Lived experiences of barriers to sexual and reproductive healthcare for people with sensory and physical disabilities in Bulawayo, Zimbabwe.

Clinician Perspectives on Ethics and COVID-19: Minding the Gap in Sexual and Reproductive Health.

Background Although the sexual and reproductive health and rights (SRHR) of young people and migrants should be prioritised, young migrants’ sexual and reproductive health (SRH) is rarely studied in Sweden. Objectives To explore young migrants’ understanding and experiences of sexual rights and examine their perceptions and experiences in accessing SRH services. Methods This is a mixed method study including a national survey that recruited 1773 newly arrived young migrants; a youth clinic survey that recruited 1089 youths after visiting youth clinics; and a qualitative study that included 13 interviews with newly arrived Arabic-speaking migrant men. The results are synthesised using a new ecological framework of access to understand the factors influencing young migrant access to health care based on the levels of the ecological model and the five steps of access: approachability, acceptability, adequacy, affordability, and quality. Results Young migrants understood SRH as both ‘essential’ and ‘a right.’ Their sexual rights were less fulfiled compared to other young people in Sweden, particularly for men, non-binary, LGBTQ+, those born in South Asia, without a residence permit, and those of low economic conditions. SRH services were largely unapproachable as almost half of those who needed them did not utilise them. Services were generally acceptable due to the ‘open environment,’ however, some young migrants faced cultural insensitivity, fear of exposure, low parental support, and long waiting times. SRH services’ quality was perceived as good, however, negative experiences were reported, particularly in the domains of respect, equity, privacy, non-prejudice, and consultation quality. Conclusion The access of young migrants to SRH services is facilitated by an ‘open environment’ and available and good quality services; however, they faced serious barriers such as limited access to information about the health system, comprehensive sexual education, lack of cultural sensitivity, and cultural racism.

The provision of comprehensive sexuality education (CSE) accords opportunities for scientifically accurate information about sexual and reproductive health (SRH). We used a mixed-methods study to characterise adolescent SRH knowledge, attitudes and service utilisation experiences in the context of CSE implementation in Zambia. In-school young people aged 12–24 years (N = 1,612) in the North-Western Province were randomly surveyed. A 29-item index was constructed to measure alignment of knowledge, attitudes and values (KAV) with the CSE curriculum. Logistic regression, stratifying by sexual debut status, modelled associations of past-year HIV counselling and testing and family planning service access, respectively, with CSE-KAV index scores. Focus group discussions further explored perceptions of and experiences accessing SRH services. Despite moderate SRH knowledge and acceptability of SRH services, fewer than half of sexually experienced young people reported accessing SRH services. Among sexually experienced youth, neither HIV testing nor family planning service utilisation in the previous year were associated with higher CSE-KAV index scores. Salient barriers to SRH service uptake included limited perceived benefits, unsupportive household and community environments, and negative interactions with health providers. To increase accessibility and uptake of youth SRH services, linking school-based CSE to SRH services is recommended.

Patient concerns about accessing sexual and reproductive health services outside of primary care: A survey in rural and urban settings in the Pacific Northwest

BackgroundVarious countries in the world have achieved promising progress in promoting, protecting and guaranteeing sexual and reproductive health rights (SRHRs) since the 1994 International Conference on Population and Development (ICPD) in Cairo. However, SRHRs have not been recognized to their maximum potential in Ethiopia, despite the domestication of the international instruments related to their successful implementation. This study was intended to determine the magnitude of SRHRs knowledge, reproductive health services utilization and their independent predictors among rural reproductive-age women in the Aleta Wondo District, Ethiopia.MethodsA community-based cross-sectional study was conducted among 833 rural reproductive-age women from April to May 2019. A systematic random sampling technique was employed to select households, and a structured questionnaire was used to gather the data. EPI INFO version 7 was used to enter the data, and SPSS version 23 was used for data analysis. Logistic regression analysis was employed to assess the association between outcomes and explanatory variables. Odds ratios at 95% CI were also computed and reported.ResultsOf 833 respondents, 43.9% had good knowledge of SRHR, and 37% had used at least one sexual and reproductive health (SRH) service. Variables that had a statistically significant association with SRHR knowledge in multivariable analysis were: had formal education, household with the highest income, having information sources for SRH services, and knowing about SRH services and providing institutions. SRH services utilization was associated with: having information sources for SRH services, had formal education, household with the highest income, and knowing about SRH services and providing institutions.ConclusionIn this study demographic and economic factors, such as education and household monthly income were positively identified as independent predictors for knowledge of SRHR and SRH services utilization. Therefore, responsible government sectors and NGOs should design and implement programs to promote women’s educational status and household economic status to enhance women’s SRHR knowledge and SRH services utilization.

