Sexual and Reproductive Health and Rights for Women with Disabilities

Today is World Contraception Day. As we reflect on the role that birth control and reproductive rights have played on modern day society, we must not forget those who continue to be denied access to sexual- and reproductive health (SRH) services, such as women with disability. Disabled women are often denied contraceptives or sexual health services because they are perceived to not have sexual needs or sexual lives.

More than 15% of the world’s population is affected by disability, including physical, sensory impairments, developmental and intellectual disability and psychosocial disability. This means a significant portion of our population continues to experience discrimination on what is regarded as basic human rights.

In 2007, the United Nations Convention of the Rights of Persons with Disabilities stipulated international law that all governments should guarantee access to sexual and reproductive health to people with disabilities. However, in practice, women with disabilities face challenges in accessing SRH services for a number of reasons:

  • They are infantilised
  • They are viewed as asexual or hypersexual (lacking control of sexual urges)
  • They are viewed as incapable of reproduction or too weak to carry a pregnancy
  • They are viewed as being unattractive or unfit for marriage or being sexual partners

These myths are far from the truth and are demeaning to people with disability. Yet, these prejudices continue to be the major deterrent in disabled women receiving SRH services. In part, these misconceptions make disabled women (and men) vulnerable to sexual violence and abuse within our societies.

There is silence in addressing the lack of access to sexual health services for disabled women. In contribution, the practice of forced sterilisation and abortions perpetuates the silencing and is in direct violation of disability rights. Our SRHR (sexual and reproductive health and rights) policies do not support or uplift disabled women and this is worrisome. Not enough research is done to understand and recognise the sexual desires and needs of disabled women.  Furthermore, we do not explore the intersectionality of gender and sexual dynamics that disabled people experience i.e. LGBTQ experiences.

Most non-disabled people, health workers in particular, have sometimes been described as being disinterested, lacking awareness and understanding of women with disability and their needs. There is failure in promoting inclusiveness. Many developing countries such as Zimbabwe still have general obstacles to overcome regarding SRHR. Unfortunately, in addition to those challenges we do not have policies that address the sexual and reproductive rights of disabled women.

How do we improve the challenges that are faced by disabled women? Well, we can start by:

  • De-stigmatisation and providing information for better understanding
  • Creating awareness for SRHR that benefit people with disability
  • Improving access to health systems, facilities and services
  • Improving home-based care and community outreach for client education
  • Including disability in SRHR policies, laws and budgets
  • Including women with disabilities in policymaking, strategizing and health research

In conclusion, there is still much to be done to improve the sexual and reproductive health and rights of persons with disability. It is important to have the conversation about disability and sexuality to remove prejudice and misinformation.

Contraceptive Funding in Crisis

On this World Contraception Day, some 214 million women and girls in developing regions have an unmet need for modern contraception. These are women and girls who want to avoid a pregnancy but are not using a modern method of contraception. While the reasons for this are multiple, the costs and availability of contraception remain major barriers. 

Access to contraception is a basic human right. Governments affirmed women’s right to have access to safe, effective and affordable methods of contraception of their choice 24 years ago, at the International Conference on Population and Development in Cairo. In 2015, in the landmark Sustainable Development Goals, governments pledged to ensure universal access to family planning by 2030.

Yet, three years on, global funding for contraceptives is in crisis. There is a major gap between needs for funding for contraceptives and the resources provided by both domestic and donor governments. In low- and middle-income countries out-of-pocket payments by individuals account for more than 80% of all spending on contraceptives. Domestic governments only provide around 8% of spending, while donors fund 10%.   

Out-of-pocket spending is an inequitable form of financing health services. Those least able to afford it carry most of the cost burden. The impact on household finances exacerbates inequalities and pushes people further into poverty. The gender implication is huge. Women and girls rely heavily on access to contraceptives and reproductive healthcare, and yet many do not have the financial means.

