Access to sexual and reproductive health services is uneven across adolescent populations, but the degree of disparity tied to neurodevelopmental conditions has rarely been quantified at scale. This Swedish registry study, drawing on over 450,000 young people aged 12–22 in Stockholm County between 2018 and 2022, provides some of the most granular population-level data yet on how autism spectrum disorder and ADHD shape engagement with these services—and the findings point in sharply opposite directions for the two conditions.
Autistic males showed the most pronounced gap, with adjusted odds of in-person sexual and reproductive health visits roughly 55% lower than neurotypical peers (aOR 0.45, 95% CI 0.40–0.51). Autistic females showed a similar but less severe reduction (aOR 0.67). Importantly, digital care did not close this gap as substantially as might be expected—autistic females still showed meaningfully lower digital visit odds (aOR 0.79), suggesting access barriers extend beyond the clinic environment itself. By contrast, youth with ADHD were roughly twice as likely as controls to attend in-person visits (females: aOR 2.02), with higher rates across all provider types, contraceptive methods, and abortion-related consultations. Autistic females who did access care were more likely to see physicians than midwives, and less likely to use short-acting contraceptive methods.
These findings are significant because they challenge the assumption that digital health expansion automatically improves equity for neurodivergent populations. The persistence of lower utilization among autistic youth even in digital channels implies that sensory sensitivities, communication differences, or systemic provider barriers—not just physical access—are driving the disparity. The ADHD pattern of elevated use, including higher abortion rates, raises separate questions about unmet contraceptive counseling needs. The observational registry design cannot establish causation, and Swedish healthcare infrastructure may limit generalizability. Still, at nearly half a million participants, this is a rare study with sufficient statistical power to detect clinically meaningful subgroup differences, making it an important reference point for adolescent health equity research.