1
|
Mathabela B, Madiba S, Modjadji P. Exploring Barriers to Accessing Sexual and Reproductive Health Services among Adolescents and Young People with Physical Disabilities in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:199. [PMID: 38397689 PMCID: PMC10887722 DOI: 10.3390/ijerph21020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
Despite South Africa having a progressive and liberal sexual and reproductive health (SRH) policy framework, adolescents and young people with disabilities (AYPWDs) are less likely to receive sexual and reproductive healthcare, being consequently predisposed to a long-term detrimental impact on their health. Our study explored the barriers to accessing sexual and reproductive health services (SRHSs) in clinics among AYPWDs in Mpumalanga, South Africa. We conducted a descriptive qualitative study with twenty-seven AYPWDs in four focus group discussions using semi-structured interviews, audiotaped and transcribed verbatim, and then applied a thematic analysis of the data. Employing a socio-ecological model, the findings show a poor socioeconomic status, lack of information on SRH, and the attitudes of AYPWDs as barriers at the individual level, hindering AYPWDs from accessing SRHSs in clinics. AYPWDs also faced difficulties to talk about SRH with parents, a lack of support to seek SRHSs, improper care from family/parents, and negative attitudes of friends, at the interpersonal level. They further expressed barriers at the community/societal level as negative attitudes of non-disabled community members and poor infrastructure for wheelchair use. At the organization level, their access to SRHSs was negatively affected by HCWs' maltreatment, described in the forms of negative attitudes, being judgmental using verbal abuse, discrimination, and bullying. Furthermore, AYPWDs described difficulties in communication with HCWs, as well as violating their confidentiality and misconceived ideas on their sexuality. Intensified efforts to strengthen public health strategies are needed to improve access to SRHSs by AYPWDs in South Africa, as well as enhancing the proficiency and communication skills of HCWs and educating AYPWDs, parents, and non-disabled community members on SRH.
Collapse
Affiliation(s)
- Bheki Mathabela
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa;
| | - Sphiwe Madiba
- Faculty of Health Sciences, University of Limpopo, Polokwane 0700, South Africa;
| | - Perpetua Modjadji
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa;
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
- Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Johannesburg 1709, South Africa
| |
Collapse
|
2
|
Gréaux M, Moro MF, Kamenov K, Russell AM, Barrett D, Cieza A. Health equity for persons with disabilities: a global scoping review on barriers and interventions in healthcare services. Int J Equity Health 2023; 22:236. [PMID: 37957602 PMCID: PMC10644565 DOI: 10.1186/s12939-023-02035-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Persons with disabilities experience health inequities in terms of increased mortality, morbidity, and limitations in functioning when compared to the rest of the population. Many of the poor health outcomes experienced by persons with disabilities cannot be explained by the underlying health condition or impairment, but are health inequities driven by unfair societal and health system factors. A synthesis of the global evidence is needed to identify the factors that hinder equitable access to healthcare services for persons with disabilities, and the interventions to remove these barriers and promote disability inclusion. METHODS We conducted a scoping review following the methodological framework proposed by Arksey and O'Malley, Int J Soc Res Methodol 8:19-32. We searched two scholarly databases, namely MEDLINE (Ovid) and Web of Science, the websites of Organizations of Persons with Disabilities and governments, and reviewed evidence shared during WHO-led consultations on the topic of health equity for persons with disabilities. We included articles published after 2011 with no restriction to geographical location, the type of underlying impairments or healthcare services. A charting form was developed and used to extract the relevant information for each included article. RESULTS Of 11,884 articles identified in the search, we included 182 articles in this review. The majority of sources originated from high-income countries. Barriers were identified worldwide across different levels of the health system (such as healthcare costs, untrained healthcare workforces, issues of inclusive and coordinated services delivery), and through wider contributing factors of health inequities that expand beyond the health system (such as societal stigma or health literacy). However, the interventions to promote equitable access to healthcare services for persons with disabilities were not readily mapped onto those needs, their sources of funding and projected sustainability were often unclear, and few offered targeted approaches to address issues faced by marginalized groups of persons with disabilities with intersectional identities. CONCLUSION Persons with disabilities continue to face considerable barriers when accessing healthcare services, which negatively affects their chances of achieving their highest attainable standard of health. It is encouraging to note the increasing evidence on interventions targeting equitable access to healthcare services, but they remain too few and sparce to meet the populations' needs. Profound systemic changes and action-oriented strategies are warranted to promote health equity for persons with disabilities, and advance global health priorities.