Demand for contraceptives is expected to increase, which will further widen existing funding gaps. Estimates of the difference between today’s spending on contraceptives and the cost of meeting projected needs in low- and middle-income countries in 2020 show an additional funding gap of US$290m if current trends in use continue. Unless domestic or donor government finance increases substantially, most of this gap will have to be met by relying on user fees.

Domestic governments have the main responsibility for ensuring access to contraception, yet donors continue to play an important role, particularly in the world’s poorest countries. In the 31 lowest income countries, donors currently finance 65% of all contraceptives, while domestic governments fund 7%. Individuals’ out-of-pocket spending accounts for 28%.

Yet, while donor funding remains essential, it has faced a downward trend in recent years. Funding from the United States, the largest family planning donor, has been fairly stable but is now at risk. Funding pledges made by European and other donors in 2017 in support of the She Decides initiative and at the July London Family Planning Summit are promising, but it is too soon to tell whether they will bring a reversal in longer term funding trends

Domestic governments must live up to their responsibility to increase their funding and ensure access to contraception and healthcare. Yet, donors must also continue and step up their support. Millions of women and girls depend on it.

Raffaela Dattler, Financing for Development Advisor, IPPF

Learn more about contraceptives and how they work here.

Happy World Contraception Day!

Do you know about World Contraception Day? It was launched in 2007 with the mission of improving contraception awareness and empowering youth with the ability to arrive at informed decisions about their reproductive and sexual health.

World Contraception Day (WCD) celebrates this concept every September 26th with the vision that no woman should have an unwanted pregnancy, making way for less risky abortions, fewer newborn and maternal deaths and greater prosperity and equality for all women everywhere. So, what are we celebrating exactly?

What Exactly Is World Contraception Day?

More than 70 countries typically participate in World Contraception Day. The World Health Organization describes the importance of WCD in a way that encompasses the promotion of family planning and female autonomy, supporting free choice of women worldwide, which in turn strengthens world health goals.

Ensuring that women can access their preferred contraceptive methods and make empowered decisions about their sexual health secures their autonomy and well-being. In turn, this movement strengthens the development and health of communities.

Women have used various contraceptive methods for centuries with varying to limited success, but modern medicine now allows women to choose if, when and how many kids they want to have — which can break the cycle of impoverishment and build a more sustainable path for the future of families and communities around the world.

The world population continues to grow, and limited access to contraception by law and other restrictions threaten women and the livelihood of and quality of life for families across the world.

Even in a wealthy country like the United States, women choose to have fewer kids for valid reasons: 64 percent cite rising childcare expenses, 54 percent want more time with their kids, 49 percent worry about the economy and 44 percent can’t afford kids. Other reasons include anxiety about domestic politics, work-life balance, career ambitions, rising population levels and parental aptitude.

Why I’m Celebrating World Contraception Day

Having access to a variety of family planning methods enables couples and families to do what’s best for themselves. As families plan if, when and how many children they will have, economic, social and health benefits increase for all.

I don’t personally want to have children, and while I don’t know if that will change, I certainly want to live in a world where I never have to face the scary possibility of giving birth to a human child who I am not prepared to take care of properly.

And in an American political climate where someone like Brett Kavanaugh is even being considered a viable candidate for judgeship, I believe that we need to be talking about contraceptives and safe, consensual sexual practices more than ever before.

It’s important for other countries as well. According to the USAID, more than 225 million women want to avoid or delay pregnancy in developing countries, but they don’t currently use family planning. WCD stresses the importance of increasing access to contraceptive services and information for everyone.

Every individual has a right to quality and affordable family planning information and contraceptives. Many organizations sponsor the delivery of condoms and contraceptives to developing countries. Knowledge about family planning gets shared not only at health clinics, but at salons, too! Wherever women go, we should be making sure that information is readily available to them.

Visit World Contraception Day online at your-life.com, which provides answers to common questions people have about contraceptives, reproduction and women’s health. Visitors can also research information about pregnancy and the “growing pains” of puberty.

