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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.

No justice : torture, trafficking and segregation in Mexico

RODRIGUEZ, Priscila
ROSENTHAL, Eric
GUERRERO, Humberto
July 2015

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This report presents the findings of Disability Rights International (DRI)'s two-year investigation into the treatment of children and adults with mental disabilities in Mexico City which found a pattern of egregious and widespread human rights violations. The investigation found that in Mexico City having a disability can mean a life of detention and uncovered the existence of a “blacklist” of particularly abusive institutions that the Mexico City authorities are aware of – yet they permit these facilities to operate. DRI visited five of 25 facilities on the blacklist and specifically highlight the findings from Mama Rosa and Casa Esperanza, which was so abusive that DRI filed a formal complaint to DIF and sought immediate action by DIF to protect detainees. The report outlines the overall findings and how Mexico can take steps toward reform and justice calling for immediate steps to enforce the basic human rights of people with disabilities and outlines

Note: the report is available in pdf and word versions in both English and Spanish

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.

Taking critical services to the home : scaling-up home-based maternal and postnatal care, including family planning, through community midwifery in Kenya

MWANGI, Annie
WARREN, Charlotte
2008

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This publication is the report of a project to scale-up a community-based model, in Kenya, that enabled women to give birth safely at home or be referred to a hospital when attended by a self-employed skilled midwife living in the community. The findings of the project were that community midwifery contributed to increasing the proportion of women assisted by skilled attendants during birth in the four districts in which the scheme was trialed, amounting to just under half of all skilled attended births in the districts. Although the skilled birth attendant rate in these districts was well below the national average of 42 percent, there was a steady increase in the proportion of attended deliveries since CMs were introduced in 2005. The districts also reported an increase in postnatal assessments in the first 48 hours and increase in immunization coverage

Women's empowerment in Ethiopia : new solutions to ancient problems

ALEMU, Bogalech
ASNAKE, Mengistu
September 2007

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This report focuses on a 'Women and girls empowerment' project in Ethiopia, which expands the work of an earlier project to include girls and recognises the need for early intervention. Whereas the first project focused on removing obstacles to women's basic rights - both social and economic - and promoting access to reproductive health and family planning services, freedom from sexual exploitation, violence, forced marriage and other harmful traditional practices, this second project focuses on raising awareness and education among girls and women about reproductive health and family planning, personal rights and an emphasis on education, life skills and leadership development

Tell me more : children's rights and sexuality in the context of HIV/AIDS in Africa

THOMSEN, Sarah C
2007

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This report explores the strategies that children have developed for dealing with sexuality and relationships in the face of HIV and AIDS; and provides stakeholders with a coherent rights and youth-oriented knowledge base for the development of a sexual and reproductive health agenda for advocacy. It gives an overview of sexual rights with a focus on children’s rights, including their access to sexual and reproductive health information, as endorsed by relevant international conventions and policies. It also looks at the concept of sexuality and the sexual development of children. The report includes a summary of children’s reflections on issues of sexuality and their coping mechanisms for preventing the transmission of HIV and AIDS. Based on these findings, the report makes recommendations for effective responses that would support children’s existing coping mechanisms and enhance their ability to protect themselves

The potential impact of community-based distribution programmes on contraceptive uptake in resource-poor settings : evidence from Ethiopia

TAWYE, Yenehun
et al
December 2005

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This article assesses the impact of community-based reproductive health services (CBRHS) and programmes on contraceptive use in Ethiopia. The 1993 National Population Policy provided a strong political backing to community-based contraceptive programmes, which grew in number and outreach to the community. The article shows that 'women living in areas covered by the CBRHS programme were three times more likely to use contraception than the average Ethiopian woman'. The study concludes that scaling up the programme nationwide would have the effect of doubling the national contraceptive prevalence rate

A client-centered approach to reproductive health : a trainer's manual

POPULATION COUNCIL
February 2005

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'The Population Council has developed a novel framework for training providers to deliver client-centered reproductive health services. The essence of the approach is to bring about behaviour change in providers by making them more receptive and responsive to client needs. Further, providers are taught to treat clients with respect and dignity, to assess their reproductive health needs holistically within the context of their household circumstances, and to negotiate solutions that clients are able to implement. Known by the acronym SAHR, this approach involves four interconnected steps: Salutation, Assessment, Help, and Reassurance. Through operations research, SAHR was successfully tested in Pakistan in 2000-02. The training manual describes the SAHR approach and is meant to facilitate training of reproductive health providers in how to offer client-centered services. The manual is written in fairly generic terms and can be used, with slight modifications, in any setting or country. The manual has three sections. Section One, the introduction, is an overview of the contents. Section Two, the trainer's guide, comprises the training modules. Each module describes the individual components of client-provider interaction and includes learning objectives, key learning points, a schedule, and a list of materials required. Trainer notes and step-by-step instructions for each activity are included within each module. Section Three contains support materials to help trainers prepare for the sessions.'

