Disability and sexual and reproductive health outcomes among women in Cambodia: a cross-sectional analysis of the 2021-22 demographic and health survey.

Background: Women with disabilities may face communication, autonomy-related, provider-level, and structural barriers to sexual and reproductive health (SRH) services. Population-based evidence from low- and middle-income countries remains limited, particularly by functional domain. Objective: To examine associations between disability and contraceptive knowledge, unmet need for family planning, and unintended pregnancy among women in Cambodia. Methods: We analysed data from 19,485 women aged 15-49 years who participated in the 2021-22 Cambodia Demographic and Health Survey. Disability was measured using the Washington Group Short Set and classified by severity and functional domain. Knowledge of modern contraception was assessed among all women, unmet need among currently married or cohabiting women, and unintended pregnancy among currently married or cohabiting women with a recent live birth. Survey-weighted logistic regression was used to estimate crude and adjusted odds ratios, adjusting for age, education, wealth, residence, and marital status where applicable. Additional analyses examined functional-domain associations and stratified unintended pregnancy by age, education, and wealth. Results: Overall, 16.5% of women reported at least some functional difficulty, including 1.0% with severe disability. Severe disability was associated with lower adjusted odds of knowing a modern contraceptive method (adjusted odds ratio 0.13, 95% confidence interval 0.06-0.29). Among currently married or cohabiting women, severe disability was associated with higher adjusted odds of unmet need for family planning (adjusted odds ratio 1.93, 95% confidence interval 1.06-3.49). Among married or cohabiting women with a recent live birth, mild disability was associated with higher adjusted odds of unintended pregnancy (adjusted odds ratio 1.37, 95% confidence interval 1.05-1.79); for severe disability, the confidence interval included the null (adjusted odds ratio 1.42, 95% confidence interval 0.39-5.18). Functional-domain analyses suggested lower knowledge and higher unintended pregnancy among women with communication, hearing, remembering/concentrating, or self-care difficulties. In descriptive stratified analyses, disability-related differences in unintended pregnancy were more pronounced among older women, women with less than primary education, and women in the poorest wealth quintile. Conclusions: Disability-related SRH inequities in Cambodia vary by outcome, severity, and functional domain. Family-planning services should address communication access, supported decision-making, provider competence, privacy, and socioeconomic barriers.