Collapse
Affiliation(s)
- Mélanie Gréaux
- Faculty of Education, University of Cambridge, Cambridge, UK.
| | | | | | | | | | | |
Collapse
|
3
|
Tenaw Z, Gari T, Gebretsadik A. Sexual lives of reproductive-aged people with disabilities in Central Sidama National Regional State, Ethiopia: a mixed-methods study. BMC Public Health 2023; 23:1550. [PMID: 37582722 PMCID: PMC10428632 DOI: 10.1186/s12889-023-16511-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/10/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Sexuality is an important part of human life; people with disabilities have the same sexual desires as people without disabilities. However, the status of the sexual lives of reproductive-aged people with disabilities is unfolded in Ethiopia. Therefore, this study was aimed to assess sexual lives and its associated factors among reproductive-aged people with disabilities in central Sidama National Regional State, Ethiopia. METHODS A mixed-methods study was conducted among randomly selected 685 reproductive-age people with disabilities and fifteen (15) in-depth interviews among individuals who have sexual practice experience from June 20 to July 15, 2022. The quantitative data were collected through face-to-face interviewing techniques using a structured and semi-structured questionnaire. A multilevel logistic regression analysis model was employed to analyze the data. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the measures of associations. The qualitative data were managed and analyzed using the phenomenological research analysis approach. RESULTS In this study, 59.9% (95% CI: 56.1, 63.5) of the people with disabilities have practiced sexual intercourse. Of these, 30.8% (95% CI: 27.4, 34.4) were males and 29.1% (95% CI: 25.7, 32.6) were females with disabilities. Being female (AOR = 2.81; 95% CI: 1.70, 4.62), having an occupation (AOR = 7.55; 95% CI: 4.03, 14.1), having a disability and being in a wheelchair (AOR = 0.27; 95% CI: 0.09, 0.82), having a good self-perception (AOR = 0.46; 95% CI: 0.28, 0.77), and having a rich economic status (AOR = 2.05; 95% CI: 1.08, 3.89) were factors associated with the sexual practice. The qualitative findings revealed that having sexuality information (training) is the facilitator, and community discrimination and low economic income are the barriers to sexual practice. CONCLUSION Sexual practice among people with disabilities is low in the Dale and Wonsho districts and Yirgalem city administration. Socio-demographic and economic factors and sexuality training are the associated factors. Therefore, creating job opportunities and economic empowerment, providing sexuality training, and creating community awareness are crucial to improving the sexual practice of reproductive-age people with disabilities.
Collapse
Affiliation(s)
- Zelalem Tenaw
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
| | - Taye Gari
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Achamyelesh Gebretsadik
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| |
Collapse
|
4
|
Experiences, Barriers, and Facilitators to Sexual and Reproductive Health Care Access of People with Sensory Impairments: A Scoping Review. SEXUALITY AND DISABILITY 2023. [DOI: 10.1007/s11195-023-09778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|
5
|
Vujcich D, Wilshin C, Lock E, Reeves K, Lobo R. Patients' and health care providers' perspectives of sexual and reproductive health services for people with disability: a scoping review protocol. JBI Evid Synth 2023; 21:449-456. [PMID: 36111861 DOI: 10.11124/jbies-22-00044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to summarize the nature and focus of research that has been conducted into patients' and health care providers' perspectives of sexual and reproductive health access for people with disability. INTRODUCTION Article 25 of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) requires people with disability to be provided with equitable access to sexual and reproductive health services. However, there are few scoping or systematic reviews examining the provision of inclusive sexual and reproductive health services to people with disability. Current and planned reviews are either not inclusive of a full range of disabilities or geographical regions, are limited to reproductive health, or focus exclusively on the perspectives of health professionals. INCLUSION CRITERIA Qualitative, quantitative, mixed method studies, and gray literature concerning sexual and reproductive health service access for people with disability will be included. The UNCRPD definition of disability will be adopted, together with a multidimensional conceptualization of "access." METHODS The review will be conducted in accordance with JBI methodology. A search strategy has been developed for MEDLINE, Embase, CINAHL, and gray literature. After de-duplication, results will be independently screened against the inclusion criteria by 2 reviewers. There will be no geographical limitations, but non-English-language publications will be excluded. Only literature published after the UNCRPD came into effect (May 3, 2008) will be included. Charting tools will be used for data extraction, and results will be presented in descriptive, diagrammatic, and tabular formats.
Collapse
Affiliation(s)
- Daniel Vujcich
- School of Population Health, Curtin University, Bentley, WA, Australia
| | | | | | | | | |
Collapse
|
6
|
Gül S, Yağmur Y. The effect of web-based genital hygiene education provided to the women with disabilities on their self-care agency and genital hygiene behaviors: A randomized controlled trial. Health Care Women Int 2022; 44:670-688. [PMID: 36300997 DOI: 10.1080/07399332.2022.2128801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this study, we examined the effect of web-based genital hygiene education provided to women with orthopedically disability on self-care agency and genital hygiene behaviors. The research was conducted as a randomized controlled trial. 62 participants in the sample group were randomly assigned. There were statistically significant differences between the pretest, mid-test and post-test total mean scores of Self-Care Scale, Genital Hygiene Behavior Scale and all sub-dimensions in the expiremental group (p < 0.001) and there was not a significant difference in the control group (p > 0.05).
