A family of Microsoft word processing software products for creating web, email, and print documents.
The following changes fixed the problem.
In Advanced under options, uncheck "scale content to A4 or 8.5 x 11 paper sizes under Print.
Also use File > Export > Create PDF/XPS Document and click Options. Make sure Document structure tags for accessibility are checked—this embeds the tagged structure that screen readers need to navigate the document. You can also enable Create bookmarks using Headings for easier navigation. Critically, don't use Print to PDF or the basic Save As PDF option—these strip out accessibility information entirely.