Disability and sexual and reproductive health service utilisation in Uganda: an intersectional analysis of demographic and health surveys between 2006 and 2016

Pattern of contraceptive use among reproductive-aged women with disabilities in Bangladesh: Evidence from multiple indicator cluster survey 2019

BACKGROUND

Contraception is crucial for reproductive-aged women with disabilities, empowering them to manage reproductive choices and enhancing overall health, autonomy, and well-being.

OBJECTIVE

The objective of this study was to examine the usage patterns of contraceptive methods among reproductive-aged women with disabilities in Bangladesh.

METHODS

We analyzed data from 47,465 reproductive-aged women from the 2019 Bangladesh Multiple Indicator Cluster Survey. Outcome variables included contraceptive usage patterns, grouped into any contraceptive methods, any modern contraceptive methods, and any traditional contraceptive methods. The primary explanatory variable considered was disabilities level (women with no disabilities, women with moderate disabilities, and women with severe disabilities), along with types of disabilities. A multilevel mixed-effects logistic regression model was used to assess associations between outcomes and explanatory variables while accounting for confounding.

RESULTS

The prevalence of any contraceptive methods use was 66.4 %, declining to 54 % among women with severe disabilities. The odd of modern contraception use was 31 % lower (aOR, 0.69, 95 % CI, 0.65-0.73) among women with moderate disabilities and 47 % lower (aOR, 0.53, 95 % CI, 0.47-0.60) among those with severe disabilities, compared to women with no disabilities. Within the individual domains of disabilities, those with vision, walking, cognitive, and self-care-related disabilities reported lower odds of modern contraception uptake than those with no disabilities.

CONCLUSIONS

The study highlights that women with disabilities use contraceptives less often, increasing vulnerability to unintended and short interval pregnancies and unsafe abortion. Strengthening family planning and prioritizing women with disabilities for modern contraceptives are vital.

Contraceptive dynamics among women with disabilities of reproductive age in Ethiopia: systematic review

BACKGROUND

In low-income countries, women with disabilities have limited access to essential sexual and reproductive health services and are disadvantaged socioeconomically. Even though some studies have been conducted previously, there are scanty findings on contraceptive use and associated factors among women with disabilities. Thus, this systematic review aimed to assess contraceptive use and associated factors among women with disabilities of reproductive age in Ethiopia.

METHODS

The Preferred Reporting Item for Systematic Review and Meta-Analyses [PRISMA] guidance is used to conduct this systematic review. Data were searched from electronic databases: PubMed/Medline, Scopus, Google Scholar, and other relevant sources. Studies screening was done using Rayyan software. The findings were narratively synthesized using a socio-ecological framework for health promotion.

RESULT

Ten cross-sectional studies and 4436 women with disabilities of reproductive age were included in this review. According to this review, women with disabilities are less likely to use contraceptives, with a prevalence of 21.7% in Gondor City and 44.4% in Addis Ababa. The associated factors were identified and themed at individual, interpersonal, community, and institutional levels.

CONCLUSION

Overall, the review findings revealed that women with disabilities continue to encounter challenges ranging from individual level to disability-unfriendly health facility infrastructure or institutional level. Therefore, health professionals and other relevant stakeholders should draw attention to creating awareness towards contraceptive use at individual and interpersonal levels, ensuring accessible contraceptive services and disability-friendly health facilities.

A mixed-methods study of the awareness and functionality of sexual and reproductive health services among persons with disability in Ghana

BACKGROUND

Persons with disabilities (PwDs) face barriers in accessing sexual and reproductive health (SRH) services due to lack of knowledge and awareness, stigma and discrimination, and inadequate service provision. This study aimed to examine the determinants of SRH knowledge and awareness among PwDs in Ghana, and to explore their perceptions of the functionality of SRH services.

METHODS

A sequential explanatory mixed-methods study design was used to collect and analyse quantitative (n = 402) and qualitative (n = 37) data from PwDs in two districts in Ghana. Quantitative data were analysed using descriptive and inferential statistics, while qualitative data was analysed thematically.

