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From words to actions: systematic review of interventions to promote sexual and reproductive health of persons with disabilities in low- and middle-income countries

HAMEED, Shaffa
MADDAMS, Alexander
LOWE, Hattie
DAVIES, Lowri
KHOSLA, Rajat
SHAKESPEARE, Tom
2020

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Persons with disabilities have the same sexual and reproductive health and rights (SRHR) as non-disabled persons. Yet they face numerous barriers in their access to sexual and reproductive health services and their rights are often not met. Evidence on SRHR for persons with disabilities is sparse, particularly evaluations of interventions demonstrating ‘what works.’ This systematic review assessed interventions to promote SRHR for persons with disabilities in low- and middle-income countries.

The method involved searching for qualitative, quantitative or mixed method observational studies representing primary research, published between 2010 and 2019, using MEDLINE, Embase, PubMed, Global Health and CINAHL Plus

 

BMJ Global Health 2020;5:e002903.

http://dx.doi.org/10.1136/bmjgh-2020-002903

Seeing the invisible: Sexuality-related knowledge, attitudes and behavior of children and youth with disabilities in China

SHANGHAI INSITITUTE OF PLANNED PARENTHOOD RESEARCH (SIPPR)
UNESCO
HUMANITY & INCLUSION (HI)
2019

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Young people with disabilities have the same right to Sexual and Reproductive Health (SRH) as their peers without disabilities, but their needs and rights are often overlooked. This study examines the SRH status of young people with disabilities in China. In particular, the study explored the sexuality-related knowledge, attitudes and behaviour of young people with disabilities as well as their access to sexuality-related information, education and services. The findings of the study are intended to provide evidence to support decision-making by government agencies, educators, development workers and other relevant stakeholders regarding developing and implementing disability-inclusive SRH and sexuality education policies and programmes for young people in China.

The study, using quantitative and qualitative methods, was conducted in 2015 among unmarried young persons aged 12 to 24 living with visual, hearing, physical and intellectual disabilities, in both urban and rural areas. The analysis was based on data collected through 707 completed valid questionnaires, 20 group interviews and 35 individual interviews with young people with disabilities, and individual interviews with 60 parents and teachers, along with one case study.

Everybody Matters: Good practices for inclusion of people with disabilities in sexual and reproductive health and rights programmes

Van SLOBBE, Caroline
November 2017

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This publication provides introductory chapters from two activists who work to create better opportunities for people with disabilities in Nigeria and India. Subsequently, the challenges that organisations worldwide have encountered whilst improving the access to and knowledge of sexual and reproductive health and rights for people with disabilities are presented. Ways in which they managed to find solutions and the results achieved are reviewed. Some cases show the importance of a more personal approach whilst others emphasise the advantage of changing systems and policies. Different regions, types of disabilities and various SRHR-topics are reflected in these stories. All cases provide lessons learnt that contribute to a set of recommendations for improved responses. The closing chapter highlights the challenges, solutions, and ambitions that are presented and lead up to a concise overview of recommendations.  

Good practice examples include:

A shift in SRH programming (Nepal)

Breaking Barriers with performance art (Kenya)

Her Body, Her Rights (Ethiopia)

People with disabilities leading the way (Israel Family Planning Association)

Best Wishes for safe motherhood (Nepal)

It’s my body! (Bangladesh)

Calling a spade a spade (Netherlands)

Four joining forces (Colombia)

Change agents with a disability (Zimbabwe)

Tito’s privacy and rights (Argentina)

Sign language for service providers (Kenya)

The grace of motherhood: disabled women contending with societal denial of intimacy, pregnancy, and motherhood in Ethiopia

TEFERA, Belaynesh
VAN ENGEN, Marloes
VAN DER KLINK, Jac
SCHIPPERS, Alice
2017

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This study aimed to provide better understanding of intimacy and marriage, pregnancy, birth, and motherhood experiences of women with disability in Ethiopia. Qualitative, in-depth, and semi-structured interviews along with personal observations were used to explore the full experiences of participants, as told in their own words. The result of the interviews indicated that relationships and motherhood proved a very rewarding option for women with disabilities. They also expressed their need for intimacy regardless of society’s denial. Challenges identified include negative societal attitudes toward women with disabilities regarding relationship, pregnancy, and child-rearing. Accessibility of health centers in addition to the ignorance and negative attitudes of the physicians are also reported to be major challenges for the interviewees. This study highlights how rewarding the experience of motherhood was for the interviewees and also shows that women with disabilities face challenges at every step of their experiences, because of society’s prejudices toward disability.

