Provider Reflections on Contraceptive Access and Informed Consent for People With Disabilities in Rural Healthcare Settings

People with disabilities face persistent barriers to reproductive autonomy, particularly in under-resourced settings. These include provider bias, coercive counseling, inaccessible facilities, inadequate insurance coverage, and limited access to assistive technologies. This mixed-methods study explores provider-reported challenges in delivering contraceptive care to people with disabilities in Montana, a predominantly rural state. Data were collected through 90 surveys and 9 in-depth interviews with licensed healthcare providers. Key barriers identified include (1) limited appointment time and capacity to manage complex needs; (2) communication difficulties and challenges obtaining informed consent; (3) inaccessible clinical environments and equipment; (4) insufficient disability-specific training; and (5) rural healthcare shortages that exacerbate racial, geographic, and disability-related disparities. Providers also reported uncertainty about best practices for contraceptive counseling, discomfort with disability-related care, and difficulty navigating guardianship dynamics. Despite these challenges, many providers expressed a strong desire for additional training and institutional support to improve care delivery. Findings underscore the need for systemic reforms, including expanded provider education, improved reimbursement structures, and investment in universal design and accessibility. The study highlights how ableism, rurality, and historical reproductive oppression intersect to shape provider behavior and patient experience. Addressing these barriers is essential to advancing reproductive justice and ensuring that people with disabilities can make informed, autonomous decisions about their reproductive lives.