Collapse
Affiliation(s)
- Sidar Gül
- Department of Midwifery, Faculty of Health Science, Siirt University, Siirt, Turkey
| | - Yurdagül Yağmur
- Department of Obstetric and Gynecological Nursing, Faculty of Nursing, Inonu University, Malatya, Turkey
| |
Collapse
|
7
|
Educational needs, motives and experiences of sex care workers for people with disabilities in the Netherlands. SEXUALITY AND DISABILITY 2022. [DOI: 10.1007/s11195-022-09760-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
AbstractIn some countries, personal assistants may facilitate sexual engagement of people with disabilities. A specific form of facilitating sexuality are services that offer paid sex with sex care workers. In the Netherlands, there is no training available for sex care workers. To provide input for such training, this study examined sex care workers’ (perceived importance of) knowledge about sexuality and relevant aspects of sex care, their educational needs, motives for becoming a sex care worker, and experiences. An online survey was completed by 29 sex care workers (response rate 52%). The sex care workers expressed high importance of knowledge and generally reported good, but slightly lower current knowledge levels on these aspects. Educational needs included both general and disability-related sexuality and sexual problems and how to deal with problem behaviors and/or emotional disinhibition. Some participants indicated that learning how to prevent physical strain was important. The importance of setting boundaries was reported. Overall, participants experienced little stigma, although few reported negative experiences. Important motives for sex care work included the lack of attention to sexuality support for clients with disabilities and wanting to contribute to clients’ sexual citizenship. The formulated educational needs may be helpful in the development of such training. In addition to knowledge and practical skills, the training should pay attention to discovering and setting boundaries, providing a safe space for reflection on one’s own body experience and ethics, as well as considering the clients’ perspectives.
Collapse
|
8
|
Nketsia W, Mprah WK, Opoku MP, Juventus D, Amponteng M. Achieving universal reproductive health coverage for deaf women in Ghana: an explanatory study of knowledge of contraceptive methods, pregnancy and safe abortion practices. BMC Health Serv Res 2022; 22:954. [PMID: 35897008 PMCID: PMC9327200 DOI: 10.1186/s12913-022-08323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background The first world conference on sexual and reproductive health (SRH) in 1994 helped create the awareness that reproductive health is a human right. Over the years, attempts have been made to extend services to all persons; however, lapses persist in service provision for all in need. Recently, countries have been encouraged to target minority groups in their reproductive health service provision. However, studies have rarely attempted to develop deeper insights into the experiences of deaf men and women regarding their knowledge of SRH. The purpose of this study was to develop an in-depth understanding of the knowledge of deaf persons regarding services such as knowledge of contraceptive methods, pregnancy and safe abortion practices. Methods A sequential explanatory mixed-methods approach was adopted for this study. In the first quantitative phase, 288 deaf persons recruited from three out of the 16 regions in Ghana participated in this study. They completed a 31-item questionnaire on the main issues (knowledge of contraceptive methods, pregnancy and safe abortion practices) addressed in this study. In the second phase, a semi-structured interview guide was used to collect data from 60 participants who took part in the first phase. The key trend emerging in the first phase underpinned the interview guide used for the data collection. While the quantitative data were subjected to the computation of means, t-tests, analyses of variance, correlations and linear regressions to understand the predictors, the in-depth interviews were analysed using the thematic method of analysis. Results The results showed a convergence between the quantitative and qualitative data. For instance, the interview material supported the initial findings that deaf women had little knowledge of contraceptive methods. The participants offered reasons explaining their inability to access services and the role of religion in their understanding of SRH. Conclusion The study concludes by calling on policymakers to consider the needs of deaf persons in future SRH policies. The study limitations and other implications for future policymaking are discussed.
