Healthcare access for a disabled woman is not the sum of two separate problems. It is a single, intersectional encounter in which the building, the equipment, the clinician’s training, the consent architecture and the reimbursement code all have to line up — and where any one of them missing pushes her below the standard of care non-disabled women receive. That is what the Convention on the Rights of Persons with Disabilities (CRPD) and the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) describe, in different vocabularies, as the same right. And that is what an everyday clinical visit — the gynaecological exam, the antenatal booking, the prescription review, the consent form — keeps revealing as missing.
2026 is the year that framing changed at the treaty level. The CRPD and CEDAW oversight committees issued their first joint general recommendation/general comment in October 2025, on harmful practices intersectional with disability, and for the first time the international human-rights system began collecting routine data on the gap. Reading the rest of this article requires holding two ideas at once: the legal floor has been settled for two decades, and the lived floor — the one in clinics — is only now being measured.
What “access” means in healthcare for a disabled woman
”Access” in this context is not a single barrier but a compounded one. Roughly one billion women and girls live with a disability worldwide — about one in five — and the WHO’s 2024 update to its Global Report on Health Equity for Persons with Disabilities documents that they encounter healthcare across at least four simultaneous axes of difficulty: physical access to the room and the equipment in it; communication access to the clinician’s questions and explanations; attitudinal access to a clinician who treats her as the decision-maker about her own body; and structural access to a system whose risk-assessment tools, screening pathways and billing codes were not designed with her in mind.
The compounded gap is what makes the disabled-woman category analytically distinct from “women” or from “people with disabilities” considered separately. Disabled women report intimate-partner violence at two to three times the rate of non-disabled women, per the WHO Violence Against Women global estimates and the 2024 UN-Women supplementary brief. Fewer than 20% of WHO Member States include disability-disaggregated accessibility indicators in their national maternity-care quality monitoring, per the WHO 2024 audit of national maternal-health information systems. The figures co-vary because they describe the same encounter — a woman whose disability is treated as the reason her testimony, her pain and her consent count less than a clinician’s interpretation of them.
The treaty floor: three articles that finally talk to each other
The right of a disabled woman to healthcare is, on paper, one of the better-articulated rights in international law. Three articles do the load-bearing work.
Article 25 of the CRPD requires States Parties to recognise the right of persons with disabilities to “the enjoyment of the highest attainable standard of health without discrimination on the basis of disability,” and specifies that this includes services “as close as possible to people’s own communities.”
Article 12 of CEDAW, dating from 1979, obliges States to eliminate discrimination against women in the field of healthcare; the Committee’s General Recommendation No. 24 (1999) reads that obligation as covering reproductive, mental, and occupational health.
Article 6 of the CRPD — the only article in any UN human-rights treaty addressed specifically to women with disabilities — requires States Parties to take “all appropriate measures to ensure the full development, advancement and empowerment of women” with disabilities.
What changed in 2025 is that the two oversight committees stopped reading those articles in parallel and started reading them together. The joint general recommendation/general comment on harmful practices intersectional with disability, adopted in October 2025 after a three-year drafting process, names specific failure modes: non-consensual sterilisation, forced contraception, denial of legal capacity to make sexual and reproductive-health decisions, and coercive psychiatric treatment of women with intellectual and psychosocial disabilities. It is the first joint interpretive instrument the two committees have produced. A country’s record on either treaty is now formally cross-referenced when the other committee reviews it.
Where the gap shows
The compounded gap is visible most clearly in five concrete clinical situations. Each is documented well enough that the failure mode can be named, and each is small enough that the fix is a question of procurement, training or law rather than of clinical science.
Physical-exam infrastructure: the exam-table problem
The most measurable gap in disabled women’s healthcare is also the most basic: the equipment in the room. The WHO’s 2024 Global Report on Health Equity for Persons with Disabilities includes an equipment-access annex that surveyed national procurement standards for clinical equipment in 132 countries. Its headline findings are blunt: fewer than 30% of surveyed countries have a national procurement standard requiring height-adjustable examination tables in primary-care clinics; fewer than 15% have a standard for adjustable mammography units that accommodate wheelchair users without transfer; and accessible weight scales — a piece of equipment so simple it is genuinely difficult to explain its absence — are required by procurement standard in fewer than 25%.
