Q&A: Ensuring deaf population’s access to reproductive health care resources
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A recent commentary titled “Reproductive Justice for the Deaf Community” highlighted what health care professionals must do to provide the deaf community full access to reproductive health care and other resources.
“Sexual health literacy and behaviors in the deaf community are limited by society due to inaccessible information and limits on access to physician-mediated contraception, the result of which is that deaf women are 67% more likely to become pregnant unintentionally than the general population,” Tiffany L. Panko, MD, MBA, wrote in Obstetrics & Gynecology. “As a medically trained deaf woman conducting reproductive health research, I am uniquely positioned to bring this issue to light based on my lived experience and accumulated personal and professional knowledge.”
In this interview, Panko, who is the director of the Deaf Health Laboratory at Rochester Institute of Technology’s National Technical Institute for the Deaf in Rochester, New York, discusses how reproductive justice for deaf people can be achieved, drawing from both professional and personal experiences.
Healio: How is deaf people’s access to reproductive health resources limited?
Panko: The issue actually begins with inadequate health education (like for many Americans) and language deprivation. Many deaf children grow up in hearing families that do not know American Sign Language (ASL), so they miss out on opportunities for incidental learning such as overhearing important conversations about family medical histories; this phenomenon is known as the dinner table syndrome. In addition, families may not feel equipped to speak with their child about sexual or reproductive health, deferring to the school. The problem is, sometimes teachers defer questions to the parents, or the school doesn’t have enough personnel or resources for effective health education.
Healio: How does this limited access affect deaf people’s reproductive health?
Panko: Limited access to language and health education early in life leads to limitations in health literacy down the road. Most people agree that navigating the health care system is often fraught with difficulties; there are additional challenges that deaf people face, such as figuring out when and where to go for care and ensuring ASL interpreters are provided at appointments. For example, suppose a woman looks online for options accessing an abortion. They will find that many resources are text-heavy or rely on being able to talk on the telephone. Further, ASL interpreters are often not trained to interpret in medical situations and/or are video remote interpreters (VRI). Using VRIs for sensitive appointments interferes with the clinician’s ability to build a relationship with the deaf patient and goes against recommendations from the National Association of the Deaf.
Healio: What work needs to be done to accommodate the reproductive needs of deaf people?
Panko: There needs to be a more conscious and concerted effort in ensuring health information is available in ASL. We saw an increase during the COVID-19 pandemic, with efforts from organizations such as Partners in Deaf Health and Deaf in Scrubs providing updates in ASL on social media, as well as televised public service announcements with interpreters on screen instead of only English captions. However, these kinds of efforts should not be limited to pandemics. For instance, there hasn’t been widespread messaging in ASL about Roe v. Wade being overturned and what that actually means, leading some deaf people to think that abortion is illegal nationally. As far as I know, the only ASL content on abortion is provided on the WhoNotWhen website.
Healio: How can clinicians accommodate their deaf patients on an individual basis?
Panko: Clinicians need to keep the above in mind, remembering that their deaf patient often may be coming to them with limited knowledge and limited opportunities for learning about their own health. Along with ensuring optimal communication by providing accommodations such as ASL interpreters, giving deaf patients ample time to ask questions and process information is helpful. Also, it would be prudent to keep in mind that the deaf patient may not know what to ask for further explanation on, so the teach-back method — [having patients explain their understanding of what their clinician tells them back to the clinician] — can help address gaps in understanding.
Healio: Is there anything else you want to highlight about reproductive justice for deaf people?
Panko: It’s important to acknowledge that the reproductive justice movement started with women of color. Deaf women of color are marginalized members of multiple communities, where they experience systemic racism in addition to audism (discrimination based on hearing status). Deaf women of color need to be at the forefront, with a seat at the table on public health research teams.