The Double Burden: Barriers and Facilitators to Socioeconomic Inclusion for Women with Disability in Bangladesh

Abstract

Purpose: Recent evidence suggests that, globally, women with disability suffer multiple forms of discrimination and exclusion from mainstream society when compared with their female peers and men without disability. In Bangladesh, which is a grossly overpopulated low-income country in South Asia, women with disability have poor health outcomes within a gender-biased cultural context. This study aimed to define the current barriers and facilitators to socioeconomic inclusion for women with physical disability living in the community in Bangladesh and to highlight the impact of these barriers on health. Methods: Semi-structured in-depth interviews were conducted with 15 women who had either a spinal cord injury or amputation, and who had been discharged for at least 3 months after inpatient admission. Mixed purposeful sampling (a mixture of typical case sampling and criterion sampling) was used to recruit the study participants. A thematic analysis was conducted to extract themes from the data. The social determinants of health framework and the International Classification of Functioning (ICF) model were then used to contextualise the data.Results: Five major themes were identified including: exclusion from formal education, exclusion from the work force, exclusion from public facilities, exclusion from marriage and increased risk of violence and exclusion from community activities and social groups. Facilitators to inclusion include: provision of accessible buildings and transport, community- based advocacy services and vocational training services.Conclusions: The combination of physical disability and female gender presents multiple complex barriers to inclusion in the socioeconomic and cultural life of Bangladesh. Practical interventions through both up-scaling and expansion of disability-specific programming and sustained policy implementation are required to facilitate individual empowerment and better health outcomes for women with disability.

Barriers and facilitators to work participation for persons with lower limb amputations in Bangladesh following prosthetic rehabilitation

“…A woman may have sought her first paid employment after their spouse had an amputation, thereby assuming a disproportionate amount of paid and unpaid work without the equitable exchange of work roles where their husband undertook domestic or childcare duties. This finding is consistent with previous studies examining the impact of disability on relationships and work roles 29,30,34 and could be attributable to cultural norms where work roles are often defined by sex. Men may find the loss of their typical role difficult and be unable to adapt to work assumed to be the purview of women.…”

“…Many disguised their limb loss until after they were successfully recognised as competent in their new role by their managers or co-workers. These experiences are not uncommon in the experience of disability and work participation 30,38 and highlight opportunities for rehabilitation services to help address negative stereotypes associated with disability and create an informed understanding of the abilities of people with LLA within their communities. 30,38,41…”

“…Many of these experiences are consistent with the broader body of literature about the experience of disability in Bangladesh and highlight complex interactions between factors, such as perceptions of disability, gender roles, culture, access and the environment. 29,30 Most participants in this sample were relatively young males with amputation at transtibial or transfemoral level, due to road traffic or workplace accidents many years prior, with either primary or early secondary school education. While these participants were typical of those who have accessed prosthetic rehabilitation in Bangladesh, 6 it is likely that the sampling method favoured those who found participation convenient given their proximity to the rehabilitation centres where the interviews were conducted.…”

“…[34][35][36] These sorts of discussions are necessary to help reduce the risk of relationship breakdown, exacerbation of disability impact and related risk of poverty, given the discrimination, exclusion and isolation that disproportionately affects women with disability in Bangladesh. 29,30 Brokering these conversations can be difficult for many clinicians without training specific to this type of facilitation. As such, we encourage clinicians to work with those in the rehabilitation team with these skills.…”

Factors Influencing Participation in Daily Activities by Persons With Spinal Cord Injury: Lessons Learned From an International Scoping Review

“…injuries) and mortality have been reported with postdischarge poor survival rates of 50% after 5 years and 15% after 10 years. 8,9 Lack of supporting resources and accessible wheelchair-friendly environments in the community were also linked to poor long-term survival. 10 These conditions raise the question of how persons with SCI in Bangladesh can be enabled to manage their health and live a quality of life in the community.…”