The COVID-19 pandemic disrupted transportation in Canada, with dramatic interruptions in services that had disproportionate impacts on marginalized communities. For people with disabilities, such impacts included limited or reduced availability of public transit or paratransit services, and fear of contracting COVID-19 when using transportation. This led many to limit their use of public transit, including delaying or missing appointments with doctors.
In partnership with the DisAbled Women’s Network of Canada (DAWN) and Ase Community Foundation for Black Canadians with Disabilities, we conducted interviews with 61 women, non-binary and transgender people with disabilities to examine the impact of the pandemic on access to sexual and reproductive health services for people with disabilities. We found that they experienced significant transportation barriers when accessing sexual and reproductive health services during the COVID-19 pandemic. We recount some of their stories here; all names are pseudonyms.
People with disabilities reported health and safety concerns, namely, fears of contracting COVID-19 when using public modes of transportation like buses and taxis. Those who did not have access to their own car or were unable to drive relied on family members, friends or other support people to get them to appointments.
“I did end up missing one of [my gynecology appointments]. I still haven’t done that yet. It was just transportation, getting someone to go with me, being able to access it.” – Anika
“It’s very stressful, having to travel back and forth on the ferry and on the bus. There were extra barriers to what’s already an expensive and stressful experience in terms of being an immunocompromised person.” – Vanessa
The lead author (Alexandra Rego), also a person with a disability, experienced this firsthand. Relying on the paratransit system was not something that she was prepared to do during the pandemic. Like many study participants, Alexandra coordinated schedules with family members to get her to necessary health-care appointments. Often, these became all-day excursions, leading her to postpone appointments for sexual and reproductive health.
Many participants in our study did not have access to a private vehicle, whether their own or that of a family or friend. Thus, avoiding the risk of shared transportation services was not feasible. This aligns with prior research on transit usership in 2020 that noted individuals who stopped riding transit were more likely to be in privileged positions, specifically white, wealthy men, born in Canada and not living with a disability.
People with disabilities who continued to rely on public transportation described disruptions to services, including reductions or cuts to services, that left them with expensive, unsafe and inaccessible options.
“Before COVID, we had a service in our town through a cab company. Almost like a bus service, it was a big van. You got picked up every 20 minutes on each side of town. It was only like $2.50 a ride. Because of COVID, they had to stop using it. There was no way to social distance in there. They still haven’t started that service back up. You better be dying if you’re going to the hospital, because you’re looking at a $50 [taxi] trip just to get there and back. […] How are we supposed to be doing anything?” – Sarah
“I wasn’t going anywhere when things were bad. But I had to rely on [the paratransit system] and then there was a while when they had to shut down, too, because the drivers had [COVID-19]. And then taxis were expensive and not all taxis are accessible either. Evenings, they didn’t always have the accessible taxis available, they would stop running.” – Irene
Participants who had lower incomes and lived in rural areas spoke of a lack of accessible and affordable transit options. Disability income support was not enough to provide basic needs, which include transportation. They described assessing the severity of their health concerns because of transportation barriers, and consequently choosing to delay or cancel their appointments.
In our study, virtual care was noted as an accessible option during the pandemic, with benefits including not having to leave their house for a doctor’s appointment and receiving improved continuity of care.
“Virtual care makes [health-care appointments] super accessible.”
“Having more opportunity to do phone, virtual appointments when you have disabilities and sometimes a few more hurdles, I have really welcomed that.” – Candice
“I think for me, especially with this disability, it would have been next to impossible to even get to where I am [with my gender transition] without telehealth.” – Vanessa
“I’m honestly so happy that [virtual care] became available. I know that people with disabilities have been wanting this for so long. And yet we’re not listened to until non-disabled people need access to it. But it’s been wonderful to have the option because sometimes it’s really hard to get out of the home. It makes it easy to really work into my schedule […] It makes [health-care appointments] super accessible.” – Cynthia
Our findings are in line with research that suggests virtual care increased health service accessibility during the pandemic. However, while virtual care can be a useful tool, some in our study also described needing the option of in-person appointments.
Accessible transportation, even beyond the pandemic, is vital to facilitate access to sexual and reproductive health care for people with disabilities in Canada. People with disabilities should not have to delay their care. In our study, several recommended the provision of vouchers and direct funding to help with the cost of travel that they could not otherwise afford.
Public transportation policies should address disability-related needs, including infection prevention and control as well as minimizing changes to transportation routes, schedules and cancellations. Accessible transportation is already scarce and prioritizing paratransit will ensure more people with disabilities access the transportation they need.
Additionally, echoing prior recommendations, virtual access to care must be maintained to increase accessibility. In-person appointments must address the accommodations and access needs of people with varying disabilities. These measures are needed to provide accessible, disability-affirming care.