BackgroundThe need to advance the sexual and reproductive health (SRH) and rights of women with a disability is becoming more widely recognized. Regrettably, in low- and middle-income settings like Ethiopia, several barriers impede women with a disability (WWDs) from receiving SRH services and care.ObjectivesThis study aims to explore barriers and enablers for women with a disability to access sexual and reproductive health services in Addis Ababa, Ethiopia.MethodsA qualitative phenomenological study was conducted among the purposively selected reproductive age (18–49) group of WWDs living in Addis Ababa who were members of the Ethiopian National Association of Persons with physical disabilities and the Ethiopian National Association for Blind. Ten in-depth interviews, and 2 focus group discussions, were conducted using an interview guide. The analysis involved the use of both a priori codes (from the theory) and emergent inductive codes (from the question guide).ResultsIn this study, several barriers were identified as keeping participants from accessing SRH services, such as unfavorable community views, organizational barriers in health facilities [HFs], financial limitations, transportation problems, and a lack of knowledge about the SRH programs that are available. The enabling factors that made WWDs access SRH services include social support and networking, access to education, positive providers' attitudes, and women's self-confidence/Assertiveness.ConclusionThe study reveals that financial problems brought on by inadequate health insurance coverage, economic hardship, the expense of transportation to the health facility, and the lack of preferential treatment at the health facility are some of the hurdles that WWDs face while accessing SRH services and care. To address these problems and promote SRH access, measures should be taken to decrease financial barriers, improve physical access, and build strong relationships with the community, the church, and healthcare providers.

BackgroundThe United Nations through universal health coverage, including sexual and reproductive health (SRH), pledges to include all people, leaving no one behind. However, people with disabilities continue to experience multiple barriers in accessing SRH services. Studies analysing the impacts of disability in conjunction with other social identities and health determinants reveal a complex pattern in SRH service use. Framed within a larger mixed methods study conducted in Uganda, we examined how disability, among other key social determinants of health (SDH), was associated with the use of SRH services.MethodsWe analysed data from repeated cross-sectional national surveys, the Uganda Demographic and Health Surveys (DHS) of 2006, 2011, and 2016. The three outcomes of interest were antenatal care visits, HIV testing, and modern contraception use. Our main exposure of interest was the type of disability, classified according to six functional dimensions: seeing, hearing, walking/climbing steps, remembering/concentrating, communicating, and self-care. We performed descriptive and multivariable logistic regression analyses, which controlled for covariates such as survey year, sex, age, place of residence, education, and wealth index. Interaction terms between disability and other factors such as sex, education, and wealth index were explored. Regression analyses were informed by an intersectionality framework to highlight social and health disparities within groups.ResultsFrom 2006 to 2016, 15.5-18.5% of study participants lived with some form of disability. Over the same period, the overall prevalence of at least four antenatal care visits increased from 48.3 to 61.0%, while overall HIV testing prevalence rose from 30.8 to 92.4% and the overall prevalence of modern contraception use increased from 18.6 to 34.2%. The DHS year, highest education level attained, and wealth index were the most consistent determinants of SRH service utilisation. People with different types of disabilities did not have the same SRH use patterns. Interactions between disability type and wealth index were associated with neither HIV testing nor the use of modern contraception. Women who were wealthy with hearing difficulty (Odds Ratio (OR) = 0.15, 95%CI 0.03 – 0.87) or with communication difficulty (OR = 0.17, 95%CI 0.03 – 0.82) had lower odds of having had optimal antenatal care visits compared to women without disabilities who were poorer.ConclusionThis study provided evidence that SRH service use prevalence increased over time in Uganda and highlights the importance of studying SRH and the different disability types when examining SDH. The SDH are pivotal to the attainment of universal health coverage, including SRH services, for all people irrespective of their social identities.

