “don’t put it back down for me … I end up having to climb up,” she said. “They don’t offer assistance.”
The Centers for Disease Control and Prevention reports accessibility problems across the health-care industry. But reproductive health settings may be uniquely consequential due to the physically intimate nature of gynecological examinations.
For example, a lack of lift exam tables or adjustable tables can make it difficult for physicians to properly examine patients.
“You’ll start an exam and you’ll realize they’re too far up or … down,” one doctor told researchers in a 2023 study on gynecological care for disabled women, describing logistical difficulties during the gynecologic examination. “Patients who have contractures, it’s really hard to just get the legs to physically open up…”
Another study published that same year concluded that female patients with disabilities hit more stumbling blocks when trying to access reproductive health services than non-disabled patients. Inaccessible medical equipment can cause patients to miss or delay the routine appointments that both allow early detection of reproductive health issues and deepen the relationship between provider and patient.
“These limitations can slow down or delay care for people in need of contraception, prenatal care, abortion care, and routine screenings,” Dr. Michael Chichak, a physician at the online mental health treatment platform MEDvidi, told RNG.
Many patients experience anxiety at the doctor’s office. For disabled or larger patients, adding this kind of emotional distress from inaccessible equipment can leave them feeling like they’re being indirectly judged.
“There’s a dignity issue as well, in addition to the logistics issue,” Chichak said. “If the space feels like it was not created for patients to enjoy, that may discourage them from returning.”
Research from the National Institutes of Health suggests that assistive technology and medical equipment can significantly influence the psychological well-being of such patients.
As Centeno-Bloom put it: “Why would you want to go somewhere where you are caused more pain in a lot of cases than you are helped?”
Long road to disability justice
The Americans with Disabilities Act (ADA) has broadly prohibited disability discrimination in health care since 1990. In August 2024, the Department of Justice finalized its updated regulation for Title II of the ADA, a specific regulation of ADA implementation that requires nondiscrimination by all state and local government-run entities.
Following that Biden-era regulatory update, the ADA National Network—which provides guidance and training on implementing the landmark disability law—laid out specific medical diagnostic equipment standards.
All public health clinics, emergency rooms, and hospitals are among the places that must soon have at least one examination table that is adjustable, rather than traditional setups that can be difficult for patients with mobility limitations. These facilities must also offer a weight scale that allows patients to be weighed while in their wheelchairs, and mammography and X-ray equipment that accommodates patients who are unable to stand.
Government-run facilities can establish baseline standards for the rest of the industry to follow, and some private facilities are already beginning to implement more accessible equipment.
The Von Voigtlander Women’s Hospital, a part of University of Michigan Health, offers dedicated care for women with disabilities. It features height-adjustable exam tables and staff trained to assist patients with mobility challenges like safe transfers.
Other health systems have made similar improvements, including the University of Pittsburgh Medical Center and the University of Alabama-Birmingham Medicine.
While these changes are not yet standard across the health-care system, they offer a glimpse into what the future of accessible health care could look like.
“There would be less friction, and access to care would just be more seamless,” Jillian MacLeod, a staff attorney at the Disability Rights Education & Defense Fund, said.
Two in 5 have disabilities
Such changes wouldn’t just benefit patients needing reproductive care, but many millions seeking all types of medical care in the U.S.
Two in 5 adults over the age of 65 have a disability, including mobility challenges, according to the CDC. Having readily available accessible medical equipment could help make routine appointments less traumatic for elderly patients.
Disability is also more common in certain demographic groups that already face acute barriers to health care, according to the CDC, including women, Native Americans, and people who live in poverty. Inaccessible medical equipment exacerbates these inequalities.
Without updated figures from the federal government, it’s unclear how many clinics nationwide will have acquired accessible medical equipment when the DOJ’s regulation timeline ends in August 2026.
There are many reasons why uptake might be slow beyond weak federal enforcement mechanisms, Chichak suggested, including cost. Accessible medical equipment like height-adjustable exam tables can cost thousands of dollars more than traditional, static exam tables.
“Even clinics that genuinely want to improve access face the pressures of limited budgets and space, and upgrading equipment is more complex than it appears,” Chichak said.
‘Big gap in awareness’ of disability health
MacLeod and Centeno-Bloom both linked the uneven implementation of the DOJ’s accessibility rule to not only the lack of federal oversight but also to generally poor knowledge of the rights and health needs of disabled and larger-bodied patients.
MacLeod recalled a training session she led for around 90 clinic staff who provided reproductive health care. When she polled the participants to find out their levels of familiarity with disability rights laws, nearly three-quarters said that they were not familiar at all. Twenty-eight percent said that they were somewhat familiar with the topic.
“There’s a really big gap in awareness and knowledge,” Macleod said.
Centeno-Bloom agrees that provider attitude and awareness are some of the biggest obstacles to implementation. But so is perspective, she said.
“They’re lacking input from the disabled community,” she said.
The updated federal rules mark a significant step toward reducing structural barriers to basic reproductive care. But their success depends on near-universal implementation..
For Centeno-Bloom, that success also means including disabled people in how their own health care is designed and delivered.
“If you’re out of sight and mind,” she said. “Nothing’s going to change if they’re speaking for us and not just giving us the ability to speak for ourselves—not only have a seat at the table—but actually be heard.”
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