Abuse and denial of sexual and reproductive rights of women with psychosocial disabilities in Mexico

RODRIGUEZ, Priscila
et al
February 2015

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This report presents the situation faced by women with psycho-social conditions in Mexico based on the results of a year-long study. This research included the application of a questionnaire to fifty-one women with psychosocial disabilities who were either members of the Colectivo Chuhcan or received outpatient services at four different health clinics and psychiatric institutions in Mexico City. The main finding of this report is that the Mexican government has failed to implement policies that ensure that women with psychosocial disabilities have safe access to sexual and reproductive health services, on an equal basis with others. It is recommended this research be extended to the rest of the country to gain a clearer picture on the situation of the sexual and reproductive rights of women with disabilities at a national level

Human Rights

www.macao-tz.org
December 2014

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Malezi AIDS Care Awareness Organization (MACAO) is a non-profit organization reaching out to neglected Indigenous people in Ngorongoro District, Arusha Region of Northern Tanzania.  Macao founded in 2003, Macao is a humanitarian organization that provides assistance to approximately 200,000 Indigenous Maasai community in Ngorongoro district for addressing needs of water and sanitation, food security, health Care Research, Education, Research environment, Maasai Traditional Research, Human Rights and sustainable economic development by strengthening their livelihoods.  In addition to responding to major relief situations, MACAO focuses on long-term community development through over 4 Area Development Project. We welcome the donors and volunteers to join us in this programs, we are wolking in ruro villages.

Moving forward and gaining ground: the sterilisation of women and girls with disabilities in Australia

FROHMADER, Carolyn
June 2012

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This paper addresses the issue of forced sterilisation and reproductive right of women and girls with disability in Australia. "It discusses some of the critical issues in the consideration of forced sterilisation as a human rights issue, and looks at some of the key strategies WWDA has employed to advance our efforts to promote the sexual and reproductive rights of disabled women and girls, on an equal basis with other women and girls"
Available in pdf, word, large print text only and powerpoint presentation formats

Access to health care, reproductive health and disability: A large scale survey in Sierra Leone

GROCE, Nora
TRANI, Jean-Francois
BROWN, Joyce Brown
KETT, Maria
BAH, Osman
MORLAI, Teddy
BAILEY, Nicki
2011

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This is the first study to compare health status and access to health care services between disabled and non-disabled men and women in urban and peri-urban areas of Sierra Leone. It pays particular attention to access to reproductive health care services and maternal health care for disabled women. A cross-sectional study was conducted in 2009 in 5 districts of Sierra Leone, randomly selecting 17 clusters for a total sample of 425 households. All adults who were identified as being disabled, as well as a control group of randomly selected non-disabled adults, were interviewed about health and reproductive health. As expected, we showed that people with severe disabilities had less access to public health care services than non-disabled people after adjustment for other socioeconomic characteristics (bivariate modelling). However, there were no significant differences in reporting use of contraception between disabled and non-disabled people; contrary to expectations, women with disabilities were as likely to report access to maternal health care services as did non-disabled women. Rather than disability, it is socioeconomic inequality that governs access to such services. We also found that disabled women were as likely as non-disabled women to report having children and to desiring another child: they are not only sexually active, but also need access to reproductive health services.

HIV decline in Zimbabwe due to reductions in risky sex?|Evidence from a comprehensive epidemiological review

GREGSON, Simon
et al
April 2010

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This article presents research which assessed the contributions of rising mortality, falling HIV incidence and sexual behaviour change to the decline in HIV prevalence in Zimbabwe. It comprised of a comprehensive review and secondary analysis of national and local sources on trends in HIV prevalence, HIV incidence, mortality and sexual behaviour in the period 1985 - 2007. The findings provide the first convincing evidence of an HIV decline accelerated by changes in sexual behaviour in a southern African country, nevertheless, in 2007 one in seven adults in Zimbabwe was still infected by a life-threatening virus and mortality rates remained at crisis point

A handbook for network support agents and other community workers supporting HIV prevention, care, support and treatment

March 2009

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This manual is intended to help network support agents and other community workers be more effective in disseminating standardised information about HIV and AIDS. It "...emphasises the importance of the acquisition of knowledge, skills and the right attitude needed to identify the psychosocial needs of people of people infected and affected by HIV/AIDS and address these needs by giving information, counselling and appropriate referrals. Knowledge of counselling and psychosocial care, is combined as much as possible with prevention activities such as adopting HIV basic care positive prevention and adherence to treatment"

PleasureABLE : sexual device manual for persons with disabilities

NAPHTALI, Kate
MACHATTIE, Edith
2009

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"This manual was created as a practical resource for persons with disabilities and health care clinicians who work with these clients. It includes research, clinical expertise, and product information to aid with dialogue surrounding sexual and reproductive issues and disabilities. The information presented here is not prescriptive, and the specific products not recommended per se, but are meant to provide examples and illustrations of some of the potential options that can be introduced into the sexual practices of the individual or be used as an adjunct in the discussions of sexuality and disability by the health care clinician. The devices included are a sampling of what is available (in Canada) in 2009"

