The short answer: use File → Save As → PDF, not File → Print → Save as PDF. The "Save As" method preserves your heading structure, alt text, lists, and table formatting as proper PDF tags. The "Print to PDF" method destroys all of that structure and produces what is essentially a flat image — visually identical, but completely inaccessible to screen readers.

That single choice is the difference between a PDF that blind and low-vision students can navigate and one that reads as a wall of undifferentiated text. Here is exactly how to do it right, from start to finish.

Step 1: Structure Your Word Document First

An accessible PDF starts with an accessible Word document. No export method can fix a document that was never structured properly. Before you think about PDFs, make sure you are using these built-in Word features:

Use Heading styles, not bold text. This is the single most common mistake faculty make. Selecting text and clicking the Bold button makes it look like a heading, but it carries no structural meaning. Screen readers cannot distinguish bold body text from an actual heading. Instead, select your heading text and apply Heading 1, Heading 2, or Heading 3 from the Styles pane on the Home tab. Use them in order — Heading 2 sits under Heading 1, Heading 3 under Heading 2. Think of it like an outline.

Use built-in list formatting. Click the numbered list or bulleted list button on the Home tab instead of manually typing "1." or dashes. Built-in lists are tagged as lists in the exported PDF, which tells screen readers how many items are in the list and where each item starts and ends.

Set table headers. If you use tables, click inside the table, go to the Table Design tab, and check Header Row. This tells assistive technology which row contains column labels. Avoid using tables purely for visual layout — use them only for actual tabular data.

Add alt text to every image. Right-click any image, select Edit Alt Text, and write a brief description of what the image conveys. If the image is purely decorative (a divider line, a background pattern), check the Mark as decorative box. Alt text you set in Word carries over to the PDF when you export correctly.

Avoid text boxes. Text boxes in Word create floating content that breaks reading order in the exported PDF. Screen readers may read the text box content out of sequence or skip it entirely. Use normal paragraph text instead. If you need a callout or sidebar, use a bordered paragraph or a single-cell table.

Step 2: Run the Built-In Accessibility Checker

Before exporting, let Word catch problems for you. Go to Review → Check Accessibility (on Windows) or Tools → Check Accessibility (on Mac). Word will flag missing alt text, skipped heading levels, low-contrast text, missing table headers, and other issues.

Work through each item in the results pane. Most fixes take seconds — adding alt text to a forgotten image, changing a bold line to a proper heading style, or marking a decorative shape. Fixing these issues in Word is dramatically easier than fixing them later in a PDF.

Step 3: Export Correctly

This is where the critical choice happens.

On Windows

1. Go to File → Save As (or File → Export → Create PDF/XPS).
2. Choose PDF as the file type.
3. Click the Options button in the Save dialog.
4. Check the box labeled "Document structure tags for accessibility." This is often checked by default, but verify it every time.
5. Make sure "Create bookmarks using: Headings" is also checked — this gives your PDF a navigable bookmark panel.
6. Click OK, then Save.

On Mac

1. Go to File → Save As.
2. In the File Format dropdown, select PDF.
3. Click Save. On Mac, Word automatically includes accessibility tags when you use Save As — there is no separate checkbox.

That is it. Your PDF now contains tagged headings, lists, tables with headers, alt text on images, and a logical reading order.

Step 4: What NOT to Do

Do not use Print to PDF. On both Windows and Mac, going to File → Print and selecting "Save as PDF" or "Microsoft Print to PDF" sends the document through the print pipeline. This renders every page as a visual image and wraps it in a PDF container. All heading structure, alt text, list formatting, and table headers are stripped out. The resulting file looks identical on screen but is completely unnavigable by a screen reader.

Do not use third-party PDF printer drivers. Tools like CutePDF, PDF Creator, or Bullzip work the same way as Print to PDF — they intercept the print stream and produce flat, untagged files.

Do not copy and paste content into a blank PDF in Acrobat. This rarely preserves structure and introduces reading-order problems.

A note about Google Docs: If you work in Google Docs and use File → Download → PDF, the resulting tags are significantly weaker than what Word produces. Google Docs currently does not export proper table tags or reliable heading hierarchy in PDFs. If accessibility matters — and it must — export from Word whenever possible. For a deeper look at PDF accessibility fundamentals, see our complete guide to making PDFs accessible.

Step 5: Verify the Result

Exporting correctly gives you a strong foundation, but verification catches edge cases. If you have Adobe Acrobat Pro:

1. Open the PDF and go to View → Show/Hide → Navigation Panes → Tags. You should see a tree of tags:

   ,

   ,

   ,

   ,

   , and so on. If the Tags panel is empty, something went wrong during export.

   Run Acrobat's built-in checker: Accessibility → Accessibility Check (or Tools → Accessibility → Full Check in older versions). This flags missing alt text, untagged content, reading order issues, and more.

   If you do not have Acrobat Pro, free tools like the PAC (PDF Accessibility Checker) can verify tag structure. We also have a guide on how to check if your PDF is accessible that walks through this process in detail.

   Common Mistakes at a Glance

   Mistake	Why It Breaks Accessibility
   Bold text instead of Heading styles	Screen readers cannot identify headings; no document navigation
   Missing alt text on images	Blind users get no information about visual content
   Text boxes for layout	Reading order becomes unpredictable
   Print to PDF	All tags and structure are destroyed
   Manual numbering instead of list styles	Lists are not identified as lists by assistive technology
   Tables without header rows	Screen readers cannot associate data cells with column labels

   For more on why the print method specifically causes so many problems, see Print to PDF Breaks Accessibility — Here's Why.

   What About Documents You Have Already Exported?

   If you follow these steps going forward, your new PDFs will be well-structured and accessible. But most faculty have years of existing documents — lecture slides, syllabi, handouts, lab manuals — that were exported without accessibility in mind.

   Retrofitting those files manually in Acrobat is tedious and time-consuming. Each document requires adding tags, setting reading order, writing alt text, and marking table headers by hand.

   Already have hundreds of Word-exported PDFs that were not created accessibly? Aelira can remediate them in bulk — scanning for accessibility issues and auto-fixing structure, alt text, and reading order using AI. Try it free.