RESULTS

Most of the participants had high awareness of SRH (94.3%), sexually transmitted infections (STIs) (92.5%) and HIV/AIDS (97.0%). Employment status was positively associated with SRH awareness [aOR = 1.62; 95% CI = 1.02, 2.59]. Disability type was a significant predictor of STI [aOR = 2.02; 95% CI = 1.39, 2.94] and HIV/AIDS [aOR = 2.32; 95% CI = 1.21, 4.44] awareness, with the visually impaired having higher odds than the physically disabled. Age group was also a significant predictor of STI awareness, with older respondents having higher odds than younger ones [aOR = 1.76; CI = 1.01,3.05 for 30-39 years; aOR = 2.48; CI = 1.22, 5.05 for 40-49 years]. The qualitative findings revealed four main themes: conceptualisation of SRH, active engagement in SRH information seeking, tensions between knowledge and religious beliefs and perceived utility of SRH services.

CONCLUSION

Despite the high levels of SRH knowledge and awareness among PwDs, there are significant gaps and challenges related to disability type, age group, misconceptions, beliefs, and service non-functionality that limit the utility of SRH services. The findings call for tailored education to reduce misconceptions and put in pragmatic steps to deliver quality SRH services and information to PwDs. Further research is needed to assess the sexual lives of PwDs and explore the perspectives of all relevant stakeholders, including service providers and policymakers on how to enhance SRH outcomes for PwDs in Ghana.

The sexual behavior of young people living with a disability: Findings from the KAP study in Northern Uganda

Introduction

Young people living with disability form one of the most vulnerable population groups globally. There is limited information on the use of SRH services among young people living with a disability.

Methods

This analysis is based on household survey data among young people. Drawing on a sample of 861 young people living with a disability (15 -24 years), we investigate the sexual behaviour, and identify the risk factors associated with sexual behavior of young people living with a disability. Multilevel logistic regression was used.

Results

Results indicate that risky sexual behaviour was associated with alcohol consumption (aOR = 1.68; 95%CI: 0.97, 3.01), having limited knowledge of HIV and STI prevention methods (aOR = 6.03; 95%CI: 0.99, 30.00), and low life skills (aOR = 4.23; 95%CI: 1.59, 12.87). The odds of not using a condom at last sex were significantly higher among in-school young people than out of school young people (aOR = 0.34; 95%CI: 0.12, 0.99).

Discussion

Targeted interventions aimed at reaching out to young people living with a disability should consider their sexual and reproductive health needs, barriers, and facilitators. Interventions can also promote self-efficacy and agency of young people living with a disability in making informed sexual and reproductive health choices.

Are women with disabilities less likely to utilize essential maternal and reproductive health services?-A secondary analysis of Pakistan Demographic Health Survey

BACKGROUND

People with disabilities deal with widespread exclusion from healthcare services, including sexual and reproductive health (SRH) rights. Studies analyzing the relationship between disability and key SRH utilization outcomes have often reported mixed findings. In Pakistan, very little to no literature is available on this topic, therefore we aim to determine inequalities in the utilization of essential maternal and reproductive health services between women with and without disabilities in Pakistan.

METHODS

This was a secondary analysis of Pakistan Demographic Health Survey 2017-18 performed on a weighted sample of 6,711 women aged 15-49 years with a live birth in the 5 years preceding the survey. Six types of disabilities were assessed i.e. vision, hearing, communication, cognition, walking and self-care. Utilization of essential maternal and reproductive health services was assessed through a set of four outcome variables: (i) modern contraceptive use; (ii) skilled antenatal care (ANC); (iii) skilled birth attendance (SBA); and (iv) skilled postnatal care (PNC). Multivariate Cox regression analysis was performed to determine the association between dependent and independent variables. Data were analyzed using Stata MP Version 16.0.

RESULTS

A total of 6,711 women were included out of which 14.1% (n = 947) live with at least one form of disability. Mean age was 29.4 (S.E = 0.13) years. The most prevalent form of disability was vision (7.0%), followed by walking (4.8%), cognition (4.8%) and hearing (1.8%). Women with disabilities were comparatively less educated, belonged to older age group, and had higher parity than their non-disabled counterparts. With the exception of modern contraceptive use, which was more prevalent in the group with disabilities, women with disabilities were less likely to utilize skilled ANC, SBA and PNC in bivariate analysis. However, these associations turned insignificant in the adjusted model. Overall, no statistically significant differences were observed in the utilization of essential reproductive health services between women with and without disabilities after adjusting for important covariates.

CONCLUSION

Our analyses did not find any statistically significant differences in the utilization of essential maternal and reproductive health services between women with and without disabilities. In-depth research utilizing qualitative or mixed methods is required to understand how well the healthcare system in Pakistan is responsive to the different needs of disabled women.