How to make sexual health services inclusive and accessible

Sexual and reproductive health is a fundamental human right that everyone is entitled to. But for millions of people with disabilities, these rights are routinely ignored or denied.

Worldwide, one in five women has a disability, and too many are still denied control and choice over their bodies, their sexuality and having a family. This must change.

Supporting cross-movement dialogues is vital to ensure disability-inclusive sexual and reproductive health and rights programmes and services. We’re calling on donors, governments and other non-governmental organisations (NGOs) to work with us to tackle the barriers urgently, so that people with disabilities can claim the fundamental rights they are entitled to.

At the International Conference on Family Planning (ICFP) in Colombia, along with our partners from the disability movement, Sightsavers will highlight the need to prioritise the rights of people with disabilities in sexual and reproductive health programmes and funding, and ensure their meaningful participation in related discussions and forums.

Reproductive injustice

People with disabilities experience relentless reproductive injustices. The barriers they face range from attitudinal to environmental and – crucially for our conversations at ICFP – institutional.

Attitudinal barriers include misconceptions around people with disabilities having sexual relationships, false and discriminatory beliefs that people with disabilities shouldn’t have children, and negative attitudes from health workers. People with disabilities also often face coercion and pressure to take up services. Women and girls with disabilities face a significantly higher risk of forced sterilisation, coerced abortion and manipulation to use contraceptives, including long-acting methods like implants.

Environmental barriers include a lack of ramps, wheelchairs and disability-friendly sanitation facilities, as well as long journeys that people with disabilities often have to take to health centres and family planning facilities. A lack of sign language interpreters or accessible materials can mean some people with hearing or vision impairments are denied information about their sexual and reproductive health and rights (SRHR).

Institutional barriers include the lack of focus on people with disabilities in SRHR and family planning policies. They are often only briefly mentioned among other marginalised groups, and disability rights policies rarely address the full scope of SRHR (usually only mentioning family planning). The absence of disability-disaggregated data makes it harder for governments, health providers and others to assess access to and uptake of SRHR services for people with disabilities.

Recommendations for inclusive sexual and reproductive health and rights

Instead of seeing disability inclusion as an ‘add-on’, we must prioritise the rights of people with disabilities to ensure they have control over their own bodies, fertility and sexuality.

Recommendations for governments, donors and NGOs:

• Incorporate and mainstream disability inclusion in planning, processes and budgeting. Commit to making more than 15 per cent of SRHR programmes and funds disability inclusive.
• Listen to and involve people with disabilities in all decisions about their sexual and reproductive health rights, so they can shape the changes needed to claim their rights and prioritise their sexual wellbeing.
• Recognise the unique challenges people with disabilities face in claiming their sexual and reproductive health and rights, including the history of eugenics and risk of coercion. Focus programme targets on access to SRHR services and information, bodily autonomy and informed choice, not on contraceptive use. Focusing on quantitative targets around contraceptive use can lead to coercion of women due to pressure to meet these targets.
• Train and support health workers – including through institutional curricula – to improve disability awareness and ensure people with disabilities receive SRHR information and services without discrimination or stigma.
• Collect and analyse disability-disaggregated data on SRHR information and services to inform better policies and services for people with disabilities.

The reproductive justice movement has achieved incredible progress. However, a tendency towards working in silos to meet government or donor priorities, in combination with limited resources for intersectional movement building, means people with disabilities are too often left behind.

If we are serious about meeting global targets on universal health coverage and the Sustainable Development Goals, every SRHR programme and service must be inclusive and accessible.

This blog was originally published on the ICFP website.