The effect of family size and composition on fertility desires, contraceptive adoption, and method choice in South Asia

JAYARAMAN, Anuja
MISHRA, Vinod
ARNOLD, Fred
March 2008

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This research looks at the influence of family size and composition on reproductive behaviour in three South Asian countries - Nepal, India, and Bangladesh - that are known for strong son preference. Data from recent Demographic and Health Surveys, was analysed to see whether the choice of contraceptive method adopted (modern versus traditional; temporary versus permanent) and desire for another child differed by parity and sex composition of surviving children

HIV/AIDS in Haiti : key findings of the mortality, morbidity, and utilization of services survey : EMMUS-iv 2005-2006

MEASURE DHS (Demographic Health Surveys)
2008

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This report presents survey findings on HIV prevalence in Haiti and other related results, including knowledge of HIV and AIDS, attitudes toward people living with HIV, and sexual behaviour. The survey was undertaken by the Mortality, Morbidity, and Utilization of Services Assessment Survey (EMMUS-IV) [Enquête Mortalité, Morbidité et Utilisation des Services] conducted between October 2005 and June 2006. The French version of this report follows the English version

A report card on maternal mortality

UNITED NATIONS CHILDREN'S FUND (UNICEF)
2008

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‘Progress for Children’ is a series that monitors progress towards the Millennium Development Goals. This edition focuses on maternal health and, in particular, maternal mortality. It considers general progress and then examines particular regions. The report card acknowledges progress in improving maternal health, but argues that it is not sufficient to meet the MDG target of reducing maternal mortality by three quarters between 1990 and 2015

Sexual health for people with intellectual disability

EASTGATE, Gillian
2008

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This article explores how people with intellectual disability often experience difficulties meeting their sexual needs and desires due to poor education and social isolation. However, the article highlights that people with intellectual disability are capable of safe, constructive sexual expression and healthy relationships with appropriate education and good social support. It emphasises that providing this support is an essential part of supporting people with intellectual disability
Salud Publica Mex, 50 suppl 2

Women, harm reduction, and HIV

PINKHAM, Sophie
MALINOWSKA-SEMPRUCH, Kasia
September 2007

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This report looks at factors that reduce women drug users’ access to health care including punitive policies, discrimination by police and health care providers, the intense social stigma attached to drug use by women, a preponderance of harm reduction and drug treatment programmes directed primarily toward men, an absence of sexual and reproductive health services for drug users, and poor access to effective outpatient drug treatment. Pregnant drug users are particularly vulnerable. In too many instances, they receive little or no accurate information about drug use during pregnancy or prevention of mother-to-child transmission of HIV. In some countries pregnant drug users are rejected by health care providers, threatened with criminal penalties or loss of parental rights, or coerced into having an abortion or abandoning their newborns to the state. Poor access to medication-assisted treatment jeopardises the pregnancies of opiate-dependent drug users. It includes recommendations for consideration when designing services for women drug users and also examines issues around policies to protect women's health

Uganda demographic health survey 2006

UGANDA BUREAU OF STATISTICS (UBOS)
MACRO INTERNATIONAL INC
August 2007

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The 2006 Uganda Demographic and Health Survey (UDHS) is a nationally representative survey of 8,531 women age 15-49 years and 2,503 men age 15-54 years and is the first such survey to cover the entire country. The primary purpose of the UDHS is to furnish policymakers and planners with detailed information on fertility; family planning; infant, child, adult, and maternal mortality; maternal and child health; nutrition; and knowledge of HIV/AIDS and other sexually transmitted infections. In addition, in one in three households selected for the survey, women age 15-49, men age 15-54, and children under age 5 years were weighed and their height was measured to assess their nutritional status. Women, men, and children age 6-59 months, in this subset of households were also tested for anemia, and in addition the women and children were tested for vitamin A deficiency. In addition to the main report, the key findings, a preliminary report, a wall chart and fact sheet are also available online

Understanding and challenging HIV stigma : toolkit for action Module J : young people and stigma

CLAY, Sue
CHIIYA, Chipo
CHONTA, Mutale
June 2007

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This is the seventh booklet in this revised toolkit to raise awareness and promote practical action to challenge HIV stigma and discrimination. The module focuses on young people and stigma. Stigma towards young people is similar to that faced by adults, but it is often exacerbated because of vulnerability and judgements about age, morality, education and experience. The impact of stigma on young people has many consequences, including exclusion, isolation, dropping out of school, delaying starting ARV treatment, and suicide or thinking about suicide. The toolkit was written by and for HIV trainers in Africa and changes and additions were made with the help of a regional trainers network workshop in Zambia in August 2005

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