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Family Planning for Women and Girls with Disabilities

Dr FRASER, Erika
CORBY, Nick
MEANEY-DAVIS, Jessie
2021

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This is an updated evidence review looking at the evidence on factors affecting access to and uptake of family planning for women and girls with disabilities in low- and middle-income countries and the evidence on good practice on increasing full free and informed contraceptive choice for women and girls with disabilities.

 

Query:

1) What is the evidence on factors affecting access to and uptake of family planning for women and girls with disabilities in low and middle income countries, highlighting examples from FP2020 commitment-making countries?

2) What is the evidence on good practice on increasing full free and informed contraceptive choice for women and girls with disabilities – from the same countries or elsewhere? 

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

HIV & disability in West Africa: A combined analysis of 4 studies conducted in Burkina Faso, Niger, Guinea Bissau and Cape Verde (2019) - VIH & Handicap en Afrique de l’Ouest : Une analyse combinée de 4 études conduites au Burkina Faso, Niger, Guinée Bis

DE BEAUDRAP, Pierre
2019

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This paper includes four studies which seek to better understand the situation by HIV-related situation of disabled men and women living in West Africa. 
Using epidemiological investigation, qualitative interviews and collections of testimonies, these studies offer insight into the vulnerability of people with disabilities in the area of ​​sexual health
 

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.

Sexual Abuse of Persons with Disabilities - Research

Rob Aley
et al
November 2016

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The aim of the research was to investigate the social, cultural and institutional factors which contribute to the high incidence of sexual abuse of persons with disabilities in East Africa and to identify interventions which could change detrimental attitudes, beliefs and practices which perpetuate this high incidence. The research is framed within the United Nations Convention on the Rights of Persons with Disability (UNCRPD), particularly articles 12, 13 and 16.

The study used a qualitative participatory action research approach and worked with local partner organisations and Ugandan and Kenyan field level researchers to collect data. Survivors of sexual abuse were not interviewed but instead the research investigated the understandings, beliefs and practices of a range of service providers and key responders who are involved in the prevention of and response to sexual abuse against persons with disabilities in their communities. Groups consulted included police, teachers, health-care workers, government administrators, faith and community organisations and traditional leaders, as well as persons with disabilities and their parents. Participatory workshops were run with a reference group of people with disabilities (with a range of impairments and experiences) and relevant specialists at the initial stage and during the participatory analysis process. After initial orientation and training the field researchers undertook a total of 52 individual interviews and 9 focus group discussions with a range of stakeholders.

The overall findings show that social attitudes and understanding of disability and sexuality in general are strong influencing factors on the risks that persons with disability face in relation to sexual abuse. Participants reported a range of harmful attitudes and beliefs about disability and about the needs and rights of persons with disabilities. It is very common for cases of abuse to go unreported and to be dealt with at the family or community level, rather than being viewed as a serious criminal matter which should be taken to the formal authorities. Many barriers exist, especially at community level which mean abuse does not get reported. Lack of awareness and knowledge, stigma and exclusion and poverty were key drivers of continuing abuse and survivors of abuse seldom get proper support. Guidelines, training and clear procedures for good practice in the various professions were generally weak or absent. Key recommendations were generated for both community level interventions and in relation to policy and training at regional and national levels. The practical implementation of some recommendations was undertaken.

Sexual Abuse of Persons with Disabilities - Research

ALEY, Rob
et al
November 2016

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Abstract
The aim of the research was to investigate the social, cultural and institutional factors which contribute to the high incidence of sexual abuse of persons with disabilities in East Africa and to identify interventions which could change detrimental attitudes, beliefs and practices which perpetuate this high incidence. The research is framed within the United Nations Convention on the Rights of Persons with Disability (UNCRPD), particularly articles 12, 13 and 16.

The study used a qualitative participatory action research approach and worked with local partner organisations and Ugandan and Kenyan field level researchers to collect data. Survivors of sexual abuse were not interviewed but instead the research investigated the understandings, beliefs and practices of a range of service providers and key responders who are involved in the prevention of and response to sexual abuse against persons with disabilities in their communities. Groups consulted included police, teachers, health-care workers, government administrators, faith and community organisations and traditional leaders, as well as persons with disabilities and their parents. Participatory workshops were run with a reference group of people with disabilities (with a range of impairments and experiences) and relevant specialists at the initial stage and during the participatory analysis process. After initial orientation and training the field researchers undertook a total of 52 individual interviews and 9 focus group discussions with a range of stakeholders.

The overall findings show that social attitudes and understanding of disability and sexuality in general are strong influencing factors on the risks that persons with disability face in relation to sexual abuse. Participants reported a range of harmful attitudes and beliefs about disability and about the needs and rights of persons with disabilities. It is very common for cases of abuse to go unreported and to be dealt with at the family or community level, rather than being viewed as a serious criminal matter which should be taken to the formal authorities. Many barriers exist, especially at community level which mean abuse does not get reported. Lack of awareness and knowledge, stigma and exclusion and poverty were key drivers of continuing abuse and survivors of abuse seldom get proper support. Guidelines, training and clear procedures for good practice in the various professions were generally weak or absent. Key recommendations were generated for both community level interventions and in relation to policy and training at regional and national levels. The practical implementation of some recommendations was undertaken.