Evidence for the implementation of contraceptive services in humanitarian settings

Sexual and reproductive health (SRH) is essential for men’s health, but a large body of research has indicated that the underutilization of most SRH services by men is a persistent issue that needs to be addressed. Men’s reluctance to access sexual and reproductive health services is one of the factors that leads to high morbidity and mortality rates among men, although their diseases may have been prevented or cured. This study aimed to explore factors that influence the decision of men who resided in men’s hostels and who accessed urology clinics in KwaZulu-Natal to seek help for their sexual and reproductive health issues. An exploratory qualitative approach was adopted using focus group discussions. We interviewed seventy-two men of ages above 15 years. The data were analyzed thematically. The Biomedical Research Ethics Committee (BREC) of UKZN granted ethical clearance (BE 347/19). Of the 72 interviewed men, thirty-three men attended urology clinics in the selected hospitals, and thirty-nine men resided in the hostels around Durban in KZN. Seven themes (lack of awareness of SRH services; participants’ reluctance to access SRH services; influence of culture and religion; lack of financial resources; influence of relationship dynamics; perceived low risk of individual sexual behaviors; and healthcare factors that discourage men from accessing SRH services) emerged from the data that were identified as barriers to SRH service utilization by men, whilst three themes (healthcare enabling factors; access to general information on SRH services; and personal motivational factors) emerged as factors that encouraged the participants to access these services. The participants’ reluctance to access SRH services was attributed to the lack of awareness of available SRH services, the influence of culture and religion, lack of financial resources, relationship dynamics, the perceived low risk of sexual behaviors for individuals, and healthcare workers’ negative attitude towards men requiring SRH services. The availability of healthcare resources, the appointment of more male healthcare workers, and more positive attitudes among healthcare workers will encourage men to utilize SRH services. The exposure of various barriers to SRH service utilization by this investigation warrants urgent attention from the government to impart knowledge about this phenomenon to men.

Impacts of the COVID-19 pandemic on access to sexual and reproductive health services for women and transgender people with disabilities in Canada: a qualitative study

Youth in Albania are initiating sexual activity at an earlier age. However, use of all forms of contraception has declined in the last decade and uptake now stands at 4%. The self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms has risen dramatically, as has reliance on abortion as a predominant method of family planning. In 2020-2022, we conducted a multi-method qualitative study in Albania to document the availability and accessibility of sexual and reproductive health (SRH) services and examine challenges that youth face when seeking SRH care. This study comprised a document review, a curriculum review, a community-based survey with 273 youth, semi-structured interviews with 15 youth, semi-structured interviews with 15 key informants, and a service mapping exercise in Tirana. Lack of adequate infrastructure and bureaucratic hurdles make it difficult for youth to navigate and access SRH services in Albania. A third of survey participants (n = 90, 33%) expressed discomfort inquiring about SRH matters, while nearly two-thirds rarely or never sought SRH services from a doctor or clinic. Furthermore, Albania’s school-based sexuality education curriculum lacks in topics, content, and responsiveness, resulting in inconsistent learning experiences and limited knowledge of SRH. Sexuality education is primarily focused on the anatomy and physiology of reproduction, leading to significant knowledge gaps in other aspects of SRH. Only half of survey participants (n = 150, 55%) had received any education on birth control, contraception, or family planning; and only few had knowledge about gender identity (n = 103, 38%), or consent (n = 77; 28%). Widespread lack of awareness and fear of judgment contribute to the underutilization of SRH services among youth in Albania. Improving knowledge and awareness, alongside investing in infrastructure and capacities, are essential to enhancing accessibility and quality of SRH services for Albanian youth. Key messages • Lack of knowledge and awareness prevent youth from accessing SRH services. • Establishing youth-friendly services and training health providers and educators are crucial to delivering confidential and non-judgmental youth-friendly SRH care.

A Call for Comprehensive, Disability- and LGBTQ-Inclusive Sexual and Reproductive Health Education

Women with physical disabilities experience compounded marginalization due to ableism, gender inequality, and entrenched socio-cultural norms. These intersecting barriers severely limit their autonomy and access to sexual and reproductive health (SRH) services, particularly in low- and middle-income settings like Pakistan. Objective: To explore the lived experiences and challenges in accessing SRH services among married women with physical disabilities in Lahore, Pakistan. Methods: A qualitative phenomenological study was conducted from January to June 2024 in Lahore, Pakistan. Purposive sampling was used to recruit 15 married women aged 18–40 years with physical disabilities. In-depth semi-structured interviews were conducted in Urdu, audio-recorded, transcribed verbatim, and translated into English. Thematic analysis was performed using NVivo software, following Colaizzi’s seven-step method. The study was grounded in the theoretical frameworks of social constructivism and intersectionality to examine how structural and attitudinal factors shape SRH experiences. Results: Participants reported numerous barriers to accessing SRH services, including negative societal attitudes, discriminatory healthcare practices, inaccessible facilities, and inadequate SRH education. The internalization of stigma, invisibility in SRH discourse, and lack of provider sensitization further marginalized these women. Many participants expressed that health systems neither addressed their specific SRH needs nor considered their lived realities. Conclusion: The study underscores the urgent need to integrate disability-sensitive approaches into SRH policies in Pakistan. Addressing structural ableism, gender discrimination, and socio-cultural bias is critical to ensuring equitable access to SRH services for women with disabilities. A more inclusive health policy framework, provider training, and community awareness are essential to improve SRH outcomes for this underserved population.