Collapse
Affiliation(s)
- William Nketsia
- School of Education, Western Sydney University, Sydney, Australia
| | - Wisdom Kwadwo Mprah
- Centre for Disability and Rehabilitation Studies, Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Maxwell Peprah Opoku
- Special Education Department, United Arab Emirates University, P. O. Box 15551, Al-Ain, United Arab Emirates.
| | | | | |
Collapse
|
9
|
Ip IMH, Honey A, McGrath M. Attitudes Toward Dating People with Disability Amongst Young People in Australia and Hong Kong. SEXUALITY AND DISABILITY 2022. [DOI: 10.1007/s11195-022-09734-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractThis paper explores attitudes toward dating people with disability amongst young people in Australia and Hong Kong. Data relating to disability were extracted from an e-survey that investigated young people’s (n = 2208) experiences of and attitudes toward dating. Quantitative data were analysed using descriptive statistics while open ended responses were subjected to interpretive content analysis. When asked about preferred characteristics for potential dates, young people identified factors that were unlikely to be negatively influenced by disability, such as loyalty, honesty, dedication, humour, and kindness. Yet when asked whether disability would influence their dating choices, most said that it would and expressed an unwillingness to date people with disability. Young adults in Hong Kong expressed less openness to dating people with disability than those in Australia. Physical disability and mental health issues were seen as less of a barrier to dating than intellectual or developmental disability. Despite recent gains in public attitudes toward people with disability, improvements are needed in terms of young people in the general population viewing people with disability as suitable partners and thus, allowing them to enjoy equal rights to relationships and sexuality. Culture is an important determinant, indicating a potential for change.
Collapse
|
10
|
Di Santo SG, Colombo M, Silvaggi M, Gammino GR, Fava V, Malandrino C, Nanini C, Rossetto C, Simone S, Eleuteri S. The Sexual and Parenting Rights of People with Physical and Psychical Disabilities: Attitudes of Italians and Socio-Demographic Factors Involved in Recognition and Denial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1017. [PMID: 35055837 PMCID: PMC8775460 DOI: 10.3390/ijerph19021017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 11/16/2022]
Abstract
The sexual and parenting rights (SPRs) of people with disabilities (PwDs) are under-recognized. Sociodemographic factors may influence attitudes towards them. The aims of this study were: (1) to analyze the levels of agreement of a sample of Italian people with some SPRs of PwDs; (2) to inquire if the SPRs of people with psychical disabilities (PwPSYDs) were less recognized than those with physical disabilities (PwPHDs); (3) to verify if sociodemographic characteristics associated with under-recognition. An online anonymous survey was distributed using non-random sampling methods to conduct an inquiry into the level of agreement with statements regarding the SPRs of PwPHDs and PwPSYDs to have satisfying sexuality, to marry, and to adopt children. Answers from 973 Italian participants, aged 18-84 years (71.1% females) were analyzed. At least 70% of respondents declared in favor of the SPRs of PwPHDs. The SPRs of PwPSYDs were always subjected to higher under-recognition. Religiosity, male sex, higher age, and lower education were the factors most often associated with being against the SPRs of PwDs. Improved identification of the less tolerant respondents and the less recognized categories may allow for specific strategies for promoting the recognition of the SPRs for PwDs.
Collapse
Affiliation(s)
- Simona Gabriella Di Santo
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Roma, Italy
- Italian Association of Applied Sexology and Psychology (AISPA), Via Marostica 35, 20146 Milano, Italy
| | - Margherita Colombo
- Superior School of Clinical Sexology of Turin, Via Unione Sovietica 335, 10135 Torino, Italy
| | - Marco Silvaggi
- Institute of Clinical Sexology (ISC), Via Savoia 78, 00198 Roma, Italy;
| | | | - Valentina Fava
- Research Group for Sexology, Via S. Sofia 78, 95123 Catania, Italy; (V.F.); (C.M.)
| | - Chiara Malandrino
- Research Group for Sexology, Via S. Sofia 78, 95123 Catania, Italy; (V.F.); (C.M.)