You can celebrate World Contraception Day by sharing information on it, practicing safe and consensual sexual habits and honoring your sexual health by giving your body the TLC it deserves!

What is the ‘Right’ Age to Talk to Girls About Safe Sex?

World Contraception Day was at the end of September, which many people were simply unaware of. This is particularly the case in communities like the Luzira slum area of Kampala, where there are high rates of early pregnancy, maternal mortality, unsafe abortions, and HIV/STI infection stemming from unprotected sex and lack of education and services related to sexual and reproductive health and rights (SRHR), especially for adolescent girls. But in a highly religious and conservative country like Uganda, when is the right time to start talking to girls about how to protect themselves, while acknowledging that abstinence is the most effective option?

To give a bigger picture, WHO defines adolescents as ‘young people between the ages of 10 – 19 years’, which is synonymous with ‘teenager’, a person aged from 13 – 19 years. According to a 2011 Uganda Demographic and Health Survey (UDHS), 24% of all teenagers in Uganda are either pregnant or have already given birth, and more than one in three never – married women aged 15–24 have had sex. This has implications not only for a young mother and her children, but on a national scale where larger socio-economic structures are impacted. Hence, the importance of addressing teenage girls. But it raises the question, when is the right time?

Girl Up Initiative Uganda (GUIU) has programs for girls in primary school to supplement their basic education.  Life skills are at the crux of the curriculum, with adolescent health and SRHR being a key component. One of GUIU’s goals is to dispel any myths and clear up previous misinformation, seeing the knowledge it imparts as a form of empowerment.

Photo Credit: GUIU
Photo Credit: GUIU

On September 23rd, GUIU held a girls health education training for 80 girls at Murchison Bay Primary School, and then a larger mass education session for 500 girls that focused on girls health education, headed by a local medical nurse Ms. Namuyimbwa Hajara. The topics covered included the dangers of early sex and pregnancy, such as exposure to HPV and cervical cancer.  Monica Nyiraguhabwa, GUIU’s Executive Director who strives towards empowering girls in Uganda, stressed that when dealing with girls ages 8-16 (the average age of the girls in the program being 12) great care has to be taken to avoid upsetting parents; and that therefore, taking an ‘abstinence only’ approach is perhaps the best age-appropriate option. With girls in secondary school, however, it is more acceptable to discuss the use of contraception in detail.

That said, with girls on the higher end of the age spectrum, SRHR education becomes a bit more complicated. While it is difficult to pin-point what age a girl will engage in or be exposed to sexual activity, an education program that provides contraception information has to take center stage. To this end, World Contraception Day was set up to spread the word about safe sex and the use of contraception among adolescents and young adults, to ensure they have all the necessary information to protect themselves.

Perhaps as girls are approaching the upper echelons of adolescence, around 15 years old, this is a crucial time to start the conversation, at least in an educational setting. In addition to the need for proactive parents, in conservative countries where cultural and spiritual leaders, religious figureheads, and traditional elders are heavily influential, they must realize the importance of addressing sexual activity with adolescents, especially girls. The position that some leaders take in scarcely talking about sex, or reacting negatively to the distribution of contraceptives by various groups, perpetuates ignorance and promotes harmful patterns among youth who are hungry for honest and useful SRHR information.  This eagerness was demonstrated at a GUIU adolescent health day held for an entire school at the request of the headmaster and staff for over 500 girls between ages 10 – 16. The mass campaign garnered much engagement and participation from the girls, who had a lot of questions and were eager to participate in the conversation.

Locally run organizations like GUIU are taking the important step in starting this conversation so that girls can freely ask questions and receive the correct information about their changing bodies. When they enter secondary school as GUIU alumni, the organization will ensure that they are provided with resources around safe sex and contraception. If an adolescent girl finds herself in situation where she may engage in sexual activity, is it not better that she knows in advance how she can protect herself, and have access to the means to do so? When girls continue to drop out of school because of early pregnancy, it should become obvious that this issue must be tackled head on!