diff --git a/lib/prawn.rb b/lib/prawn.rb
index df1a255fb..08fd561d2 100644
--- a/lib/prawn.rb
+++ b/lib/prawn.rb
@@ -74,6 +74,7 @@ def verify_options(accepted, actual)
 require_relative 'prawn/soft_mask'
 require_relative 'prawn/security'
 require_relative 'prawn/transformation_stack'
+require_relative 'prawn/accessibility'
 require_relative 'prawn/document'
 require_relative 'prawn/font'
 require_relative 'prawn/measurements'
diff --git a/lib/prawn/accessibility.rb b/lib/prawn/accessibility.rb
new file mode 100644
index 000000000..528bc8cd8
--- /dev/null
+++ b/lib/prawn/accessibility.rb
@@ -0,0 +1,136 @@
+# frozen_string_literal: true
+
+module Prawn
+  # Provides tagged PDF (accessibility) support for Prawn documents.
+  #
+  # When a document is created with `marked: true`, all content can be
+  # wrapped in structure elements that screen readers and assistive
+  # technologies use to navigate the document.
+  #
+  # @example
+  #   pdf = Prawn::Document.new(marked: true, language: 'en-US')
+  #
+  #   pdf.structure(:H1) do
+  #     pdf.text 'Document Title'
+  #   end
+  #
+  #   pdf.structure(:P) do
+  #     pdf.text 'Body paragraph text.'
+  #   end
+  #
+  #   pdf.artifact do
+  #     pdf.text 'Page 1'  # not read by screen readers
+  #   end
+  module Accessibility
+    # Whether this document is tagged for accessibility.
+    #
+    # @return [Boolean]
+    def tagged?
+      renderer.marked?
+    end
+
+    # Wrap content in a structure element. The block's content will be
+    # associated with the given tag in the document's structure tree.
+    #
+    # Can be nested — inner structure calls become children of the outer.
+    #
+    # @param tag [Symbol] PDF structure type (:Document, :Part, :Sect,
+    #   :H1-:H6, :P, :L, :LI, :Lbl, :LBody, :Table, :TR, :TH, :TD,
+    #   :Figure, :Formula, :Form, :Span, :Link, :Note, :BlockQuote,
+    #   :Caption, :TOC, :TOCI, :Reference)
+    # @param attributes [Hash] optional attributes
+    # @option attributes [String] :Alt alternative text (for Figure, Formula)
+    # @option attributes [String] :ActualText replacement text for screen
+    #   readers (e.g., "required" for "*", "selected" for "X")
+    # @option attributes [String] :Lang language override for this element
+    # @option attributes [Symbol] :Scope table header scope (:Column, :Row, :Both)
+    # @yield content to render inside this structure element
+    # @return [void]
+    def structure(tag, attributes = {}, &block)
+      return yield if !tagged? || !block
+
+      tree = renderer.structure_tree
+      tree.begin_element(tag, attributes)
+      tree.mark_content(tag, &block)
+      tree.end_element
+    end
+
+    # Wrap content in a structure element without marking the content
+    # directly. Use this for container elements (Table, TR, L, LI) where
+    # the children will each have their own marked content.
+    #
+    # @param tag [Symbol] PDF structure type
+    # @param attributes [Hash] optional attributes
+    # @yield content to render inside this structure element
+    # @return [void]
+    def structure_container(tag, attributes = {}, &block)
+      return yield if !tagged? || !block
+
+      tree = renderer.structure_tree
+      tree.begin_element(tag, attributes)
+      yield
+      tree.end_element
+    end
+
+    # Mark content as an artifact (decorative, not read by screen readers).
+    # Use for page numbers, decorative borders, backgrounds, watermarks.
+    #
+    # @param type [Symbol, nil] artifact type (:Pagination, :Layout,
+    #   :Page, :Background)
+    # @yield content to render as artifact
+    # @return [void]
+    def artifact(type: nil, &block)
+      return yield if !tagged? || !block
+
+      renderer.structure_tree.mark_artifact(artifact_type: type, &block)
+    end
+
+    # Render a heading at the specified level.
+    #
+    # @param level [Integer] heading level 1-6
+    # @param content [String] heading text
+    # @param options [Hash] options passed to `text()`
+    # @return [void]
+    def heading(level, content, options = {})
+      tag = :"H#{level}"
+      if tagged?
+        structure(tag) { text(content, options) }
+      else
+        text(content, options)
+      end
+    end
+
+    # Render text wrapped in a paragraph structure element.
+    #
+    # @param content [String, nil] text to render. If nil, yields a block.
+    # @param options [Hash] options passed to `text()`
+    # @yield optional block for complex paragraph content
+    # @return [void]
+    def paragraph(content = nil, options = {}, &block)
+      if tagged?
+        if block
+          structure(:P, &block)
+        else
+          structure(:P) { text(content, options) }
+        end
+      elsif block
+        yield
+      else
+        text(content, options)
+      end
+    end
+
+    # Render an image wrapped in a Figure structure element with alt text.
+    #
+    # @param alt_text [String] alternative text for the image
+    # @yield block that calls `image()` or other drawing methods
+    # @return [void]
+    def figure(alt_text:, &block)
+      if tagged?
+        structure(:Figure, Alt: alt_text, &block)
+      else
+        yield
+      end
+    end
+  end
+end
diff --git a/lib/prawn/document.rb b/lib/prawn/document.rb
index 92e263697..621bd91a4 100644
--- a/lib/prawn/document.rb
+++ b/lib/prawn/document.rb
@@ -58,6 +58,7 @@ class Document
     include Prawn::Stamp
     include Prawn::SoftMask
     include Prawn::TransformationStack
+    include Prawn::Accessibility
 