| | - Chiara Nanini
- Interdisciplinary Centre for Research and Training in Sexology (CIRS), Via Angelo Ceppi di Bairolo 1/8, 16126 Genova, Italy;
| | - Cristina Rossetto
- Study Center for Affective and Sexual Disorders Treatment (DAS), Via G.T. Invrea 20/2, 16129 Genova, Italy;
| | - Sara Simone
- Institute of Research and Training (IRF), Via Luigi Alamanni 23, 50123 Firenze, Italy;
| | - Stefano Eleuteri
- World Association of Sexual Health, c/o Kristen Mark World Association for Sexual Health Secretariat 1300 S. 2nd Street, Suite 180, Minneapolis, MN 55454, USA;
- Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035, 00185 Roma, Italy
| |
Collapse
|
11
|
Moreira PS, Bittencourt EDS, Paixão GMD, Omura KM. Avaliação de motéis e pousadas em relação à acessibilidade para pessoas com deficiência ou restrição de mobilidade. CADERNOS BRASILEIROS DE TERAPIA OCUPACIONAL 2022. [DOI: 10.1590/2526-8910.ctoao22863017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Introdução Pessoas com deficiência se deparam com inúmeras barreiras no desempenho da atividade sexual; dentre elas, está o acesso a locais acessíveis destinados a essa finalidade. Objetivo O objetivo do presente estudo foi mapear e avaliar a acessibilidade arquitetônica de estabelecimentos que têm como atividade-fim o sexo, tais como motéis e pousadas, localizados na região metropolitana de Belém. Método Trata-se de uma pesquisa de caráter quantitativo, transversal, descritivo, na qual foram avaliados 22 estabelecimentos, através de um questionário de avaliação de acessibilidade elaborado pelos pesquisadores, contendo 11 questões objetivas sobre a acessibilidade arquitetônica de banheiros, rampas de acesso, elevadores, sinalização, formas de comunicação, altura da cama e área de circulação. Resultados Os resultados acerca da sinalização sonora e visual demonstraram que 32% dos estabelecimentos não apresentam nenhuma das formas de sinalização, assim como comunicação alternativa e piso tátil. Em contrapartida, 82% dos estabelecimentos avaliados apresentaram altura dos interfones, interruptores e sinalizadores dentro dos padrões. Em relação à acessibilidade dos banheiros, 43% dos estabelecimentos não apresentaram nenhum mobiliário acessível. Conclusão O presente estudo demonstra resultados não satisfatórios quanto aos parâmetros básicos de acessibilidade dos motéis participantes, constituindo-se graves barreiras ao acesso do público com algum tipo de deficiência. Conclui-se que há a necessidade de maiores discussões sobre o assunto, além de fiscalização para o cumprimento das normas de acessibilidade e mobiliário acessível para que pessoas com deficiência possam usufruir desses serviços.
Collapse
|
12
|
McKinney EL, McKinney V, Swartz L. Access to healthcare for people with disabilities in South Africa: Bad at any time, worse during COVID-19? S Afr Fam Pract (2004) 2021; 63:e1-e5. [PMID: 34342484 PMCID: PMC8335793 DOI: 10.4102/safp.v63i1.5226] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 11/15/2022] Open
Abstract
People with disabilities, especially those living in low- and middle-income countries, experience significant challenges in accessing healthcare services and support. At times of disasters and emergencies, people with disabilities are further marginalised and excluded. During the coronavirus disease 2019 (COVID-19) pandemic, many people with disabilities are unable to access healthcare facilities, receive therapeutic interventions or rehabilitation, or gain access to medication. Of those who are able to access facilities, many experience challenges, and at times direct discrimination, accessing life-saving treatment such as intensive care unit admission and ventilator support. In addition, research has shown that people with disabilities are at higher risk of contracting the virus because of factors that include the need for interpersonal caregivers and living in residential facilities. We explore some of the challenges that people with disabilities residing in South Africa currently experience in relation to accessing healthcare facilities.
Collapse
Affiliation(s)
- Emma L McKinney
- Interdisciplinary Centre for Sports Science and Development, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town.
| | | | | |
Collapse
|
13
|
Ganle JK, Baatiema L, Quansah R, Danso-Appiah A. Barriers facing persons with disability in accessing sexual and reproductive health services in sub-Saharan Africa: A systematic review. PLoS One 2020; 15:e0238585. [PMID: 33044966 PMCID: PMC7549766 DOI: 10.1371/journal.pone.0238585] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/19/2020] [Indexed: 01/10/2023] Open
Abstract
Background There is evidence that persons with disabilities often encounter grave barriers when accessing sexual and reproductive health services. To the best of our knowledge, however, no systematic review has been conducted to pull together these pieces of research evidence for us to understand the nature, magnitude and extent of these barriers in different settings in sub-Saharan Africa. We do not yet have a good understanding of the strength/quality of the evidence that exist on the barriers persons with disabilities face when accessing sexual and reproductive health services in sub-Saharan Africa. We therefore conducted a systematic review to examine the barriers persons with disabilities face in accessing sexual and reproductive health services in sub-Saharan Africa. Methods A systematic review was conducted using PRISMA guidelines (PROSPEROO protocol registration number: CRD42017074843). An electronic search was conducted in Medline, EMBASE, CINAHL, PsycINFO, and Web of Science from 2001 to 2020. Manual search of reference list was also conducted. Studies were included if they reported on barriers persons with disability face in accessing sexual and reproductive health services. The Critical Appraisal Skills Programme and Centre for Evidence Based Management (CEBMa) appraisal tools were used to assess methodological quality of eligible studies. Findings A total of 1061 studies were identified. Only 26 studies covering 12 sub-Saharan African countries were eligible for analysis. A total of 33 specific barriers including inaccessible physical health infrastructure and stigma and discrimination were identified. These barriers were further categorised into five levels: broader national level barriers; healthcare system/institutional barriers; individual level barriers; community level barriers; and economic barriers. Conclusion Persons with disabilities face a myriad of demand and supply side barriers to accessing sexual and reproductive healthcare in sub-Saharan Africa. Multilevel interventions are urgently needed to address these barriers.
