Disparities in Accessing Sexual and Reproductive Health Services at the Intersection of Disability and Female Adolescence in Tanzania.

Virpi Mesiäislehto,Richard Sambaiga,Hisayo Katsui

doi:10.3390/ijerph18041657

Abstract

Despite at times having greater needs for sexual and reproductive health (SRH) services, adolescents with disabilities often face challenges when trying to access them. This inaccessibility is further exacerbated during female adolescence. The qualitative study examines how SRH services respond to the characteristics of Tanzanian adolescent females with disabilities. We used the method of empathy-based stories to investigate the perceptions of 136 adolescent females with disabilities of their access to SRH services in Tanzania. The study used thematic content analysis and the Levesque model of health care access was applied as an analytical framework. The results demonstrate that discrimination affects access at different phases of care-seeking, that affectionate behaviour of providers is a central enabler of access, and that for this population access relies on a collective effort. We propose that affection, as an enabler of access, is as an additional provider dimension of access to SRH services for adolescents with disabilities, serving as a “reasonable accommodation” to the health care systems in southern contexts and beyond.

Highlights

Adolescents with disabilities are as likely to be sexually active as their peers without disabilities and have equal rights to sexual and reproductive health (SRH) services [1].Adolescence is a decisive time in a person’s life during which significant physical, mental, and emotional changes take place [2]
Adolescents with disabilities have unique, and at times greater needs for SRH services but they often face challenges accessing them, especially in many African contexts [3,4,5,6]. These greater SRH needs often result from a lack of information on sexual and reproductive health and rights (SRHR) [4]; sexual abuse and rape, which increases the likelihood of pregnancy [5]; being infected with HIV or sexually transmitted infections (STIs) [7]; and an over-arching stigma [8]
This study is among the first to examine the inequalities faced by adolescent females with disabilities when attempting to access SRH services in Tanzania

Summary

Introduction

Adolescents with disabilities are as likely to be sexually active as their peers without disabilities and have equal rights to sexual and reproductive health (SRH) services [1].Adolescence (ages 10–19) is a decisive time in a person’s life during which significant physical, mental, and emotional changes take place [2]. Adolescents with disabilities have unique, and at times greater needs for SRH services but they often face challenges accessing them, especially in many African contexts [3,4,5,6] These greater SRH needs often result from a lack of information on sexual and reproductive health and rights (SRHR) [4]; sexual abuse and rape, which increases the likelihood of pregnancy [5]; being infected with HIV or sexually transmitted infections (STIs) [7]; and an over-arching stigma [8]. Access to SRH services is hindered by physical inaccessibility [9], communication barriers [10], negative attitudes of service providers [4], lack of confidentiality [4,11], costs [4], mistreatment [11], and an overall inadequacy of service delivery [3,4]

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Methods

Results

Discussion

Conclusion