     alias inspect to_s
 
@@ -72,6 +73,7 @@ class Document
       right_margin top_margin bottom_margin skip_page_creation
       compress background info
       text_formatter print_scaling
+      marked language
     ].freeze
 
     # Any module added to this array will be included into instances of
@@ -239,6 +241,10 @@ def initialize(options = {}, &block)
 
       renderer.min_version(1.6) if options[:print_scaling] == :none
 
+      if options[:language]
+        state.store.root.data[:Lang] = options[:language]
+      end
+
       @background = options[:background]
       @background_scale = options[:background_scale] || 1
       @font_size = 12
diff --git a/spec/prawn/accessibility_spec.rb b/spec/prawn/accessibility_spec.rb
new file mode 100644
index 000000000..6af7516d3
--- /dev/null
+++ b/spec/prawn/accessibility_spec.rb
@@ -0,0 +1,201 @@
+# frozen_string_literal: true
+
+require 'spec_helper'
+
+RSpec.describe Prawn::Accessibility do
+  describe 'with tagged document' do
+    let(:pdf) { Prawn::Document.new(marked: true, language: 'en-US') }
+
+    describe '#tagged?' do
+      it 'returns true for marked documents' do
+        expect(pdf).to be_tagged
+      end
+
+      it 'returns false for unmarked documents' do
+        plain = Prawn::Document.new
+        expect(plain).to_not(be_tagged)
+      end
+    end
+
+    describe 'language' do
+      it 'sets Lang on the catalog' do
+        root_data = pdf.state.store.root.data
+        expect(root_data[:Lang]).to eq('en-US')
+      end
+    end
+
+    describe '#structure' do
+      it 'wraps content in a structure element' do
+        pdf.structure(:H1) do
+          pdf.text('Title')
+        end
+        output = pdf.render
+
+        expect(output).to include('/StructTreeRoot')
+        expect(output).to include('/StructElem')
+      end
+
+      it 'emits BDC/EMC in the content stream' do
+        pdf.structure(:P) do
+          pdf.text('Hello')
+        end
+        output = pdf.render
+
+        expect(output).to include('BDC')
+        expect(output).to include('EMC')
+      end
+
+      it 'is a no-op for untagged documents' do
+        plain = Prawn::Document.new
+        plain.structure(:P) do
+          plain.text('Hello')
+        end
+        output = plain.render
+
+        expect(output).to_not(include('/StructTreeRoot'))
+      end
+    end
+
+    describe '#structure_container' do
+      it 'creates a parent structure without marking content directly' do
+        pdf.structure_container(:Table) do
+          pdf.structure(:TD) do
+            pdf.text('Cell')
+          end
+        end
+        output = pdf.render
+
+        expect(output).to include('/StructElem')
+        expect(output).to include('/Table')
+        expect(output).to include('/TD')
+      end
+    end
+
+    describe '#artifact' do
+      it 'wraps content in Artifact markers' do
+        pdf.artifact do
+          pdf.text('Page 1')
+        end
+        output = pdf.render
+
+        expect(output).to include('/Artifact BMC')
+        expect(output).to include('EMC')
+      end
+
+      it 'supports artifact type' do