Collapse
Affiliation(s)
- John Kuumuori Ganle
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
- Stellenbosch Institute for Advanced Study, Stellenbosch, South Africa
- * E-mail:
| | - Leonard Baatiema
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Reginald Quansah
- Department of Biological, Environmental and Occupational Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Anthony Danso-Appiah
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| |
Collapse
|
14
|
Thomaz EBAF, Costa EM, Goiabeira YNLDA, Rocha TAH, Rocha NCS, Marques MCDO, Queiroz RCDS. Accessibility to people with motor, visual, or hearing disabilities during delivery and childbirth: the structure of SUS facilities linked to Rede Cegonha. CIENCIA & SAUDE COLETIVA 2020; 26:897-908. [PMID: 33729345 DOI: 10.1590/1413-81232021263.17582020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/03/2020] [Indexed: 11/22/2022] Open
Abstract
There are no nationwide studies characterizing accessibility for people with disabilities during delivery. This study aimed to describe the physical structure of hospital units regarding accessibility for pregnant and puerperae with motor (MD), visual (VD), or hearing (HD) disabilities in Brazil. This is an ecological, descriptive study conducted in all 606 health facilities linked to the "Rede Cegonha" where deliveries occurred, according to 2015 databases. We performed the descriptive and geospatial analysis and considered the presence of motor accessibility when the establishment had a handrail or elevator ramp, wheelchair-sized doors, and accessible bathroom with bars. We assumed visual accessibility when there was tactile signage on the floor (Braille system or embossed figures) and hearing accessibility when there was signage by texts, pictures, signs, posters, or symbols in the environments. In Brazil, only 26 (4.3%) of the facilities had accessibility for people with MD, 20 (3.3%) for people with VD, and none for HD. Motor accessibility was worse in the North and Northeast of Brazil, and hearing accessibility in the North region. Despite advances in the implementation of the "Rede Cegonha" in Brazil, the facilities' structure is not adapted for women with MD, VD, or HD.
Collapse
Affiliation(s)
| | - Elisa Miranda Costa
- Departamento de Saúde Pública, Universidade Federal do Maranhão. R. Barão de Itapary 155, Centro. São Luís MA Brasil.
| | | | | | | | | | | |
Collapse
|
15
|
Casebolt MT. Barriers to reproductive health services for women with disability in low- and middle-income countries: A review of the literature. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 24:100485. [DOI: 10.1016/j.srhc.2020.100485] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 12/28/2019] [Accepted: 01/07/2020] [Indexed: 12/18/2022]
|
16
|
Pate JR, Scheadler T, Spellings C, Malnati A, Hillyer S. Sport as a tool for community leaders of people with disabilities: exploring an innovative, immersive exchange training program. MANAGING SPORT AND LEISURE 2019. [DOI: 10.1080/23750472.2019.1653219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Joshua R. Pate
- Hart School of Hospitality, Sport, and Recreation Management, James Madison University, Harrisonburg, VA, USA
| | - Travis Scheadler
- Department of Transformative Learning, University of Kentucky, Lexington, KY, USA
| | - Carolyn Spellings
- Center for Sport, Peace, and Society, University of Tennessee, Knoxville, TN, USA
| | - Alicia Malnati
- Center for Sport, Peace, and Society, University of Tennessee, Knoxville, TN, USA
| | - Sarah Hillyer
- Center for Sport, Peace, and Society, University of Tennessee, Knoxville, TN, USA
| |
Collapse
|
17
|
Obasi M, Manortey S, Kyei KA, Addo MK, Talboys S, Gay L, Baiden F. Sexual and reproductive health of adolescents in schools for people with disabilities. Pan Afr Med J 2019; 33:299. [PMID: 31692876 PMCID: PMC6815493 DOI: 10.11604/pamj.2019.33.299.18546] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/24/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Persons with disabilities have the same sexual and reproductive health (SRH) needs as the abled people but they often face barriers to SRH information and services which are necessary for healthy and safe relationships, protection from HIV and other sexually transmitted infections (STIs). This study sought to access the SRH services among adolescents with disabilities in four Special Needs Schools in Ghana. Methods The study adopted a cross-sectional study design with a quantitative approach to data collection between the months of January to March, 2018. A structured and pretested questionnaire was used to collect data from adolescents with disabilities from selected schools in Ghana. Both descriptive and inferential statistics were performed using chi-square test and multivariate logistic regression. Results Majority of participants had hearing disability (52.1%). The average age at menarche among females was 13 years whiles the age at which puberty was attained among boys was 14 years. School teachers were the major source of information on SRH for the respondents (63.7%) followed by parents (12.2%). A majority (67.1%) of respondents had good knowledge of SRH. Factors which were significantly associated with knowledge level were age (p=0.026), religion (p=0.034), sources of information (p<0.001), guardians (p=0.049). Conclusion The majority of participants had good knowledge of SRH, although their knowledge of contraceptive and access were poor. Only condoms were mostly known. There is the need for increased awareness on the availability of other contraceptives methods and the removal of barriers to contraceptive methods.
