Factors affecting utilization of sexual and reproductive health services among women with disabilities- a mixed-method cross-sectional study from Ilam district, Nepal

Abstract

Background Persons with disabilities can have physical, mental, intellectual, or sensory impairments which can hinder their social participation. Despite Sustainable Development Goals call for “universal access to sexual and reproductive health (SRH)”, women with disabilities (WwDs) continue to experience barriers to access SRH services in Nepal. This study evaluated factors affecting the utilization of SRH services among WwDs in Ilam district, Nepal. Methods A mixed-method study with 384 WwDs of reproductive age was conducted in Ilam district, eastern Nepal. Quantitative data were collected using a structured questionnaire. Relationships between utilization of SRH services and associated factors were explored using multivariate logistic regression analysis. Qualitative data were collected from focus groups with female community health volunteers and interviews with WwDs, health workers and local political leaders. They were audio-recorded, translated and transcribed into English and were thematically analyzed. Results Among 384 respondents (31% physical; 7% vision,16% hearing, 7% voice&speech,12% mental/psychosocial, 9% intellectual, 18% multiple disabilities), only 15% of them had ever utilized any SRH services. No requirement (57%) and unaware of SRH services (24%) were the major reasons for not utilizing SRH services. A majority (81%) of them reported that the nearest health facility was not disability-inclusive (73%), specifically referring to the inaccessible road (48%). Multivariate analysis showed that being married (AOR = 121.7, 95% CI: 12.206–1214.338), having perceived need for SRH services (AOR = 5.5; 95% CI: 1.419–21.357) and perceived susceptibility to SRH related disease/condition (AOR = 6.0; 95% CI:1.978–18.370) were positively associated with the utilization of SRH services. Qualitative findings revealed that illiteracy, poor socioeconomic status, and lack of information hindered the utilization of SRH services. WwDs faced socioeconomic (lack of empowerment, lack of family support), structural (distant health facility, inaccessible-infrastructure), and attitudinal (stigmatization, bad behaviour of health care providers, perception that SRH is needed only for married) barriers to access SRH services. Conclusions Utilization of SRH services among WwDs was very low in Ilam district, Nepal. The findings of this study warrant a need to promote awareness-raising programs to WwDs and their family members, sensitization programs to health service providers, and ensure the provision of disability-inclusive SRH services in all health facilities.

Achieving universal reproductive health coverage for deaf women in Ghana: an explanatory study of knowledge of contraceptive methods, pregnancy and safe abortion practices

“…According to both male and female deaf persons, young deaf women are more likely to engage in abortion than girls because of the sexual edge among the youth. This finding is partly consistent with that of other studies on the greater exposure of young girls to poor SRH practices than older women [ 39 , 66 ]. Once again, culture and stereotypes in society could help explain this trend.…”

“…It was revealed that participants who indicated that they were married were more likely to be knowledgeable about pregnancy and contraceptive methods than those who indicated that they were single. This finding partly substantiates that of another study regarding the high level of SRH knowledge among married compared to single persons [ 66 ]. Persons who are single and deaf do not have access to SRH because they engage less with these services, and policies do not generally target their needs.…”

Level of satisfaction and sexual and reproductive health needs of deaf persons in Ghana: a sequential explanatory mixed method study

“…As participants grow, they more likely would be unsatisfied with SRH services-a trend that is unexpected. Although previous study has reported the likelihood of aged persons with disability to utilize SRH services [38], this study has shown that they might not be satisfied with the service they were provided. The expectation is that the older the deaf persons, the more likely they would be to have experience, develop knowledge of SRH, and be able to support their dependents.…”

“…In low-or middle-income contexts, little attention has been given to the experiences of deaf persons [20-22, 26, 37] and persons with other disability conditions [37][38][39][40] in accessing SRH services. In a Nepalese mixed-method study, 384 persons with disability of reproductive age to understand factors affecting the utilization of SRH services [38]. The finding showed inaccessible health facilities and marital status impacted access to services.…”

The Right to Sexuality, Reproductive Health, and Found a Family for People with Intellectual Disability: A Systematic Review

“…Results showed that SRH services did not respond well in terms of the 6 A’s—approachability, acceptability, availability, accommodation, affordability, and appropriateness—reflecting the social dynamics [ 77 ]. Barriers can be classified as socioeconomic, structural, and attitudinal [ 79 , 84 ]. Socioeconomic barriers encompassed a lack of empowerment, a lack of family support, and cultural and religious factors.…”