Sexual and reproductive health services for autistic young people in the United States: A conceptual model of utilization.

Researchers talked to autistic people, parents, and healthcare providers about sexual and reproductive health services. They found many barriers like doctors not understanding autism, not enough services available, and negative attitudes about autistic people's sexuality. They also found helpful things like clear communication, longer appointments, and trauma-informed care. The study created a model to help improve these services for autistic people in the future.

This qualitative study developed a conceptual model for sexual and reproductive health service utilization among autistic people in the United States. Researchers interviewed 18 autistic individuals, 15 parents, and 15 service providers to identify barriers and facilitators to accessing sexual and reproductive health services. Key barriers included limited service availability, lack of autism-trained providers, insufficient autism-specific information, poor accommodation of communication differences, and negative cultural attitudes toward autistic sexuality. Facilitators included person-centered trauma-informed care, clear service expectations, and adequate appointment duration.

The resulting conceptual model, based on social ecological theory, was validated by stakeholders and designed to guide future research, practice improvements, and policy development for equitable service access.

Healthcare providers should receive autism-specific training for sexual and reproductive health services. Services need accommodation for communication differences, longer appointment times, and trauma-informed approaches. Policy development should address service availability and provider training gaps to ensure equitable access for autistic individuals.

This qualitative study used a relatively small convenience sample of 48 participants from the United States only. The conceptual model requires empirical testing and validation. Generalizability to other countries with different healthcare systems may be limited.

Sexual and reproductive health services promote the ability of people to have safe, satisfying, non-coercive sexual experiences and make informed decisions about pregnancy. Stakeholder input is needed to understand barriers or facilitators to service access for autistic people, who report unmet needs. We recruited 18 autistic people, 15 parents, and 15 service providers in the United States to participate in an interview and two surveys. Using their input, we created a conceptual model of sexual and reproductive health service needs, access barriers, and facilitators.

Stakeholders rated a variety of sexual and reproductive health services as important for autistic people, including those with intellectual disability or minimal verbal language. Stakeholders identified barriers to sexual and reproductive health service utilization including lack of service availability, lack of service providers with autism or neurodiversity training, lack of accurate information about autism and sexuality, verbal and communication differences that are not accommodated by service providers, and socio-cultural attitudes about sexuality. Stakeholders identified facilitators to service access including person-centered, trauma-informed care, service accommodations such as clear and detailed expectations, and long-enough appointments. We created a conceptual model based on the social ecological model of health to organize these utilization factors and support future research, provider, and policy action.

Stakeholders provided feedback and responded favorably on the model's accuracy, utility for spurring research, practice, and policy improvements, and application to diverse groups of autistic people. The model shows the many feasible ways to support equitable access to services for autistic people.