Collapse
Affiliation(s)
- Mercy Obasi
- Department of Public Health, University of Utah, West Africa Campus, Kpong, Ghana
| | - Stephen Manortey
- Department of Public Health, University of Utah, West Africa Campus, Kpong, Ghana
| | - Kofi Adesi Kyei
- Department of Radiography, School of Biomedical & Allied Health Sciences, Accra, Ghana.,National Centre for Radiotherapy and Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Michael Kwabeng Addo
- National Centre for Radiotherapy and Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Sharon Talboys
- Department of Public Health, University of Utah, West Africa Campus, Kpong, Ghana
| | - Lynette Gay
- Department of Public Health, University of Utah, West Africa Campus, Kpong, Ghana
| | - Frank Baiden
- Department of Public Health, University of Utah, West Africa Campus, Kpong, Ghana
| |
Collapse
|
18
|
Carew MT, Braathen SH, Hunt X, Swartz L, Rohleder P. Predictors of negative beliefs toward the sexual rights and perceived sexual healthcare needs of people with physical disabilities in South Africa. Disabil Rehabil 2019; 42:3664-3672. [PMID: 31081389 DOI: 10.1080/09638288.2019.1608323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Although sexuality is a ubiquitous human need, recent empirical research has shown that people without disabilities attribute fewer sexual rights and perceive sexual healthcare to benefit fewer people with disabilities, compared to non-disabled people. Within a global context, such misperceptions have tangible, deleterious consequences for people with disabilities (e.g., exclusion from sexual healthcare), creating an urgent need for effective strategies to change misperceptions.Methods: To lay the groundwork for developing such strategies, we examined predictors of the recognition of sexual rights of people with physical disabilities within the South African context, derived from three key social psychological literatures (prejudice, social dominance orientation and intergroup contact), as well as the relationship between sexual rights and beliefs about sexual healthcare. Data were obtained through a cross-sectional survey, given to non-disabled South Africans (N = 1989).Results: Findings indicated that lack of recognition of the sexual rights for physically disabled people predicted less positive beliefs about the benefits of sexual healthcare. In turn, high levels of prejudice (both cognitive and affective) toward disabled sexuality predicted less recognition of their sexual rights, while prejudice (both forms) was predicted by prior contact with disabled people and possessing a social dominance orientation (cognitive prejudice only). Evidence was also obtained for an indirect relationship of contact and social dominance orientation on sexual healthcare beliefs through prejudice, although these effects were extremely small.Conclusion: Results are discussed in terms of their implications for rehabilitation, as well as national-level strategies to tackle negative perceptions of disabled sexuality, particularly in contexts affected by HIV.Implications for rehabilitationFindings demonstrate an empirical link between prejudice toward disabled sexuality, lack of recognition of sexual rights and viewing sexual healthcare of less benefit for disabled people.Consequently, there is need for increased attention to these dimensions within the rehabilitative context.Contact with disabled people, including dedicated interventions, is unlikely to meaningfully impact beliefs about the benefits of sexual healthcare.
Collapse
Affiliation(s)
- Mark T Carew
- Department of Epidemiology and Public Health, University College London, London, UK
| | | | - Xanthe Hunt
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Poul Rohleder
- Department of Psychosocial and Psychoanalytic Studies, University of Essex, Essex, UK
| |
Collapse
|
19
|
Van der Heijden I, Harries J, Abrahams N. In pursuit of intimacy: disability stigma, womanhood and intimate partnerships in South Africa. CULTURE, HEALTH & SEXUALITY 2019; 21:338-351. [PMID: 29847286 DOI: 10.1080/13691058.2018.1470256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/24/2018] [Indexed: 06/08/2023]
Abstract
Notions of womanhood inculcate naturalised ideologies of femininity, sexuality, motherhood and caregiving. The paper asks how disability stigma intersects with womanhood to characterise intimate partnerships in South Africa. In-depth interviews with 30 women with a range of disabilities were conducted in informal settlements in Cape Town. Findings suggest that disability stigma may hamper attainment of normative womanhood and sexual relationships for women with disabilities in South Africa. Limited opportunities to meet potential partners, hegemonic gender expectations and restricted sexual and physical contact shape their intimate partnerships. However, women with disabilities also challenge ableist constructs of normalcy and discredit negative images of disabled womanhood. Because of this, theoretical models of intimate partner violence should consider the influence of disability on constructions of sexuality and norms in intimate partnerships. Building on women with disabilities' stigma-avoidance strategies will help facilitate better relationship outcomes. Social norms interventions with broader society, communities, women with disabilities and their partners, family and carers can help destabilise assumptions that women with disabilities are unable to have long-lasting and fulfilling sexual and intimate partnerships. Moreover, accessible and relevant sexuality education and information on relationships, intimate partner violence, maternal and sexual and reproductive health care can ensure healthy and safe intimate partnerships for women with disabilities.
