The intersectional jeopardy of disability, gender and sexual and reproductive health: experiences and recommendations of women and men with disabilities in Northern Uganda

Abstract

The 2030 Sustainable Development Goals committed to "Leave No One Behind" regardless of social identity. While access to sexual and reproductive health (SRH) services has improved globally, people with disabilities continue to face enormous barriers to SRH, infringing on their SRH rights (SRHR). Uganda adopted pro-disability legislation to promote the rights of people with disabilities. Despite these legal instruments, SRHR of people with disabilities continue to be violated and denied. To address this, we sought to understand and document how people with disabilities perceive the relationships between their use of SRH services, legislation, and health policy in three districts of the post-conflict Northern region of Uganda. Through an intersectionality-informed analysis, we interviewed 32 women and men with different types of impairments (physical, sensory and mental) and conducted two focus groups with 12 hearing and non-hearing disabled people as well as non-participant observations at seven health facilities. We found that disabled people's access to SHR services is shaped by the intersections of gender, disability, and violence, and that individuals with disabilities experienced discrimination across both private-not-for-profit and public health facilities. They also encountered numerous physical, attitudinal, and communication accessibility barriers. Despite policy implementation challenges, people with disabilities expected to exercise their rights and made concrete multi-level recommendations to redress situations of inequity and disadvantages in SRH service utilisation. Intersectionality revealed blind spots in policy implementation and service utilisation gaps. Universal health coverage can be operationalised in actionable measures where its universality meets with social justice.

The unintended consequences of COVID-19 mitigation measures matter: practical guidance for investigating them

“…While it might take more time to involve patient partners, Ridgway argues that it leads to better research and that there is a cost to pay when researchers neglect contacts with patients. Third, intersectionality-informed analyses can be useful to highlight the complex relationships and interactions between COVID-19, social identities, social inequities, power dynamics, and social context [113,114].…”

“Imagining the world anew”: a transformative, rights-based agenda for UHC and SRHR in 2021 and beyond

“…For instance, Mac-Seing et al document the continuing challenges that people with disabilities in Northern Uganda face in accessing SRH services, including stigma and discrimination, despite Uganda’s adoption of pro-disability legislation. 18 As noted earlier, in Mexico, where indigenous women account for a disproportionate number of annual maternal deaths, Juárez-Ramírez et al highlight both how the standard model of obstetric care continues to fail indigenous women, and the significant gulf between how healthcare personnel and indigenous women themselves explain the barriers to respectful, quality maternal health care. 13 Both pieces serve as reminders that if the voices and perspectives of populations that continue to face disproportionate marginalisation are excluded, SRH services – even when integrated in UHC systems – are unlikely to have the transformative health impacts to which we aspire.…”

Disability and sexual and reproductive health service utilisation in Uganda: An intersectional analysis of Demographic and Health Surveys between 2006 and 2016

“…Given the importance of the experience of violence expressed by people with disabilities in our qualitative study [24], this study included participants who answered the Domestic Violence Module within each DHS which focused on adult women and men, aged 18 to 49 years old. In the 2006 DHS, one female participant in every three households responded to the Module questions, while one male respondent was selected among the remaining two households [26].…”

“…That study used an intersectionality-informed analysis to explore the co-existence of multiple social identities and social and health inequities experienced by vulnerable populations [25]. Major themes from the study included the complex intersections of disability with gender, HIV, and experience of violence [24]. The main objective of this present study was to investigate how disability was associated with selected SRH service utilisation in Uganda between 2006 and 2016.…”

“…Framed within this background of con ict and access to health services, we were interested to examine how disability, among other social determinants of health, in uences the use of SRH services. A parallel qualitative study found that adult women and men with disabilities living in Northern Uganda faced multiple challenges when using SRH services such as maternal care, contraception use, and HIV testing [24]. That study used an intersectionality-informed analysis to explore the co-existence of multiple social identities and social and health inequities experienced by vulnerable populations [25].…”