Reproductive health needs of physical handicapped females in Kinshasa, DR Congo

Abstract

<p align="justify"> <span style="font-size:10pt;">Objective: Our study is intended to evaluate mobility impairment’s level in adult females, their sociodemographic status, knowledge, and practices related to reproductive health in order to provide healthcare givers and policy makers with tools to meet appropriate needs of these vulnerable persons in Kinshasa, DR Congo. Study design: A cross-sectional descriptive study from March 20th 2012 throughout July 20th 2012 concerned 138 physical (non mental) disabled attendees of 7 centers for disabled adults in Kinshasa, DR Congo. Concerns about extend of the disability focused on parts of the body concerned, functional capacity (self walking, crutches, prosthesis, wheel-chairs) and manual freedom. Participants were interviewed using open-ended questions about sociodemographic status, knowledge, and practices related to reproductive health. Issues concerned included age at menarche, age at first sex experience, marital status, education level, employment status, obstetric history, sex abuse, birth control and sexual transmitted diseases. For statistic analysis OR (CI at 95%) was calculated to seek for possible association between physical impairment and parturition’s characteristics. Results: The mean age of the study group (31.1 ± 5.7 years) ranged from 15 to 40 years. Most were affected by legs and the majority (69.1%) needed crutches or wheelchair for moving. Only 21 (15.2%) were married, most (15) of them with a disabled colleague. Mean parity and gravidity were 2.78 ± 2.3 (range 0 - 11) and 3.4 ± 2.5 (range 0 - 12), respectively. Sex experience was initiated at 17.5 ± 3.7 years (range of 12 - 35), 13 (9.4%) had experienced rape, and 37 (26.8%) had (illegally) aborted. Of the 117 women who had had a child 82 (70.7%) had vaginal delivery. In 24 of 34 cesarean sections fetopelvic disproportion or protracted pelvis was the main indication (68.6%), the risk for cesarean section being somewhat related to involvement of 2 legs. Data concerning the issue of knowledge and practices related to reproductive health were very limited and unreliable. Conclusion: Based on the age at menarche, at first intercourse and having had child reflect obvious interest of disabled in sex and reproduction, even if unmarried. Their limited information on reproductive health education results in unplanned pregnancy, unsafe abortion and risk for HIV and other sexual transmitted diseases. The rate of vaginal delivery is likely to redeem own perception on their health status. This could be basis for adhesion to specific programs devoted to physical, psychological, and social limitations. </span> </p> <p> <span></span> </p

Experiences of women with physical disabilities accessing prenatal care in low‐ and middle‐income countries

“…Of the included articles, quality appraisal scores ranged from 3.0 to 7.05. Six studies (55%) were conducted in six different African countries: Uganda (Ahumuza et al., 2014), Democratic Republic of Congo (BarthÈlÈmy & Yves, 2013), Cameroon (Bremer et al., 2010), Ghana (Ganle et al., 2016), Kenya (Khasoha, 2013), and Ethiopia (Tefera et al., 2017). Four studies were conducted in two South Asian countries (36%): two in India (Dean et al., 2017; Murthy et al., 2014) and two in Nepal (Devkota et al., 2017; Morrison et al., 2014).…”

“…The total sample of women with physical disabilities across the 11 studies was 546+ (6‐184); one study did not report how many participants were women with physical disabilities versus women with a visual impairment (Tefera et al., 2017). Five studies recruited women with physical, sensory and/or intellectual disabilities (Dean et al., 2017; Ganle et al., 2016; Murthy et al., 2014; Tefera et al., 2017), three included only women with physical disabilities (BarthÈlÈmy & Yves, 2013; Bremer et al., 2010; Carvalho & Brito, 2016), and one each enrolled women with, and without, physical disabilities (Devkota et al., 2017), women with physical, sensory and/or intellectual disabilities as well as key informants (Khasoha, 2013), and both men and women with physical disabilities (Ahumuza et al., 2014).…”

“…An even greater obstacle to accessing care was the lack of disability accommodations in prenatal clinics and maternity wards (BarthÈlÈmy & Yves, 2013; Bremer et al., 2010; Dean et al., 2017; Ganle et al., 2016; Khasoha, 2013). Elevators were absent or non‐functional, examination tables and hospital beds that were too high for transfers (Dean et al., 2017; Ganle et al., 2016; Khasoha, 2013), wheelchairs and stretchers were scarce (Dean et al., 2017), handicapped toilets and personnel to assist with toileting, transport and transfers were lacking (Ganle et al., 2016) as were ramps (Khasoha, 2013).…”

“…Limited knowledge of reproductive health was reported (BarthÈlÈmy & Yves, 2013; Bremer et al., 2010) with the notable exception of the Brazilian cohort (Carvalho & Brito, 2016). While many women with physical disabilities expressed joy in the pregnancy, some were concerned about the inheritable nature of physical disabilities (Tefera et al., 2017) or were embarrassed by the pregnancy (Morrison et al., 2014).…”