Abstract
BackgroundThere is evidence that women with disabilities (WWDs) experience the most difficulty accessing and using sexual and reproductive health and rights (SRHRs) services and information worldwide. However, there are currently no workable interventions to reach WWDs with essential SRHR services. This study aims to test the effect of an integrated health facility and individual-level intervention on access to SRHRs information and services among sexually active WWDs aged 15–49 years in Ghana.MethodsA quasi-experimental study design with four arms will be implemented in four districts in the Northern region of Ghana to test the effect of three inter-related interventions. The inventions are (1) capacity building in disability-centred SRHRs information and service delivery for healthcare providers, (2) support for WWDs to access disability-unfriendly healthcare infrastructure, and (3) one-on-one regular SRHRs education, information provision, and referral. The first two interventions are at the health-facility level while the third one is at the individual/family level. The first arm of the experiment will expose eligible WWDs to all three interventions. In the second arm, WWDs will be exposed to only the two-health facility-level interventions. The third arm will expose WWDs to only the individual level intervention. The forth arm will constitute the control group. A total of 680 (170 in each arm) sexually active women with physical disability and visual impairments will take part in the study over a period of 12 months. To assess the effect of the interventions on key study outcomes (i.e. awareness about, and use of modern contraceptive, ANC attendance, and skilled delivery among parous women), pre- and post-intervention surveys will be conducted. Difference-in-Difference analysis will be used to examine the effect of each intervention in comparison to the control group, while controlling for confounders. Cost-effectiveness analyses will also be conducted on the three-intervention arms vis a vis changes in key outcome measures to identify which of the three interventions is likely to yield greater impact with lower costs.DiscussionLack of access to SRHRs information and services for WWDs is not only a violation of their right to appropriate and quality SRH care but could also undermine efforts to achieve equitable healthcare access as envisaged under SDG 3. This research is expected to generate evidence to inform local health programmes to increase access to SRHRs among WWDs by strengthening local health system capacity to provide disability-sensitive SRHRs services.Trial registration Name of the registry: Pan African Clinical Trials Registry (PACTR). Trial ID: 14591. Date of registration: 02/01/2020. URL of trial registry record: https://pactr.samrc.ac.za/Researcher/TrialRegister.aspx?TrialID=14591
Highlights
There is evidence that women with disabilities (WWDs) experience the most difficulty accessing and using sexual and reproductive health and rights (SRHRs) services and information worldwide
We propose to implement three interventions to enable WWDs in Ghana who are aged 15–49 years gain better access to Sexual and reproductive health and rights (SRHRs) services and information
The current study proposes to implement an integrated set of interventions to address some key barriers women with disability face accessing sexual and reproductive health and rights information and services in Ghana
Summary
There is evidence that women with disabilities (WWDs) experience the most difficulty accessing and using sexual and reproductive health and rights (SRHRs) services and information worldwide. This study aims to test the effect of an integrated health facility and individual-level intervention on access to SRHRs information and services among sexually active WWDs aged 15–49 years in Ghana. Global maternal mortality ratio has decreased from 380 to 210 per 100,000 live births between 2000 and 2013 [1] This progress notwithstanding, many women still lack access to life-saving sexual and reproductive health (SRH) services in many low-income countries, including Ghana. Persons with disabilities remain one of the most marginalized and socially excluded groups, and this disadvantage transcends several spheres: PWDs have generally poorer health, lower education achievements, fewer economic opportunities and higher rates of poverty than people without disabilities [2,3,4]. Women with disabilities are more likely to be poorer and have lower social and economic status than their counterparts who have no disability [3, 4]
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