Introduction
The majority of the over one billion people with disabilities (PWDs) around the world face challenges related to sexual and reproductive health and rights (SRHR). The main causes are cultural, legal, political and social practices that continue to marginalize people with disabilities when it comes to SRHR. Literature shows that societies do not approve for PWDs to engage in sexual and reproductive issues. PWDs were regarded as people without sexual feelings. Women with disabilities were sterilized without their consent. PWDs were seen as people who cannot make decisions when it comes to sexual and reproductive rights (Rugoho & Maphosa, 2017). PWDs are also systemically denied the opportunity to access SRHR information. Parents and teachers are not comfortable in discussing sexual and reproductive issues with children with disabilities as shown by various studies. Even their peers are discouraged from discussing sexual and reproductive issues.
Recently, SRH for PWDs has received the attention of world leaders and policy makers through the adoption of the United Nations Convention on the Rights of Persons with Disabilities (CRPD). The CRPD explicitly recognizes sexual and reproductive rights of PWDs. The Convention challenges all cultural, social, political and religious practices that may harm the rights of people with disabilities, especially in matters of marriage, family, parenthood and relationships. The right of persons with disabilities to the autonomy of their bodies was recognized, including attendant rights to be married and to have children. The Convention mandates governments to promote access to good quality and affordable SRH care and programmes to people with disabilities. Governments are further mandated to guarantee access to sexual and reproductive health to people with disabilities. However, it has been over ten years now yet the millennia of stigma has not disappeared. People with disabilities are still facing challenges in accessing sexual and reproductive information.
The current book seeks to add more evidence on how disability and sexual and reproductive health issues are handled the world over. The book also shows different opportunities and initiatives that are currently being promoted the world over in an effort to assist people with disabilities to access sexual and reproductive rights. Chapter 2 is broadly based on examining the sexuality education programmes available in global literature. The focus of the chapter is mainly adolescents with severe disabilities. As demonstrated by D.P. Ngilangwa in 2016, adolescents with severe disabilities constitute one of the most neglected groups when it comes to sexual and reproductive issues yet more vulnerable to sexual abuse, unplanned pregnancy, HIV and sexually transmitted diseases. A systematic review of literature in the chapter shows that most efforts on sexual and reproductive rights of adolescents with severe disabilities focused more on sexual abuse prevention and neglected the positive cognitive emotional, social interactive and physical aspects of sexuality. However, delivery strategies were better represented and included multimodal communication, the use of concrete materials, social stories, instruction, modelling, role-play, repetition and review. In conclusion the chapter recommends for the need to develop theoretically sound programmes which cover the full extent of sexuality.
The United Nationsā 2030 agenda for sustainable development has called for availability and sustainable management of sanitation and water for all including people with disabilities. In most low-income countries, sanitary infrastructure facilities for people with disabilities have always been a challenge and this has caused trauma to girls and women with physical disabilities every month in most developing countries. Chapter 3 clearly demonstrates that while international policies and declarations on the inclusion of persons with disabilities at all levels in society have been put in place, people with disabilities continue to be discriminated against. Lack of access to sanitary facilitiesāespecially toiletsāhas seen girls with physical disabilities absenting themselves from school during menstruation period. The majority of the suffering of adolescents with disabilities (AwDs) has not been well documented. There are few researches targeting sexual and reproduction issues of adolescents with disabilities. This is also common in countries such as India as pointed out in Chap. 4. Over the past few years there has been a general recognition that the educational and employment opportunities of adolescents with disabilities (AwDs) in India need to be improved and that their sexual needs and aspirations, sexuality concerns and SRH and rights have been largely ignored. India has got a very large population of people with disabilities yet there is very little research on the SRH concerns of AwDs in the Indian context by reviewing the existing literature in India. The study describes the challenges faced by AwDs in acquiring sexuality and SRH education based on the results of empirical studies conducted globally.
Adolescents with visual disabilities face challenges during their menstruation. In some cases they will have their garments with menstrual blood. Chapter 5 examines in detail the nature of menstruation and attitudes towards menstruation and discusses practical menstrual management tips for girls with visual impairment and their significant others. Tips which enable females who are visually impaired to manage their menstruation more independently and with confidence are also offered. Some of these tips include the following: (1) provide information on menstruation to the female who is visually impaired by someone who the girl with visual impairment is comfortable with. This may include mother, a trusted or familiar female relative, mentor, teacher, who are all of the same sex unless otherwise requested by the girl. (2) Make the female who is blind or visually impaired choose the place where she feels comfortable to learn to use sanitary items or manage her menstrual flow. (3) Ensure enough time is devoted for individual demonstration on how to use various sanitary products of their choosing. (4) Where possible, introduce her to a range of sanitary products in order for her to be able to choose the one that best suits her circumstance and makes her very comfortable.