Collapse
Affiliation(s)
- Ingrid Van der Heijden
- a Gender and Health Research Unit , South African Medical Research Council , Cape Town , South Africa
| | - Jane Harries
- b Women's Health Research Unit, School of Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Naeemah Abrahams
- a Gender and Health Research Unit , South African Medical Research Council , Cape Town , South Africa
| |
Collapse
|
20
|
Senayah EA, Mprah WK, Opoku MP, Edusei AK, Torgbenu EL. The accessibility of health services to young deaf adolescents in Ghana. Int J Health Plann Manage 2018; 34:e634-e645. [PMID: 30311956 DOI: 10.1002/hpm.2679] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 11/09/2022] Open
Abstract
Quality health care is a fundamental human right, which is enshrined in several international and domestic legislative instruments. In the Ghanaian context, there are reports that adults with disabilities encounter barriers in their attempts to access health care. However, scholarly attention is yet to explore the perspectives of young people and adolescents with disabilities. Therefore, this quantitative study was conducted from the perspective of critical disability studies, where young deaf adolescents (YDAs) were regarded as right bearers, and where they shared their perspectives on health accessibility decisions, barriers, and needs. Sixty-seven participants, made up of 44 male and 23 female students, took part in this quantitative study. Although many YDAs who took part in this study indicated that it was not difficult to access health facilities, they claim to have encountered communication barriers. Sign language interpreters in health facilities and introduction of sign language courses in health training institutions to improve communication between health professionals and deaf patients have been suggested as ways of addressing the barriers faced by YDAs in Ghana.
Collapse
Affiliation(s)
- Ebenezer Alfa Senayah
- Centre for Disability Rehabilitation Studies, Department of Community Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wisdom Kwadwo Mprah
- Centre for Disability Rehabilitation Studies, Department of Community Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Anthony Kweku Edusei
- Centre for Disability Rehabilitation Studies, Department of Community Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eric Lawer Torgbenu
- Department of Physiotherapy and Rehabilitation Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| |
Collapse
|
21
|
Rohleder P, Braathen SH, Carew MT, Chiwaula M, Hunt X, Swartz L. Creative collaboration on a disability and sexuality participatory action research project: A reflective diary account. QUALITATIVE RESEARCH IN PSYCHOLOGY 2018. [DOI: 10.1080/14780887.2018.1499837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Poul Rohleder
- School of Psychology, University of East London, London, UK
| | | | - Mark T Carew
- University College London, Leonard Cheshire Disability & Inclusive Development Centre, London, UK
| | - Mussa Chiwaula
- Director General of the Southern African Federation of the Disabled, Botswana
| | - Xanthe Hunt
- Stellenbosch University, Department of Psychology, Stellenbosch, South Africa
| | - Leslie Swartz
- Stellenbosch University, Department of Psychology, Stellenbosch, South Africa
| |
Collapse
|
22
|
Rohleder P, Braathen SH, Hunt X, Carew MT, Swartz L. Sexuality erased, questioned, and explored: the experiences of South Africans with physical disabilities. PSYCHOLOGY & SEXUALITY 2018. [DOI: 10.1080/19419899.2018.1500935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Poul Rohleder
- School of Psychology, University of East London, London, UK
| | | | - Xanthe Hunt
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Mark T. Carew
- Leonard Cheshire Centre for Disability and Inclusive Development, University College London, London, UK
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| |
Collapse
|
23
|
Hunt X, Braathen SH, Swartz L, Carew MT, Rohleder P. Intimacy, intercourse and adjustments: Experiences of sexual life of a group of people with physical disabilities in South Africa. J Health Psychol 2017; 23:289-305. [PMID: 29182006 DOI: 10.1177/1359105317741761] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There is a growing recognition of the sexual and reproductive rights of people with disabilities, and since the World Health Organisation's World Report on Disability, increased international attention has been given to these issues. Past research, however, suggests that this group encounter barriers to sexual and reproductive rights, which are both physical and attitudinal. Against this backdrop, this article employs a sequential mixed qualitative methodology to explore the practical and subjective experiences of 13 people with physical disabilities in South Africa, with regard to their sexual lives and experiences of sexuality. These experiences were marked by concerns about their 'fitness' as sexual beings and indicated that social forces were key in shaping their expectations for their own sexual life.
Collapse
|