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Improving contraceptive choices and bodily autonomy for women and girls with disabilities

Andrea Pregel and Amalie Quevedo, September 2023

On Tuesday 26 September, the international community celebrates World Contraception Day.

The event aims to improve the awareness of contraception and enable young people to make informed choices on their sexual and reproductive health.

There is compelling evidence that shows how improving global access to low-cost contraception and its uptake through family planning programmes can:

Reduce maternal and child mortality
Reduce high-risk pregnancies
Reduce teen and unplanned pregnancies
Improve child health and nutrition
Increase the level of protection against sexually transmitted infections

Current estimates indicate that 379 million women in low and middle income countries are using modern contraceptive methods, equivalent to one-third of all women of reproductive age. This is 95 million more women than a decade ago.

Access to contraception for women and girls with disabilities

Despite this clear progress, young women and adolescent girls with disabilities continue to experience barriers in accessing voluntary contraception and family planning services.

For example, evidence shows that women with disabilities experience lower coverage of modern contraceptives (44%) compared to women without disabilities (48%). The gap is even larger in South Asia: 48% versus 59%. Similarly, adults with disabilities in sub-Saharan Africa are less likely to have comprehensive knowledge about HIV prevention and transmission (23%) compared to people without disabilities (33%).

Widespread stigma and discrimination related to the intersection of gender and disability are also major barriers that prevent women and girls with disabilities from exercising their sexual and reproductive health and rights (SRHR). These are further compounded by limited access to accessible and inclusive information, limited knowledge of disability inclusion among health workers, infrastructural barriers within health facilities, direct and indirect costs of services and contraceptive products, and discriminatory policies.

It is important to understand that these are not isolated issues. As highlighted in the recent WHO global report on health equity for people with disabilities, these barriers are part of a wider systemic failure of health systems and societal factors, which result in people with disabilities – particularly women and girls – experiencing severe health inequities and worse health outcomes compared to the rest of the population.

Teenager Maniapi hugs her mother outside their home. They're both smiling. — Without intervention, girls with disabilities such as Mbalmayo (right) could be left behind when it comes to reproductive health. © Sightsavers/Rodrig Mbok

The crucial role of informed choice and bodily autonomy

Access to contraception is crucial – but is not sufficient.

This year’s World Contraception Day theme, ‘The Power of Options’, is particularly significant, as it shines a spotlight on the fundamental role that contraceptive choices play in empowering individuals to take control of their reproductive health, fostering autonomy and enabling informed choices.

Yet adolescent girls and young women with disabilities have been systematically denied the opportunity to exercise their bodily autonomy and make free and informed reproductive choices. Evidence shows that people with disabilities – particularly women and girls – are often subjected to forced contraception and sterilisation due to persistent stigma within communities and the idea that people with disabilities should not have children.

This is a severe violation of international law – specifically, Article 23 of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), which affirms the right of people with disabilities to make free and informed decisions about their sexual and reproductive health.

Advancing sexual and reproductive health and rights for people with disabilities

One of Sightsavers’ priority objectives in its social inclusion strategy is to ensure that people with disabilities are empowered and given the necessary tools to make informed decisions on an equal basis with others, particularly when it comes to their sexual reproductive health and rights.

That is why we are making strategic and targeted investments across multiple countries to advance SRHR for people with disabilities.

For example, in Nigeria, thanks to funding from UK aid and the Inclusive Futures programme, we are running a £2.3 million inclusive family planning project in partnership with BBC Media Action, national organisations of people with disabilities and government partners.

Through this initiative, we aim to advance universal health coverage by tackling the health inequities that people with disabilities face when exercising their SRHR.

The project is implementing a comprehensive, inclusive and accessible social and behaviour change strategy. It aims to reach approximately four million people through a radio drama, factual radio programming, a digital communications campaign and interpersonal communication activities at a community level. All these activities focus on reaching women and girls with disabilities, husbands, family members and religious leaders.

The project has also completed accessibility audits of 24 public and private SRHR facilities in Kaduna state, provided in-person disability inclusion and gender equity training for more than 1,000 service providers and is supporting organisations of people with disabilities to advocate for the National Policy on SRHR of Persons with Disabilities to be adopted and integrated in Kaduna state.

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A colourful illustration showing four African women, one of whom is in a wheelchair. A speech bubble above them says 'The decision is mine'. — Communications materials made in consultation with people taking part in our inclusive family planning project in Nigeria.

An illustration showing an African health centre. A woman in a wheelchair is looking at the steps up to the door.A woman wearing dark glasses and holding a white cane is walking in the wrong direction. A woman using sign language is being questioned by another woman. — The project aimed to reach about 4 million people to try to change their behaviour and encourage more open access to family planning.

Sightsavers is also the disability partner in the West and Central Africa consortium led by MSI Reproductive Choices as part of the Women’s Integrated Sexual Health (WISH) programme, UK aid’s flagship SRHR programme.

To contribute to the ‘leave no one behind’ agenda, the WISH programme has been reaching women with disabilities whose needs were previously largely unmet through family planning and sexual reproductive health service provision. Through this programme, we are providing expertise to fellow consortium members to enhance disability-inclusive practices with the goal to:

Strengthen the knowledge and choice that people with disabilities have in terms of sexual reproductive health service provision, as well as increase community support for people with disabilities to exercise their sexual reproductive health rights
Strengthen government policies, domestic financing and accountability by embedding disability inclusion to create a stronger enabling environment for family planning and sexual reproductive health and rights that is accessible and inclusive for everyone
Improve access to sexual reproductive health service provision for clients with all types of disabilities

We are also working with partners to bridge existing gaps. For example, Sightsavers developed a training package to train SRHR healthcare providers and other stakeholders such as the Ministry of Health on how to seek informed consent and safeguard people with disabilities from marginalised communities.

“Enhancing access to sexual and reproductive health and rights for women with disabilities has been at the core of the WISH programme, and all consortium partners have made huge progress to achieve this goal. MSI is proud to see how disability inclusion is now a key part of our programming.”
Caroline Guinard, FCDO programme director
MSI Reproductive Choices

The sexual and reproductive health and rights of people with disabilities – particularly women and girls with disabilities – have been ignored for too long. If we are serious about leaving no one behind, now is the time to act. It is vital that we:

Invest adequate resources
Generate quality evidence
Ensure people with disabilities are meaningfully included in the health sector and within their communities
Empower people with disabilities to make informed choices about their bodies and futures

All of this requires a collective effort, on World Contraception Day – and every other day.

Authors

Andrea Pregel is Sightsavers’ global technical lead for inclusive health, and Amalie Quevedo is Sightsavers’ technical advisor for inclusive sexual and reproductive health and rights.

Let’s work together! If you want to know more about Sightsavers’ inclusive SRHR work, or want to explore opportunities for collaboration, please contact Andrea Pregel at [email protected]

Learn more about our work on women’s rights

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A group of smiling women in Nigeria hold posters and leaflets about family planning.

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