The downstream effect is that disabled women systematically receive less of the routine preventive care that the WHO’s own non-communicable-disease strategy is built around. The 2023 follow-up to the US NIH Disability and Health Equity consultation found that women who use wheelchairs in the US receive cervical-cancer screening at roughly two-thirds the rate of non-disabled women, and breast-cancer screening at roughly three-quarters the rate, with the gap concentrated in steps that require physical transfer onto a non-adjustable surface. UK NHS England’s 2024 audit of the breast-screening programme reached similar conclusions, prompting publication in 2025 of a site-level register of accessible mammography provision.
Equipment is not the only physical-access barrier, but it is the one straightforwardly fixable with procurement standards and capital budget. The WHO’s 2024 report concluded — unusually directly for a technical document — that the gap is “not a knowledge gap, an evidence gap, or a clinical-guideline gap. It is a procurement-rule gap.”
Maternal care: the differential nobody collects properly
The mortality and morbidity differential for disabled women in pregnancy has been documented for two decades and audited systematically for less than five. The Lancet’s 2022 Disability series carried the first peer-reviewed global synthesis: disabled women face approximately 2 to 4 times the risk of severe maternal morbidity compared with non-disabled women, with the multiplier widest in low- and middle-income countries and narrowest — but still present — in high-income systems. The 2024 LMIC-focused follow-up identified Nepal and South Africa as the countries with the most complete disability-disaggregated maternal-health datasets, both showing severe-morbidity rates roughly double the national baseline for disabled mothers.
High-income systems are not exempt. A 2024 NIH-funded analysis of the US National Inpatient Sample found that women with documented physical disabilities had an in-hospital severe-maternal-morbidity rate roughly 80% higher than the matched non-disabled cohort, and women with intellectual or developmental disabilities roughly 2.4 times higher. The UK MBRRACE-UK 2023 enquiry into maternal deaths recommended for the first time that the system formally flag disability status at antenatal booking — a recommendation the Royal College of Obstetricians and Gynaecologists endorsed in its 2024 standards update.
The shared diagnosis across these datasets is unusually consistent. Maternal-health professionals receive almost no structured training on the obstetric care of disabled women — the WHO’s 2024 review of midwifery curricula across 41 countries found disability content averaging under three hours over a three-year programme. Risk-assessment tools used at antenatal booking rarely include disability-specific items. And the reflexive assumption that a disabled woman’s pregnancy is “high-risk” routes many women into specialist tertiary care unnecessarily while routing others into routine pathways that do not adapt to their actual needs.
The single recommendation that recurs in every 2024–26 maternal-care guideline addressing disability — WHO, RCOG, ACOG, the Australian Pregnancy Care Guidelines — is to ask the disabled woman herself what accommodations she needs, and to record that answer in her notes. The 2025 joint CEDAW–CRPD recommendation calls it the “minimum procedural floor” and notes that even this floor is unmet in most surveyed systems.
The “ask the woman” principle
Sexual and reproductive health information: three documented gaps
Information access is a quieter category of barrier than equipment or mortality, but the data record on it is now substantial enough to name three specific gaps in the way clinical and public-health information reaches disabled women.
- Deaf women and HIV/AIDS prevention. UNAIDS’ 2023 thematic brief on disability and HIV reaffirmed a long-standing estimate: deaf women in low- and middle-income countries have HIV knowledge scores on the standard demographic-and-health-survey instrument approximately 30–50% lower than hearing women in the same country. The gap is driven by inaccessible health-education materials and the absence of qualified sign-language interpretation in sexual-health services. PEPFAR’s 2024 strategic update flagged this as a category its country-programme reviews will now monitor explicitly.
