Advancing Accessibility in Gynecologic and Reproductive Health Care

My interest in improving health care accessibility for patients with disabilities began in medical school. For the first time, I saw the real challenges these patients faced: appointments that took significantly longer due to accessibility barriers, health care professionals struggling to navigate limited time and resources, and patients growing frustrated because their needs weren’t being met. It became clear that our system was not designed to provide equitable care for people with disabilities.

Disability awareness remains limited in health care, despite the fact that one in four adults in the United States experiences some form of disability. The CDC defines disability as a condition that affects a person’s ability to perform daily activities or interact with the world. Yet, disability is not the opposite of health. With the right systems in place, people with disabilities can live full and healthy lives.

However, systemic barriers—such as inaccessible exam tables, lack of transfer equipment, and communication hurdles—continue to hamper gynecologic and reproductive health care. These challenges contribute to delayed diagnoses, emotional trauma, and poorer health outcomes. These barriers also discourage patients from seeking care, perpetuating a cycle of unmet medical needs. As ob-gyns, we have an opportunity and responsibility to change this reality. That’s why I launched a quality improvement initiative called Improving Gynecologic Resources for Accessibility, Collaboration, and Education, also known as iGRACE.

iGRACE aims to assess health care professional and patient perspectives on accessibility in ob-gyn clinics, with the goal of informing policy changes, education efforts, and resource allocation. Our team includes health care professionals, disability advocates, and patients with disabilities—including Cody Unser, who became paralyzed at age 12 from transverse myelitis and has since dedicated her career to disability advocacy, and Ashira Greenberg, who was born with a disability and is a leader in the field of disability advocacy with local and national groups. Both Cody and Ashira have significantly shaped the direction of this project: Ashira’s work has helped to influence practice changes and highlight the needs of people with disabilities in reproductive health care, and Cody’s lecture, Wheelchair Barbie Goes to the Gynecologist, has shed light on the unique challenges patients with disabilities face in reproductive health care.

Accessible care is not a privilege—it’s a right. By recognizing and addressing these disparities, we can build a system where every patient, regardless of ability, receives the care they deserve.

Ashley Hilton, MD, FACOG, is a fellow in the division of urogynecology and reconstructive pelvic surgery at the University of Colorado. Passionate about medical education and mentorship, she has led initiatives to support trainees applying to fellowship, including workshops on CV development and interview preparation. Dr. Hilton is also an advocate for disability awareness and accessibility in ob-gyn care, drawing from her personal experiences to drive meaningful change in the field. Her research focuses on advancing surgical outcomes and improving patient-centered care in urogynecology.

Ashira Greenberg, MPH, CHES (she/her), is a certified health education specialist with a passion for autonomy in sexual and reproductive health and improving disability awareness in local and national clinical practices. She earned her master’s in public health from Columbia University. Greenberg identifies as a disabled person and as a person with a disability, using both identity-first and person-first language to describe her personal experience with disability.