Across the world, women with disabilities continue to encounter significant barriers in accessing healthcare, mostly due to physical and informational inaccessibility, communication barriers, and socioeconomic challenges.1 In reproductive healthcare services, manifestations of multiple intersecting forms of discrimination occur concerning gender, disability, and assumptions about sexuality and motherhood, especially for women with intellectual disabilities.1 These experiences and barriers reflect the ongoing shift from a biomedical model of disability to a human rights-based model, which emphasises autonomy, dignity, and the right to equal access to services following international human rights frameworks such as the UN Convention on the Rights of Persons with Disabilities (CRPD)2 and the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW).3

Global research, including a scoping review of 40 qualitative studies, has shown that women with physical disabilities face systemic barriers to reproductive healthcare, such as inaccessible facilities, poor-quality health information, limited access to reproductive technologies, and dependence on caregivers, all of which can limit personal autonomy and decision-making.4 This aligns with broader concerns around the removal of agency and autonomy, and the impact of socio-environmental factors on healthcare equity for women with disabilities.

Aiming to better understand the attitudes towards women with disabilities, a qualitative research study was conducted in Poland: the study highlighted how societal expectations and ableist norms can shape reproductive healthcare delivery, with service quality often reflecting biases about the perceived ‘legitimacy’ of motherhood for women with disabilities.5 These findings underscore the need to not only understand barriers concerning physical access but also the social ‘norms’ and mechanisms, such as coercion, control, and discouragement, that may constrain reproductive autonomy.

Among disability groups, women with intellectual disabilities are often the most excluded from reproductive healthcare due to pervasive negative stereotypes, limited access to information, and inadequate sex education.6 Studies also show that healthcare providers struggle with communication and often fail to offer appropriate counselling and preventive care,7 which reinforces the marginalisation of this group in healthcare systems worldwide.

In Lithuania, the healthcare system is based on a compulsory health insurance model and is primarily funded through the National Health Insurance Fund. The Ministry of Health oversees the system, setting national health policies and regulations, while healthcare services are provided by a mix of public and private institutions. Primary healthcare is the main point of entry, with patients typically required to register with a general practitioner, who acts as a gatekeeper to specialist care, including reproductive healthcare services.

In 20148 and 2023,9 studies in Lithuania documented barriers faced by women with disabilities in reproductive healthcare, including negative attitudes from providers, judgmental behaviour, and discouragement of childbirth. Women with intellectual disabilities, in particular, reported avoiding gynaecological services due to the belief that they are irrelevant for those not sexually active, highlighting the influence of both public and self-stigma.

In 2021, a survey of obstetricians and gynaecologists in Lithuania identified practical barriers to providing equitable care, such as lack of time, inaccessible infrastructure, and difficulties communicating with patients with hearing or intellectual disabilities.10 These challenges reinforce the need to examine both patient and provider perspectives to fully understand the gaps in service delivery.

Taking into account the fact that no in-depth assessment of reproductive healthcare services from the perspective of women with disabilities has been carried out in Lithuania thus far, the first online survey of women with disabilities in the country was conducted in 2023 for the study presented in this article to gain a better understanding of the barriers to accessing services experienced by women with different disabilities. This study was undertaken in light of Lithuania's upcoming reviews by the CEDAW and CRPD, which underscore the need for evidence-based assessments of the country's progress in upholding the rights of women with disabilities. Although this study is situated in Lithuania, its findings have broader international relevance: the barriers identified are echoed in many other countries, regardless of income level or healthcare system structure.

The main objective of this article is to study how women with various disabilities in Lithuania access reproductive healthcare services, evaluate their experiences with these services, and explore the related attitudes of clinicians.