“It should have been my decision”: A mixed methods investigation of contraceptive coercion among U.S. patients with and without disabilities

BACKGROUND: People with disabilities have long faced threats to their bodily autonomy and reproductive decision-making. One such threat, provider-based contraceptive coercion, occurs when healthcare providers pressure patients to use (upward coercion) or not use (downward coercion) birth control. Yet, modern experiences of contraceptive coercion among people with disabilities remain underexplored. METHODS: In 2023, we surveyed U.S. reproductive-aged people assigned female at birth using Prolific, a national panel of vetted respondents. Participants reported their disability status and contraceptive care experiences. We examined differences in contraceptive coercion by disability status and tested whether self-reported discrimination in contraceptive care mediated this relationship. We also used reflexive thematic analysis to explore contraceptive coercion among people with disabilities. RESULTS: In our analytic sample (N = 1150), people with disabilities were significantly more likely than those without to report ever experiencing any contraceptive coercion (49.4% vs. 38.9%), including upward coercion (40.1% vs. 31.1%) and downward coercion (23.3% vs. 13.2%). These disparities persisted after adjusting for sociodemographic controls. Self-reported discrimination in contraceptive care mediated the relationship between disability status and contraceptive coercion. Open-ended analysis revealed the complex ways that contraceptive coercion is intertwined with disability status, often involving discriminatory, dismissive, and contradictory contraceptive counseling. CONCLUSIONS: Contraceptive coercion is more common among individuals with disabilities and is explained by self-reported discriminatory care. Understanding these experiences is key to resisting coercive practices and advancing disability-informed reproductive justice.