Plan for people with disabilities

By Sharon E. Ahumuza

The World Health Organization (WHO) reckons that 10% of any given population will be with disability. In Uganda, the number of Persons with Physical Disabilities (PWPDs) is estimated to be 7.2% of the total population. Disability is an observable deviation from the biological norms of structure or function that directly results from disease, trauma or other health condition.

Persons with physical disabilities experience varied disadvantages and they are social minorities systematically discriminated against in all areas of life. They are often discriminated against in families and in society denying them equal opportunities, rights of mobility and leisure, which undermine the development of a balanced, mature, confident person.

Persons with physical disabilities face a number of challenges as they access and utilise sexual and reproductive health services. These challenges include;

Negative attitude by the community and health workers

This is manifested in the way they are handled at the health facilities. PWPDs, particularly women, suffer from societal stigmatisation and blankness under the pretext that they should not face the challenges of pregnancy and child birth owing to their disability. Some community members and health workers also assume that PWPDs do not have sexual interests contributing to their social exclusion. More so, most of the health facilities are ill prepared to address the SRH needs of PWPDs and have subjected woman with physical disabilities to deliver by cesarean minimising the PWPDs’ opportunities to reproduce normally.

Struggle to conform to society expectations

Due to the societal assumption that PWPDs should be asexual, they tend to struggle a lot to society expectations. And most of them are inclined to have self pity and perceiving themselves as less human. Negative perceptions has led to low self esteem and has increased their vulnerability to especially sexual abuses on which most of the perpetrators are close relatives.

Poor physical accessibility   

Most of the health care facilities lack ramps and personnel to assist PWPDs such as helping them to climb stairs. In addition, health facilities do not have wheel chairs and disability friendly beds in case of delivery or admission. There is also lack of separate toilets for PWPDs in health units which subjects PWPDs to share general toilets, yet majority of them have to sit on toilet seats to ease themselves. Most of the general toilets are unhygienic and lead to infections to PWPDs who have to sit on them.

Limited access to education and sensitisation on sexual and reproductive health

The level of awareness about sexual and reproductive health among the PWPDs is limited. In addition, most of the PWPDs cannot read or write. For example UNICEF estimated that 90% of children with disabilities in developing countries, including Uganda, do not go to school. The situation is worsened by unfavourable school structures most of which lack ramps. Furthermore, restrictions on sexual and reproductive health information of the PWPDs with the belief that persons with physical disabilities should be asexual have also contributed to withholding of sex education on the assumption that the individual 'won't need it'.

Transport challenges

While the majority of the PWPDs travel by taxis, they encounter terrible experiences as they travel including going to health facilities.  They are discriminated against and marginalised by taxi operators and fellow passengers. PWPDs are discriminated against under the disguise of being too sympathetic to them. And to worsen matters, some of the taxi operators refuse to transport PWPDs claiming that they delay them by taking more time to get into taxis compared to persons without physical disabilities.

Long queues at health facilities

In most of the health facilities, there are usually long queues by the persons seeking health care. The challenge of long queues translates into getting tired which is also worsened by the physical limitations associated with physical disability and lack of prioritisation or positive discrimination by the health workers where PWPDs are left to line-up with those who do not have disabilities.

Lack of social protection

The PWPDs lack social protection from the Government according to the Social Development Sector Investment Plan. Challenges with protection of vulnerable persons particularly PWPDs are due to inadequacy in implementation of policies and insufficiency in providing for their needs in relation to their SRHR. Lack of social support and limited participation in the community further isolates them leading to increased levels of stress and hardship.
Recommendations

·     Community members and service providers including health workers, police officers and legal staff should be sensitised by the Government and non-government organisations on the rights and needs of PWPDs so as the adequately support the PWPDs. Sensitisation efforts should also target PWPDs themselves so as to assist them overcome self pity and foster the necessary positive attitudes.

·     The policy of making physical structures friendly should be implemented as part of the architectural rules for all the health facilities. Ramps should be made available in all buildings and adjustable seats and beds as well in health facilities to cater for the needs of the PWPDs.

The writer is a Makerere University School of Public Health-CDC Fellow