+        pdf.artifact(type: :Pagination) do
+          pdf.text('Page 1')
+        end
+        output = pdf.render
+
+        expect(output).to include('/Artifact')
+        expect(output).to include('/Type /Pagination')
+      end
+
+      it 'is a no-op for untagged documents' do
+        plain = Prawn::Document.new
+        plain.artifact do
+          plain.text('Footer')
+        end
+        output = plain.render
+
+        expect(output).to_not(include('/Artifact'))
+      end
+    end
+
+    describe '#heading' do
+      it 'renders text in an H1 structure element' do
+        pdf.heading(1, 'Title', size: 24)
+        output = pdf.render
+
+        expect(output).to include('/H1')
+        expect(output).to include('BDC')
+      end
+
+      it 'supports levels 1-6' do
+        (1..6).each do |level|
+          pdf.heading(level, "Heading #{level}")
+        end
+        output = pdf.render
+
+        (1..6).each do |level|
+          expect(output).to include("/H#{level}")
+        end
+      end
+    end
+
+    describe '#paragraph' do
+      it 'renders text in a P structure element' do
+        pdf.paragraph('Body text.')
+        output = pdf.render
+
+        expect(output).to include('BDC')
+      end
+
+      it 'supports block form' do
+        pdf.paragraph do
+          pdf.text('Complex paragraph')
+        end
+        output = pdf.render
+
+        expect(output).to include('BDC')
+        expect(output).to include('EMC')
+      end
+    end
+
+    describe 'ActualText' do
+      it 'passes ActualText to structure elements' do
+        pdf.structure(:Span, ActualText: 'required') do
+          pdf.text('*')
+        end
+        output = pdf.render
+
+        expect(output).to include('/ActualText')
+      end
+
+      it 'allows ActualText for checkbox indicators' do
+        pdf.structure(:Span, ActualText: 'Selected') do
+          pdf.text('X')
+        end
+        pdf.structure(:Span, ActualText: 'Not selected') do
+          pdf.text(' ')
+        end
+        output = pdf.render
+
+        expect(output).to include('/ActualText')
+      end
+    end
+
+    describe '#figure' do
+      it 'wraps content with alt text' do
+        pdf.figure(alt_text: 'A logo') do
+          pdf.text('IMAGE PLACEHOLDER')
+        end
+        output = pdf.render
+
+        expect(output).to include('/Figure')
+        expect(output).to include('/Alt')
+      end
+    end
+
+    describe 'full document round-trip' do
+      it 'produces a tagged PDF with MarkInfo and StructTreeRoot' do
+        pdf.heading(1, 'Test Document')
+        pdf.paragraph('This is a test paragraph.')
+
+        pdf.artifact(type: :Pagination) do
+          pdf.text('Page 1 of 1')
+        end
+
+        output = pdf.render
+
+        expect(output).to start_with('%PDF-1.7')
+        expect(output).to include('/MarkInfo')
+        expect(output).to include('/Marked true')
+        expect(output).to include('/StructTreeRoot')
+        expect(output).to include('/Lang')
+        expect(output).to include('/Document')
+      end
+    end
+  end
+end