Inequalities in prenatal screening by disability type: A 10-year nationwide study in South Korea

Prenatal care is essential for maternal and fetal health, yet women with disabilities may face barriers to timely care despite universal healthcare coverage. Existing research often treats “disability” as a single entity, overlooking differences in clinical needs and access barriers across disability types. This study investigated disability type-specific disparities in prenatal test utilization to inform targeted policy interventions. This nationwide retrospective cohort study linked 2013–2022 National Health Insurance Service (NHIS) data with the National Disability Registry. The study included women who gave birth during the study period. We analyzed prenatal test utilization across eight categories reclassified from 15 disability types. Multivariable logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs), adjusting for age, income, residence, CCI, and depression. After adjustment, women with internal organ disabilities showed higher odds of gestational diabetes screening (aOR 4.91, 95% CI 2.31–10.41), fetal screening (aOR 3.35, 95% CI 1.98–5.68), and first-trimester ultrasound (aOR 2.02, 95% CI 1.11–3.70) compared with women without disabilities. Conversely, women with intellectual disabilities or autism spectrum disorders tended to have lower odds of first-trimester ultrasound use compared with women without disabilities (aOR 0.67, 95% CI 0.44–1.02). Prenatal care disparities among women with disabilities may reflect disability type-specific healthcare pathways. Higher utilization among women with internal organ disabilities may reflect intensified clinical contact through high-risk pregnancy management, whereas lower early ultrasound use among women with intellectual disabilities or autism spectrum disorders suggests barriers to early entry into prenatal care despite financial support. Therefore, disability type-specific strategies should be developed with monitoring systems that track early prenatal care entry.

Key messages

• Disability type, not status, drives prenatal care; internal and intellectual types show opposite trends.

• Vouchers aren’t enough. Type-specific strategies are vital to bridge the utilization disparity.