- Cognitively disabled women and informed consent. The CRPD Committee’s concluding observations have, since 2018, repeatedly criticised healthcare systems that treat the presence of an intellectual or psychosocial disability as a presumption against the woman’s capacity to consent to her own gynaecological, contraceptive, or obstetric care. Inclusion International’s 2024 global mapping found that fewer than a quarter of surveyed countries have replaced substituted decision-making in healthcare with the supported decision-making model that Article 12 of the CRPD requires.
- Autistic women and gynaecological pain. A growing 2022–25 clinical-research literature — concentrated in the UK, the Netherlands, and Australia — has documented systematically delayed diagnosis of endometriosis, adenomyosis, and chronic pelvic pain in autistic women, with delays running on average two to four years longer than in non-autistic comparison cohorts. The mechanism is interpretive: pain communication that does not match the clinician’s expected presentation is heard as exaggeration. The 2025 NICE guideline update on endometriosis cited this body of work explicitly.
Sterilisation without consent
The non-consensual sterilisation of women with intellectual or psychosocial disabilities is the issue the CRPD Committee has raised most consistently across more than a decade of concluding observations. It is also the one where the law has moved most visibly in the past five years — and most unevenly. The 2025 joint recommendation lists national laws that still allow non-emergency sterilisation of women with intellectual or psychosocial disabilities on the basis of guardian, judicial, or familial consent as a “harmful practice” within the meaning of CEDAW General Recommendation No. 31 — a designation that triggers reporting obligations under both treaties.
Mental-health prescribing
Disabled women — across the full range of disability types — are prescribed psychotropic medication at substantially higher rates than non-disabled women, and the disaggregated outcome data needed to evaluate whether that prescribing is appropriate is largely absent. The UK Learning Disability Mortality Review (LeDeR) programme has documented, since 2017, persistent over-prescription of antipsychotics to women with learning disabilities outside their licensed indications — the “STOMP” pattern. The OECD’s 2024 Health at a Glance included for the first time a disability-disaggregated mental-health-prescribing indicator, which showed a similar over-prescription pattern across 14 of the 22 OECD countries that submitted disaggregated data.
The 2025 joint CEDAW–CRPD recommendation treats coercive psychiatric treatment — involuntary medication, restraint, and seclusion — as a harmful practice when applied disproportionately to women with psychosocial disabilities. The CRPD Committee has been more categorical than CEDAW on this question for nearly a decade; the joint recommendation imports the CEDAW Committee’s harmful-practices framework, with its stronger reporting obligation, into the same analytical space.
Country reforms in 2024–26
The legal architecture around sterilisation and supported decision-making has moved in distinct national patterns since 2020. Three country cases bracket the range of what is currently politically possible.
Spain’s reform is the cleanest example. Law 8/2021, in force since September 2021, removed the long-standing Civil Code provision allowing a court to authorise the sterilisation of a person with intellectual disability without the person’s consent, replacing the substituted-judgment framework with a supported decision-making model aligned with Article 12 of the CRPD. The CRPD Committee’s 2023 concluding observations on Spain commended the reform as a model. (See the Spain national regulation primer for the wider legal context.)
Australia’s reform has been state-by-state and slower. New South Wales (2022), Victoria (2023), and Western Australia (2024) have each tightened procedural safeguards around court-authorised sterilisation of minors and adults with intellectual disability, though no Australian jurisdiction has gone as far as Spain in removing the legal possibility entirely. The federal Disability Royal Commission’s 2023 final report recommended national-level reform, accepted in principle by the Australian government in 2024.
Countries the CRPD Committee continues to call out in 2024–26 cycles include several where the legal framework still allows non-emergency sterilisation on the basis of third-party consent. The Committee’s concluding observations identify these jurisdictions in cycle reviews and refer them, under the 2025 joint recommendation, to the CEDAW Committee’s harmful-practices reporting stream.