Impact of sex and HIV education programs on sexual behaviors of youth in developing and developed countries

KIRBY, Douglas
LARIS, B A
ROLLERI, Lori
2005

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This paper discusses findings from a review of 83 evaluations of sex and HIV education programmes. The analysis found substantial positive impact on sexual behaviours in more than two-thirds of the evaluations and identified 17 characteristics of the most effective curricula used in the programmes evaluated. More information on this review is available, including links to data sheets on each of the 83 evaluations. [Publisher's abstract, amended]

17 fact sheets on gender-related aspects of HIV/AIDS | Resource pack on gender and HIV/AIDS

UNAIDS Inter-Agency Task Team on Gender and HIV/AIDS
2005

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These fact sheets aim to provide policy makers with concise information about gender related aspects of the HIV/AIDS pandemic. They deal with core facts and issues in thematic areas and are underpinned by an analysis which clarifies how gender issues are fuelling the crisis. Each theme presents a self-contained set of issues and recommendations and many of the themes are interlinked. All of them are connected by a concern to promote a gender-enlightened and comprehensive response to HIV/AIDS and its impacts

Report of PLACE assessments in Tashkent, Uzbekistan, Central Asia : 2002 and 2003

ABDULLAEV, Shukharat
et al
July 2004

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This is a report on two PLACE assessments conducted in Tashkent in 2002 and 2003. The aim was to investigate whether there was an overlap in drug use and sexual networks, and to identify the implications for HIV prevention. The findings suggest that there is a significant overlap among youth, drug users and sex workers, and that the rate of new partnership formation remains high, while condom availability has decreased. It suggests that interventions need to focus on the sites where youth and drug users socialise and where sex workers solicit clients

PLACE in Central Asia : a regional strategy to focus AIDS prevention in Almaty and Karaganda, Kazakhstan; Osh, Kyrgyzstan; Tashkent, Uzbekistan. 2002

MEASURE EVALUATION
July 2004

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The PLACE method is designed to expose sexual and injection drug use networks, identify sites where high-risk populations overlap and help focus interventions where they are most needed. This report presents both a baseline assessment of HIV/AIDS risks and an evaluation of condom promotion programmes in four cities in Central Asia. The report shows that sexual and drug use networks are extensive and diffuse. The rate of new partnership formation is also very high, and the use of condoms with new partners is "quite high". Injection drug use is common, and needles are often shared. The report calls for programmes and interventions to concentrate their efforts on sites at high risk, where there is an overlap of high-risk populations (people meeting new partners, youth, injection drug users, sex workers)

Reproductive health strategy

WORLD HEALTH ORGANIZATION (WHO)
2004

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The strategy presented in this document is the World Health Organization's first global strategy on reproductive health. It was adopted by the 57th World Health Assembly (WHA) in May 2004. Three of the eight Millennium Development Goals (MDGs) are directly related to reproductive and sexual health, namely, improving maternal health, reducing child mortality and combating HIV/AIDS, malaria and other diseases. This strategy addresses five priority aspects of reproductive and sexual health: improving antenatal, delivery, postpartum and newborn care; providing high-quality services for family planning, including infertility services; eliminating unsafe abortion; combating sexually transmitted infections, including HIV, reproductive tract infections, cervical cancer and other gynaecological morbidities; and promoting sexual health. This document is intended for policy-makers within governments, international agencies, professional associations, nongovernmental organisations and other institutions

Best practices compendium for family planning and reproductive health

ADVANCE AFRICA. Best Practices Unit
October 2003

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This is a seachable database designed to present information on previously implemented programmes in an accessible format. It focuses on public health interventions and programme models rather than medical practices. It is continually updated, and each submission is reviewed by a technical advisory review board

Cross-generational and transactional sexual relations in sub-Saharan Africa : prevalance of behaviour and implications for negotiating safer sexual practices

LUKE, Nancy
KURZ, Kathleen
September 2002

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This paper is a literature and evidence survey of cross-generational and transactional sex in Africa. It examines the age and economic asymmetries in sexual relationships in an African context, prevalence of cross-generational and transactional sexual relationships, adolescent girls' and men's motivations and adolescent girls' negotiating power in relationships. It comes to the conclusion that adolescent girls have power when negotiating the start and end of relationships and they are strongly motivated to enter into cross-generational relationships for the material benefits and status that they bring. However, once they have entered the relaltionship the balance of power shifts to the man, especially in the context of gift-giving.
The paper also examines the evidence around cultural acceptance of cross-generational and transactional sexual relationships, violence and rape within the relationships, multiple relationships, and outcome of the relationships. The authors' recommendations are to: gather policy support for changing the social norm; mount programmatic responses; conduct research to investigate the success of programmatic responses, document the policy process, and fill other important information gaps

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