Even after more than three decades of global efforts to promote inclusive sexual and reproductive health policies, many women with disabilities in Africa still face serious challenges. Their rights are often overlooked, and they have limited access to contraception and other essential services.

Lack of access to sexual health knowledge or contraception doesn’t happen in a vacuum. It is driven by factors like poverty, gender inequality, limited education, and cultural or legal norms.

The lack of access can lead to a chain of avoidable sexual and reproductive health issues. Examples are unintended pregnancies, unsafe abortions and increased risk of HIV. Yet these problems are rarely talked about in public debates in Africa.

At the core of this crisis is a deep gap in access to sexual health information and services that meet the needs of women with disabilities. Data is limited, but evidence suggests that women with disabilities across Africa face significant barriers to accessing contraception.

We are global health researchers with an interest in the sexual health of women with disabilities. We analysed data from 10 African countries, and mapped out the regions where women are most vulnerable. We showed how education, income, community literacy and media exposure affect their access to reproductive health services.

Our research shows that access to sexual health knowledge and modern contraceptives is still out of reach for many women with disabilities in Africa.

These women are denied the autonomy to make informed reproductive choices. This worsens health inequalities and reinforces cycles of marginalisation and vulnerability.

The study

We analysed the most recent Demographic and Health Survey data from 10 African countries. They are Chad, the Democratic Republic of Congo, Kenya, Malawi, Mali, Mauritania, Nigeria, Rwanda, South Africa and Uganda. In total, 16,157 women with disabilities aged 15 to 49 were included.

These countries were selected because they had the most up-to-date data on sexual health knowledge and modern contraceptive use for women with disabilities at the time of our research.

The Demographic and Health Survey uses a two-stage sampling method. First, primary areas are selected, and then individual participants are chosen from specific communities within those areas. For this study, we included women who reported having at least one functional difficulty with seeing, hearing, speaking, or walking.

We looked at whether women were using modern contraceptives (yes or no), and we assessed their level of sexual health knowledge. This was grouped into three categories: poor, moderate, and good. Our aim was to understand how access to sexual health information and contraceptive use intersect and vary across regions. We used advanced statistical methods, including Bayesian inference and spatial modelling.

What we found

Our study shows that many women with disabilities across Africa have limited knowledge about sexual health and low use of modern contraceptives.

In Nigeria, for example, only 3% demonstrated basic sexual health knowledge. Even in Uganda, which had the highest proportion, just 27% had this foundational understanding. Modern contraceptive use was similarly low; only 1% of women with disabilities in the Democratic Republic of Congo reported using them. Uganda again recorded the highest use at just 27%.

From a regional perspective, there were clear differences both within and between countries. Mauritania, Nigeria, Uganda, Chad and the Democratic Republic of Congo had the lowest combined levels of sexual health knowledge and modern contraceptive use among women with disabilities.

In contrast, Kenya, Malawi, Mali, South Africa and Rwanda performed better in linking sexual health knowledge with the use of modern contraceptives among women with disabilities. This shows that when women know more, they’re more likely to want contraceptives. They’re also able to use them.

Several factors influence whether women with disabilities have access to information or use contraceptives. These include their level of education, marital status, where they live and how educated their community is. Others are the general wealth of the area they live, and their age.

Our findings point to a serious gap in sexual and reproductive health for women with disabilities across the region. We also pinpoint the countries and areas where the gaps are widest.

There’s an urgent need for targeted efforts to improve their sexual health education and access to modern contraception.

Importance of sexual health knowledge and modern contraceptive use

Sexual health knowledge is key to how women make decisions about using modern contraceptives.

When women understand their reproductive health needs and know how to access services, they are more likely to use contraceptives.

However, women with disabilities face major challenges in getting this information. In most parts of Africa, formats like braille, sign language and audio resources are either extremely rare or unavailable. Social, cultural and economic barriers also tend to exclude women with disabilities from getting these services. This widens inequalities and puts them at greater risk.

Despite these realities, little is known about how sexual health knowledge and contraceptive use intersect for women with disabilities in Africa.

Way forward

Interventions should focus on geographic hotspots based on our study. They should also focus on women with disabilities who are:

• uneducated or with no formal schooling

• unmarried

• living in rural communities

• from low-literacy and low-income areas

• younger in age.

Increasing access to sexual health information is crucial, but not enough. Policymakers must also address the structural, economic and socio-cultural barriers that prevent access to sexual health knowledge.

Key policy and programme recommendations include:

• community-based outreach programmes tailored for women with disabilities

• subsidised or free contraceptive options

• inclusive sexual health education using formats like braille, sign language and audio materials

• disability-friendly services within primary healthcare systems

• policy frameworks that ensure everyone can get healthcare

• engaging community and religious leaders to challenge stigma and promote inclusion.

Obasanjo Bolarinwa, Senior lecturer, York St John University; Aliu Mohammed, Lecturer in Nursing and Public Health, University of Energy and Natural Resources, and Clifford Obby Odimegwu, Professor, University of the Witwatersrand

This article is republished from The Conversation under a Creative Commons license. Read the original article.