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

Availability, acceptability and uptake of Sexual Reproductive Health interventions for young people with disabilities in Sub Saharan Africa: A scoping review protocol

INTRODUCTION

Young people with disabilities face major barriers in accessing sexual reproductive health (SRH) services in resource-poor settings, including Sub Saharan Africa (SSA). Although, there is increasing recognition of their unique SRH needs, the availability, acceptability, and uptake of SRH service delivery interventions for this population group remain understudied. Young people with disabilities encounter barriers to accessing SRH services due to stigma, poverty, lack of information and physical barriers. We aim to map existing literature on SRH service delivery interventions targeting young people with disabilities in SSA through a scoping review.

METHODS AND ANALYSIS

The scoping review will be guided by the Arksey and O'Malley methodological framework. Articles will be searched in PubMed, African Index Medicus, Google Scholar, African Journals Online, Web of Science and Embase electronic databases as well as grey literature database, Open Grey. We will also do a citation search of references of eligible papers for literature that may have been overlooked in other searches. A two-step process will be used to screen retrieved articles i) title and abstract screening ii) full text screening. Results of the scoping review will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) extension for scoping reviews.

DISCUSSION

There is a paucity of knowledge on availability, acceptability and uptake of SRH service delivery interventions for young people with disabilities in SSA. This scoping review is poised to fill the gap by demonstrating the breadth of literature on availability, acceptability and uptake of SRH service delivery interventions for young people with disabilities The scoping review aims to map the availability of SRH service delivery interventions for young people with disabilities. This mapping of evidence has the potential to identify whether there is a need for SRH service delivery interventions for young people with disabilities. Our scoping review will map which SRH service delivery interventions work or do not work, as well as gaps in SRH service delivery interventions for young people with disabilities. This information is useful for policy making and for designing effective SRH service delivery interventions for young people with disabilities.

The sexual behavior of young people living with a disability: Findings from the KAP study in Northern Uganda

Introduction

Young people living with disability form one of the most vulnerable population groups globally. There is limited information on the use of SRH services among young people living with a disability.

Methods

This analysis is based on household survey data among young people. Drawing on a sample of 861 young people living with a disability (15 -24 years), we investigate the sexual behaviour, and identify the risk factors associated with sexual behavior of young people living with a disability. Multilevel logistic regression was used.

Results

Results indicate that risky sexual behaviour was associated with alcohol consumption (aOR = 1.68; 95%CI: 0.97, 3.01), having limited knowledge of HIV and STI prevention methods (aOR = 6.03; 95%CI: 0.99, 30.00), and low life skills (aOR = 4.23; 95%CI: 1.59, 12.87). The odds of not using a condom at last sex were significantly higher among in-school young people than out of school young people (aOR = 0.34; 95%CI: 0.12, 0.99).

Discussion

Targeted interventions aimed at reaching out to young people living with a disability should consider their sexual and reproductive health needs, barriers, and facilitators. Interventions can also promote self-efficacy and agency of young people living with a disability in making informed sexual and reproductive health choices.

The Right to Sexuality, Reproductive Health, and Found a Family for People with Intellectual Disability: A Systematic Review

Although sexuality, reproductive health, and starting a family are human rights that should be guaranteed for all citizens, they are still taboo issues for people with intellectual disability (ID), and even more so for women with ID. This paper systematically reviews the current qualitative and quantitative evidence on the rights of people with ID in regard to Articles 23 (right to home and family) and 25 (health, specifically sexual and reproductive health) of the Convention on the Rights of Persons with Disabilities (CRPD). A systematic review of the current literature, following PRISMA 2020, was carried out in ERIC, PsychInfo, Scopus, PubMed, ProQuest, and Web of Science. In all, 151 articles were included for review. The studies were categorized into six themes: attitudes, intimate relationships, sexual and reproductive health, sexuality and sex education, pregnancy, and parenthood. There are still many barriers that prevent people with ID from fully exercising their right to sexuality, reproductive health, and parenthood, most notably communicative and attitudinal barriers. These findings underline the need to continue advancing the rights of people with ID, relying on Schalock and Verdurgo's eight-dimensional quality of life model as the ideal conceptual framework for translating such abstract concepts into practice and policy.

Disability and intimate partner violence: a cross-sectional study from Mwanza, Tanzania

BACKGROUND

Women with disabilities are at heightened risk of experiencing intimate partner violence [IPV], although the mechanisms through which disability acts as a risk factor for IPV are not clear.

OBJECTIVE

We analyzed cross-sectional data (n = 867) from Wave 3 of the MAISHA longitudinal study, conducted in Mwanza, Tanzania, to i) describe the levels of disability and IPV amongst women, and ii) to assess the association between level and type of disability and IPV experience.

METHODS

IPV was assessed using the WHO Multi-Country study instrument. Levels of disability (none, mild and severe) were categorized based on responses to the Washington Group Short Set questions. We fitted logistic regression models to determine the risk of experiencing each type of IPV according to disability level and type of disability.

RESULTS

We found significant associations between mild and severe disability and different types of IPV. For example, in multivariate analyses controlling for socio-demographic variables, women reporting severe disability were significantly more likely to report physical and/or sexual IPV, sexual IPV. controlling behaviors, economic IPV, and severe IPV, whereas for mild disability compared to no disability, physical and/or sexual IPV, sexual IPV, and economic IPV were significantly more likely to be reported. Cognitive disability was a significant correlate of all forms of IPV apart from physical IPV.

CONCLUSIONS

Our findings that specific types of disability and not others were associated with an elevated risk of IPV exposure indicate the need for nuanced measurement and analysis of the association between disability and IPV.

Access to Water, Sanitation and Hygiene Services and Other Preventive Measures against COVID-19 among People with Disabilities, Dodoma, Tanzania

Access to Water, Sanitation and Hygiene (WASH) among people with disabilities is a great concern in developing countries. During COVID-19 pandemic in 2020, in addition to other preventive measures the government of Tanzania invested heavily on hand washing facilities in public places. However, the interventions were mostly for the general population. A big question was the appropriateness of the preventive measures to address different kinds of disabilities. The study was conducted to assess access to WASH and other preventive measures against COVID-19 among people with disabilities. This was a qualitative study where a total of 16 key informant interviews and nine focus group discussions were conducted. The study was carried out in seven districts of Dodoma region, Tanzania. Findings show that there were inadequate WASH and other COVID-19 preventive measures designed specifically for people with disabilities against the pandemic. Many people with disabilities experienced challenges in accessing adequate water for hand washing and using hand washing facilities installed for general population. Also they received inadequate health education and timely communication on COVID-19 preventive measures in addition to challenges in keeping distance and accessing and use of face masks and sanitizers. People with mobility, hearing, and vision impairments were mostly affected. There was no representation of people with disability at the national COVID-19 task force. Specific programs for people with disabilities to address access to WASH and other preventive measures against COVID-19 would address most of the identified challenges.