Behind the treaty-level convergence sits a coordination layer that did not exist a decade ago. Inclusion International has chaired the cross-DPO working group on the joint recommendation since 2022. The Women Enabled / DPI women’s network (WEN-DPI) coordinates input from organisations of women with disabilities across more than 60 countries. The International Disability Alliance women’s caucus (IDA-Women) has been the formal interlocutor with both treaty bodies through the drafting process. On the funding side, the introduction of disability-disaggregated funding tracking by the Global Fund (from its 2024 replenishment cycle) and GAVI (from its 2024 strategy update) is, for the first time, producing data on how much of the global health-financing flow actually reaches services accessible to disabled women. The first published figures from the Global Fund’s 2024 disability marker are sobering — under 4% of country-level grant spending in the first reporting cycle was flagged as containing disability-inclusion components — but having the figure at all is the precondition for raising it.
What good provision looks like
Pulling the strands together, “good provision” for disabled women’s healthcare is not a single intervention. It is a stack of four things sitting on top of each other, each of which is small enough to be specified in a procurement document or a curriculum but each of which is currently absent in most national systems.
- A procurement standard. National procurement rules for primary-care and maternity-care equipment that require height-adjustable examination tables, transfer-free mammography, accessible weight scales, and the rest of the WHO 2024 equipment annex. Capital budget, not clinical science.
- Disability disaggregation in routine data. The Washington Group questions on disability incorporated into health-administrative datasets — not just household surveys — so a national system can track its own disabled-women’s maternal-mortality, screening, and prescribing rates in real time rather than retrospectively through one-off studies.
- A training pipeline. Structured disability content in midwifery, primary-care, and mental-health curricula. The WHO’s 2024 midwifery review applies more broadly: the gap is in the curriculum, not in the clinical literature.
- Enforced supported decision-making. Article 12 of the CRPD operationalised in the healthcare setting specifically, so substituted decision-making is replaced as the default consent architecture around contraception, sterilisation, and psychiatric treatment for women with intellectual and psychosocial disabilities.
The “ask the woman” principle from the 2024–26 maternal-care guidelines is the same idea expressed at the procedural floor. Recorded preferences, recorded accommodations, recorded consent — captured in the woman’s notes by the woman, not by a guardian or by a clinician’s interpretation. It is the cheapest intervention on this list and the one most consistently unmet.
What designers, clinicians and policy-makers should do
For each group reading this piece, the next concrete step is small. For clinicians and clinical educators: ask the woman, record the answer, audit the recording rate. The “minimum procedural floor” the joint recommendation describes is two extra lines on the antenatal booking form and one extra question in the gynaecological consultation. It does not require a policy change to start doing it tomorrow.
For health-system designers and procurement officers: read the WHO 2024 equipment-access annex against the equipment your national procurement standards currently require. Where the two diverge, the gap is the procurement rule. Closing it is a budget cycle, not a research programme.
For policy-makers and treaty-body interlocutors: the 2025 joint general recommendation is now the interpretive instrument that cross-references CRPD and CEDAW reporting cycles. National reports to either committee that do not address the harmful-practices list will, from 2026 forward, attract the other committee’s follow-up. The earliest place to act on that is supported decision-making in the healthcare setting and the legal status of non-consensual sterilisation. Spain’s Law 8/2021 is the reference model.
For everyone: the legal floor has been settled since 2006. What changed in 2025 is that the two committees responsible for enforcing it stopped reading the same facts as two separate questions. The joint CEDAW–CRPD general recommendation is not the only thing moving — the WHO equity report, the Lancet maternal-care series, the Spanish and Australian sterilisation reforms, the Global Fund and GAVI disability markers, the national audits of maternal-care and breast-screening accessibility — but it is the piece that ties the rest together, because it gives clinicians, ministries, and donors a single interpretive instrument that says, in one place, what disabled women’s healthcare access actually means. Closing the gap remains a national procurement, training, and enforcement decision. The treaty floor is no longer the missing piece.
Read more from Disability World on the CRPD, on national regulations, and on the wider 2026 reporting record.