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.

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.

Bridging the gaps between research, policy and practice in low- and middle-income countries a survey of researchers

LAVIS, John N
et al
May 2010

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This article describes the findings from a study which examined efforts to bridge the gaps between research, policy and practice in 10 low- and middle-income countries in which researchers conducting research in one of four clinical areas relevant to the Millennium Development Goals: prevention of malaria (Ghana, Laos, Senegal and Tanzania), care of women seeking contraception (China, Kazakhstan, Laos and Mexico), care of children with diarrhoea (Ghana, India, Pakistan and Senegal) and care of patients with tuberculosis (China, India, Iran and Mexico) were surveyed

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

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

Reaching truckers in Brazil with non-stigmatizing and effective HIV/STI services

CHINAGLIA, Magda
et al
May 2007

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In 2001, the Population Council conducted an assessment in Brazilian border areas, commissioned by the Brazilian Ministry of Health, with support from USAID/Brazil, to determine which populations were most in need of HIV prevention activities. The research findings in the southern region revealed the presence of an extremely mobile, international truck driver community with little or no access to HIV prevention, testing and treatment services. In response to this need, Horizons/Population Council implemented an operations research study focused on trucker drivers (2002-2005) in the south of Brazil. In collaboration with the administration of the customs stations, municipal and state STI and AIDS programmes, and Health Ministries, the investigators sought to examine the feasibility and impact of an HIV prevention project targeted at truckers crossing the southern border of Brazil

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)

National household HIV prevalence and risk survey of South African children

BROOKS, Heather
SHISANA, Olive
RICHTER, Linda
2004

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This valuable new report looks at the levels of infection of HIV and AIDS, the levels of orphaning and child headed households, sexual debut and sexual experiences and risk factors and risk environments for children aged 2-14 in South Africa. This has been investigated as the HSRC recognizes that there is very little known about HIV prevalence rates among children or about the risk factors that predispose them to becoming infected. The study looks at the social and community risk factors that predispose children to HIV infection as well as the impact of the epidemic on children in terms of orphan status and child headed households. It examines children’s knowledge of HIV and AIDS prevention, their knowledge about sexual behaviour and HIV as well as their own patterns of sexual behaviour and changes in that behaviour. This study is interesting as it explicitly includes young children

Canadian youth, sexual health and HIV/AIDS study

COUNCIL OF MINISTERS OF EDUCATION, CANADA (CMEC)
2003

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This survey was undertaken to increase the understanding of the factors that contribute to the sexual health of Canadian youth. It was done by exploring the socio-cultural, socio-environmental and interpersonal determinants of adolescent sexual behaviour. A section of the survey (pp 111-114) looks specifically at disability and sexual activity

Preventing HIV/AIDS and promoting sexual health among especially vulnerable young people

SHAW, Cathy
AGGLETON, Peter
July 2002

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This good practice guide introduces practitioners, policy-makers and researchers to two distinct but related concepts - risk and vulnerability. The guide explores how gender, race, culture, sexuality and social status all influence young people's experiences of sexual relationships and makes some more vulnerable to poor sexual health. Using case studies from Africa, Asia, Latin America and Europe, this resource sets out guidelines to inform work with especially vulnerable young people (including young people who sell sex, young people who inject drugs, and young migrants and refugees)

Mainstreaming HIV/AIDS : looking beyond awareness

WILKINS, Marissa
VASANI, Dolar
2002

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The social and environmental circumstances that lead vulnerable people to have unprotected sex, exposing them to infections, have to be resolved through addressing the causes of poverty, gender discrimination, and the use of sex as a commodity. This book addresses the impact of HIV without prejudice, by taking a human rights stance. It is useful for trainers, programme planners, policy-makers and CBR programmes

Evaluating programs for HIV/AIDS prevention and care in developing countries : a handbook for program managers and decision makers

REHLE, Thomas
et al
2002

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This handbook contains a comprehensive discussion of evaluation approaches and methodologies for HIV prevention and care programmes. Its premise is that evaluation is an integral part of any programme from initial planning onward. Section I discusses concepts and approaches to evaluation and suggests an evaluation strategy design. Section II describes operational approaches for evaluating programmes concerned with promotion of behavioural change, infection control, condom use, voluntary counselling and testing, and people living with HIV or AIDS (PLWHA). Section III focuses on methodologies for measuring behavioural trends while section IV addresses evaluation issues of programme impact assessment and cost-effectiveness analysis. This publication is designed for use by programme managers and decision makers

Reproductive health indicators for global monitoring : report of the second interagency technical meeting

WORLD HEALTH ORGANIZATION (WHO)
2001

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This document is a report of the second interagency technical meeting on indicators. The meeting reviewed country experiences in strengthening health information systems for monitoring reproductive health and discussed a guideline for district level health managers describing a process of identifying reproductive health indicators according to specific criteria. The meeting also discussed a draft set of indicators for global monitoring

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