Access to reproductive health services: the case of women with physical disabilities in Nairobi

Abstract

This study was on 'Access to Reproductive Health Services for Women with Physical Disabilities in Nairobi'. Its objectives were; to explore factors that prevent disabled women from visiting reproductive health service providers; to establish the difficulties disabled women face when they visit reproductive health service providers; to explore the challenges reproductive health care providers face when serving disabled women; and to find out measures that can be put in place to increase access to reproductive health care for disabled women. The study found that among the difficulties that women with disabilities face when they visit reproductive health service providers are mainly accessing the various physical facilities as they are disability unfriendly. Some have steps/stairs and no ramps for those on wheel chairs and who use crutches, Getting on to high exam beds with not steps or assistance was also a problem that the women experienced at the service provider. Accessing public transport, which is the most convenient means of travel to the health facility, was also a challenge. This is because of the way the buses and matatus are built does not allow for easy boarding. The doors and the aisles are narrow and wheel chairs cannot fit. The steps are also steep such that even those using crutches and wearing caliphers have difficulties. In addition most public service providers/personnel are always in a hurry and are in competition with others and therefore, do not have the patience to wait or assist women with disabilities board the vehicles. The challenges experienced just trying to get to a health provider discourages the women from g~g when they are unwell. The study observed that most of these women had not progressed beyond primary school level and were thus engaged in small petty businesses. As such, they were struggling to make a living and the financial resources available were strained and this affected their ability to afford health care. The study noted that a significant proportion of those who did not seek the information on reproductive health did not think they needed to. This was either because they had stopped having children, did not have any or were not sexually active, indicating a lack awareness as to the scope of reproductive health issues and limiting them to child-bearing and contraceptives, yet there are other concerns like breast and cervical cancer and management of infertility. The survey also revealed that medical personnel have a bad attitude towards women with disabilities. Some were said to use abusive language, ignore them, harass them when they cannot move at the same speed or do things as other able bodied women. The women interviewed also said that they received negative reactions when they sought information on sexuality and family planning as the personnel wondered why they would want to engage in sex in their condition. Thus, personal and shared unfavourable experiences at the hands of service providers and with the facility may be factors that prevent disabled women from visiting reproductive health providers. On the service provider side, the challenges they face when serving women with physical disabilities included positioning them for procedures and lack of appropriate equipment in the facility suited to those with disabilities. Lack of awareness and information on reproductive health among women with disabilities was also found to be a challenge by the service providers. They also admitted as to there being no training that prepares them on how to deal with patients with disabilities. In light of the findings, the study recommends that since awareness seminars for those with disabilities are an important source of reproductive health information these should be enhanced to include topics covering more than STDs, contraceptives and HIV/AIDS. There is also need for creating awareness among the medical personnel, to change their attitude towards sexuality and disability as was indicated by the reactions the women-w.ith disabilities received on seeking information on sexuality and family planning. Given the challenges women with disabilities face in accessing buildings and public transport the government should establish a responsible authority to oversee the accessibility of the build-up environment by leveling of pavements, building of ramps, installing lifts and ensuring access to other public places and utilities and the building of accessible public vehicles. Formulation and implementation of the relevant policies as per the Persons with Disabilities Act, 2004 to enhance the built environment to make it disability friendly will ease access not only to health providers but also to other facilities and amenities.