Reproductive healthcare is essential for all people, including lesbian and bisexual women. However, lesbians and bisexual women are among society's most marginalised and excluded members. This study aimed to explore the challenges faced by lesbian and bisexual women in accessing Sexual and Reproductive Health (SRH) Services in Bulawayo, Zimbabwe. An exploratory, descriptive qualitative study was conducted on two populations that included eight participants identified through the Voice of the Voiceless organisation in Bulawayo and 10 key informants and probed the challenges faced by lesbians and bisexual women when accessing SRH services. Data were gathered through 10 key informant interviews and 1 focus group discussion (FGD; with 8 participants). The interviews and FGDs were recorded, transcribed verbatim, coded and thematically analysed. The themes that emerged included the uptake of SRH services among lesbians and bisexual women, the challenges faced by lesbians and bisexual women when accessing SRH services, and strategies to aid the uptake of SRH services by lesbians and bisexual women. The findings showed that the uptake of SRH services was generally low and was influenced by factors such as clinical settings. The challenges mentioned included stigma and the unavailability of specific lesbian and bisexual women's services. By contrast, the most frequent strategies included affirmative training for healthcare providers and improved clinical settings to become friendly and inclusive. There is an imperative for targeted SRH services that address the distinct needs of lesbians and bisexual women, in line with the 95-95-95 strategy and Sustainable Development Goals target 3.7. The observed low uptake of these services can be attributed to several systemic barriers, including inadequate training of health providers, negative attitudes and lack of inclusive policies. Enhancing the sensitivity of health facilities, strengthening links to sexual health education and implementing supportive legal frameworks are essential steps to improve SRH outcomes in this population. These findings elucidate critical gaps within the current healthcare system and present significant opportunities for policymakers to formulate evidence-based strategies to ensure equitable access to SRH services, thereby advancing public health objectives.

BackgroundDisabled people face barriers to accessing sexual and reproductive health (SRH) services. There is evidence that the general population had difficulty accessing SRH services during COVID-19 but it remains unclear whether disabled people were differentially affected. This study sought to investigate whether people in Britain who reported a disability were more likely to report inability to access SRH services and whether this was associated with functional limitation.MethodsWe analysed data from the National Survey of Sexual Attitudes and Lifestyles (Natsal)-COVID 2 study. This was a cross-sectional, web panel survey of 6,658 18–59-year-old British residents in March–April 2021. Quota-based sampling and weighting were used to achieve quasi-representative population estimates. We defined disability as a long-term physical or mental health condition which affected ones’ ability to carry out day-to-day activities. We calculated adjusted odds ratios (AOR) by reported disability status for wanting but being unable to access ≥ 1 SRH service, wanting but not trying to access SRH services, inability to access different SRH services, and unmet need for condoms. Reasons for, and outcomes after, inability to access services were also investigated.ResultsParticipants reporting a disability (unweighted n = 1,676), compared to not, were more likely to report wanting but being unable to access ≥ 1 SRH service (AOR 2.23 [1.77–2.82]), inability to access each SRH service type, and an unmet need for condoms. Increasing functional limitation levels were more strongly associated with reporting inability to access ≥ 1 SRH service. Reported disability was associated with higher odds of wanting but not trying to access SRH services (AOR 2.60 [1.50–4.52]) among men but not among women. Participants reporting a disability were more likely to report transport issues and accessing their desired service eventually but not in the way they wanted.ConclusionsOur study provides evidence that disabled people in Britain were more likely to have difficulty accessing SRH services during COVID-19. However, the extent to which these disparities were created or exacerbated by the pandemic, and whether inequalities persist, is not clear. Our results are relevant for contemporary service design, given that many changes introduced during the pandemic have endured.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24914-3.