Access to and utilization of sexual and reproductive health services: gendered experiences of persons with physical disabilities in urban Kampala
Ahumuza, Eva Sharon
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In Uganda, like in many developing countries, issues of Sexual and Reproductive Health Rights (SRHR) among Persons with Disabilities (PWDs) particularly those with physical disabilities have largely remained hidden. This study focused on the gendered sexual and reproductive health experiences of Persons with Physical Disabilities (PWPDs) in Urban Kampala. The study sought to examine the level of awareness of PWPDs’ SRHR, the influence of body image on PWPDs’ sexual experiences and their access and utilization of SRHR as well as assess the mechanisms available for protection and promotion of PWPDs’ SRHR in Urban Kampala. The study draws from qualitative and quantitative data collected through semi-structured interviews with 40 PWPDs (20 male and 20 female) and 10 Key informant interviews with health workers, counselors and leaders of PWPDs and employees of agencies involved in disability related interventions at national level and within Kampala. Study findings revealed high levels of awareness about SRHR among male and female PWPDs in particular their rights to: reproduce, access to justice in case of sexual abuse and to choose intimate sexual partners. In addition, majority of the respondents (93% of the male and 95% of the female respondents) knew that they had a right to access reproductive health care and information services especially services related to STI diagnosis and treatment, HIV/AIDS counseling and testing services, antenatal care services and family planning services. In all the services, females had more knowledge than the males. There was however limited knowledge about abortion services because the practice is illegal. The major source of information on SRH for PWPDs in urban Kampala for majority of females (96%) than males (80%) was the health facilities. Other sources of information on SRH mentioned included; meetings/associations (41% female and 41% male), workshops (40% male and 35% female), radio (40% male) and schools (15% male and 5% female). Overall, just half male and more than half female respondents mentioned that antenatal care, family planning, STI diagnosis and treatment and HIV/AIDS counseling and testing services were within easy reach. Fifty percent (50%) male and 35% female of the study respondents reported that the facilities were inaccessible. While more female than male respondents have ever attended health facilities for different services including antenatal care, STI and HIV counseling and testing services, a number of challenges were highlighted including negative attitude of health workers, long queues at health facilities, distant health facilities and high cost of services. On reproductive rights, study findings show that majority female PWPDs had control over their reproductive lives with regard to the timing, number of children and type of contraception. On the influence of body image, slightly more male than female respondents were negatively affected by their physical appearance with regard to initiation of sexual activity, choice of intimate partner and access to and utilization of health services. Throughout the study PWPDs expressed their struggles to deal with societal attitudes and expectations particularly the belief that PWPDs should be asexual. Consequently discrimination especially for the males at the health centers was reported to be a major concern. Largely, awareness of laws that promote and protect the SRH for PWPDs was generally low among male and female respondents although majority of the respondents were aware of at least one structure involved in the promotion and protection of SRH for PWPDs. Structures mentioned included police, probation and welfare office, Kampala office for PWDs, courts of laws, community leaders. Although there are these structures in place, majority of respondents testified that PWPDs do not access justice in cases of sexual abuse. This was attributed to negative attitude of service providers. Communities and service providers’ negative attitudes emerged as a key constraint to PWPDs’ realization of their sexual and reproductive health rights. Thus both community members and service providers including health workers, police officers and legal staff should be sensitized on the rights and needs of PWPDs so as the adequately support the PWPDs. Sensitization efforts should also target PWPDs themselves to build their self-esteem and confidence and instill in them positive attitudes towards themselves. Government and non-government organizations should increase their levels of assistance to PWPDs and their caregivers to address the practical barriers in access of reproductive health services.