By Rupankar Dey
Rupankar holds a Master’s in Development Studies from Erasmus University Rotterdam. He has worked as a Sexual and Reproductive Health and Rights (SRHR) researcher for Liliane Fonds, a Dutch NGO dedicated to disability rights in Sub-Saharan Africa.
Published on International Women’s Day 2024

In Uganda, many women with disabilities face big challenges when it comes to their sexual and reproductive health. They’re often ignored or overlooked because they’re women, they have disabilities, and society doesn’t always think they should have a say in their own sexual health. Even though there are rules in place to protect them (UNFPA Uganda, 2021), the reality is different. They struggle to get the care they need because the system isn’t set up to help them properly. 

Lack of Sexual Agency for Women with Disabilities

Women with disabilities often get left out when it comes to getting the right sexual health care. Uganda’s sexual and reproductive health (SRH) policies (MoH, Uganda, 2017) claim to be inclusive , yet they fall short in addressing the specific needs of women with disabilities as they perpetuates the notion that women with disabilities are often seen as not capable of making choices about their own bodies, which isn’t fair. The rules don’t really understand the different challenges that women with disabilities face, like getting around or communicating with doctors, leading to their exclusion from essential reproductive health education and services. 

Existing studies (see Dotson, Stinson, and Christian, 2014) often overlook  the diverse abilities and challenges of these women at an individual level, rather focusing on external structural barriers. It’s time we questioned whether policies truly cater to the diverse needs of individuals shaped by their unique experiences. 

The Oversight Dilemma: Gaps in National Policies 

National policies (MoH, Uganda, 2017), while well-intentioned, prioritize the needs of the majority considered based on normative ability standards, leaving women with disabilities marginalized. This neglect results in tangible disparities in SRH and family planning services, further complicating the already daunting challenges faced by these women.

Our research reveals three critical factors exacerbating the struggles of women with disabilities: environmental barriers, family dynamics, and individual identity characteristics.

Environmental Barriers shaping individual need

Deeply entrenched religious beliefs and societal stigma surrounding disability in Ugandan society create significant barriers for women with disabilities, pushing them to the margins of SRH care. Limited awareness of sexual health, coupled with physical accessibility challenges and inadequate training among healthcare professionals, worsens their plight. These women find themselves navigating a healthcare landscape riddled with obstacles, hindering their access to vital SRH services and support. Despite efforts to improve accessibility to SRH facilities, women with disabilities in Uganda continue to encounter significant obstacles. Even when they manage to access care, they are often met with judgment and discrimination due to prevailing social stigma and religious beliefs. These deeply ingrained attitudes create an environment where the needs of these women are not fully assessed or addressed, leading to gaps in care and perpetuating inequalities in health outcomes. 

The Impact of Social Stigma

Social stigma surrounding disability casts a shadow over the lives of women in Uganda, affecting every aspect of their existence, including their access to SRH services. In many communities, disability is viewed as a curse or punishment, leading to marginalization and exclusion. As a result, women with disabilities and their families face immense pressure to conform to societal norms, often at the expense of their own reproductive choices which either force them to choose forceful abortions or restrict access to SRHR services or products in the fear of being shamed or ostracized in the society. 

Family Dynamics: A Double-Edged Sword 

 While supportive families can offer crucial assistance, financial constraints and societal norms often limit the autonomy of women with disabilities in matters of reproductive health. The tension between familial support and societal expectations forces these women to navigate conflicting pressures and restricted agency in making reproductive choices. Despite their desires, they are often silenced, their autonomy sacrificed on the altar of societal norms and ableist conventions. 

Individual Identity Characteristics

The diverse array of disabilities presents a multitude of challenges, each presenting its own barriers to accessing SRH services. Education and financial independence can empower these women, yet communication barriers, familial paternalism, and religious convictions continue to impede their progress.  

Triumph Over Challenges: The Power of Education and Independence 

Despite these obstacles, stories of resilience and triumph emerge. Education and financial independence serve as transformative tools, empowering women to assert their SRH rights with confidence. Through vocational training and tailored interventions, women with disabilities can overcome systemic barriers, reclaiming their agency and paving the way for a more inclusive future. 

Interview Excerpts: 

Mastula: “I’ve never faced discrimination, and I’m not bothered because I’m financially independent…” 

Mastula’s Mother: “My daughter is a resilient woman who refuses to be subordinate to any man.” 

These excerpts are from an interview with a Ugandan woman with mobility disability. They underscore the transformative influence of financial autonomy and familial support in empowering women with disabilities to navigate the intricate landscape of SRH care with resilience and determination. 

Religious Convictions and Cultural Norms

Religious convictions and cultural norms further compound the challenges faced by women with disabilities in accessing SRH services even if the marginalized group are financially independent. In Uganda, where religion plays a significant role in daily life, religious beliefs often dictate attitudes towards sexuality and reproductive health. Conservative interpretations of religious texts may condemn certain behaviors or practices, leading to restrictions on access to contraception, abortion, and other essential services. Cultural norms surrounding gender roles and family dynamics also influence perceptions of disability and shape access to care for women with disabilities. 

The Consequences of Restricted Access

The consequences of restricted access to SRH services are far-reaching and profound. Women with disabilities may experience increased vulnerability to sexually transmitted infections, unintended pregnancies, and obstetric complications due to limited access to contraception, family planning, and maternal health services. Additionally, the lack of comprehensive care leaves their reproductive health needs unmet, exacerbating existing health disparities and perpetuating cycles of poverty and inequality. 

A Call to Action

The voices of women with disabilities in Uganda’s SRH landscape demand to be heard and tailored interventions are essential to address their unique needs and experiences based on their identities, ensuring inclusivity in SRH initiatives. It’s time to confront systemic barriers and amplify their stories of resilience. Through targeted interventions and collaborative efforts, we can break down barriers, empower these women, and pave the way towards reproductive justice for all. Let’s rise to the challenge and build a world where every woman, regardless of ability, can access her reproductive rights with dignity and autonomy. 

NB: To ensure anonymity, the name of the interviewee has been changed. For further details, readers can contact the author for access to his research thesis and policy brief, as this blog serves as a condensed form of the research.
Email:  [email protected] 

References: 

• Dotson, L.A., Stinson, J. and Christian, L., 2014. “People tell me I can’t have sex”: Women with disabilities share their personal perspectives on health care, sexuality, and reproductive rights. In Women with Visible and Invisible Disabilities (pp. 195-209). Routledge. 
• Reproductive Health Division Department of Community Health, Ministry of Health (2017) THE NATIONAL POLICY GUIDELINES AND SERVICE STANDARDS FOR SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS, WHO. Available at: https://platform.who.int/docs/default-source/mca-documents/policy-documents/guideline/UGA-CC-31-01-GUIDELINE-2017-eng-SRHR-Policy-Guidelines-and-Service-Standards.pdf (Accessed: 21 February 2024). 
• UNFPA Uganda (2021). UGANDA DISABILITY INCLUSION IN  UGANDA: WHAT YOU NEED TO KNOW. [online] Available at:  https://uganda.unfpa.org/sites/default/files/pub- pdf/disability_inclusion_-_factsheet._final.pdf.