Recently schools have started introducing curriculum on sexual and reproductive health to all learners. Teachers and caregivers play a pivotal role in adolescent girls with disabilitiesā sexual and reproductive health. Chapter 6 presents findings from secondary data analysis of qualitative focus group data with adolescent girls with disabilities and caregivers within the Lakes region of Kenya as part of the DFID-funded Girls Education Challenge Transition (GEC-T) project. The findings highlight perceived openness and approachability as important to adolescents when selecting a source of information about sexual issues. They also suggest that while sexual education in formal schooling provided a good base knowledge to adolescents, caregivers felt that they had to supplement teaching with additional examples taken from their life histories and the wider community. Overall, the findings highlight the central role that both teachers and parents/caregivers, as well as others such as close family members, play in the provision of sex education to adolescents with disabilities. Chapter 7 is also on teachers and studentsā perception of sexual and reproductive health (SRH) education in secondary schools in Tanzania. The findings revealed that the majority of teachers and students with disabilities perceive that SRH education is important for learning in secondary schools in Tanzania. Teachers and students with disabilities believed that teaching of SRH education is important for good health and as a control mechanism for the behaviour of adolescents. Furthermore, the findings revealed that SRH education is suitable for students aged 13ā17Ā years of age. To them, SRH education helps to control awkward behaviours because of the transition period from adolescence to adulthood. In addition, it was found that cultural practices did not hinder students from learning SRH education. It is therefore concluded that SRH education was perceived as vital for health and behaviour control. The study recommends that secondary schools should educate students on the importance of SRH education. Also, the government should invest in training teachers on how to teach SRH education.
Chapter 8 is on the experiences of sexually active women with disabilities and men of reproductive ages with regard to their sexual and reproductive health needs and access to services in Durban, South Africa. Participants expressed that sexual and reproductive health services are a big part of their lives. However, there seemed to be a huge gap between their needs for services and their rights to access services. From the discussions it was apparent that respondentās rights to be treated with dignity, respect and to access sexual and reproductive health services is often overshadowed by the stereotypical assumptions that society holds about the sexuality of persons with disabilities. Participants mentioned that there is preconception that persons with disabilities are not capable of engaging in sexual activities and hence they are often considered as not sexually active. This was one of the major barriers persons with disabilities experienced not only in the public healthcare sector but also in the general society. Foremost this means that information on sexual and reproductive health matters is not widely available and/or accessible to them. This leaves them with vague knowledge about such matters. Many women reported that health providers appeared surprised that they will need family planning services. Often they are not given choices about suitable birth control methods, rather the healthcare providers usually suggested that they undergo abortion or get sterilized. Sterilization may protect women against future pregnancies, it does not, however, promote healthy sexual behaviours, which increase their risk of contracting STIs. The study findings revealed a need to address access to sexual and reproductive health services for persons with disabilities especially, through public healthcare system in South Africa.
Mental health is one of the major health challenges of the twenty-first century. People living with mental health conditions suffer the greatest discrimination demeaning their personality and they are perpetually restrained from living normal lives. Being mentally disabled constitutes an insurmountable illness in a society like Nigeria, not to describe the situation of an adolescent girl with that condition. A girl child in Nigeria and Africa as a whole is an endangered species based on some societal factors affecting their lives. It is indeed a fact that people living with mental health conditions have the right to make decisions about their lives, including their treatment. The United Nations Convention on the Rights of Persons with Disabilities creates a new pattern for mental health law, which is shifting focus from institutional care to community-based treatment which is more participatory. Chapter 9 looks at the dissemination of issues of SRH to adolescent girls living with mental disability becomes a hydra monster because of the environment of birth. Traditionally adolescents do not have a voice but are subject to control as stipulated by the society. On the other hand mental health issues in Nigeria are seen as metaphysical which naturally defy orthodox medicine. The issue of teaching sexual and reproductive health to persons with disabilities has been problematic and still is in many societies. It is even more so in Nigeria where girls with disabilities have fallen victim of sexual abuse and many have been impregnated even by close family members and trusted ones who take advantage of their vulnerabilities. Most of the time, these incidents are covered up and the cycle continues. In order to protect these vulnerable adolescents, awareness is key and the mode of transmission is to teach them their sexual and reproductive health rights and to extend this advocacy to their caregivers. In Nigeria there is lack of enabling policy and experts in the specific area of SRH are not looking in that direction. Taking a multidisciplinary approach, this chapter seeks to examine the existing legal framework and policies if any on this issue in Nigeria, focusing on adolescent girls with mental disabilities. It discusses the nature and state of the Nigerian society with regards to the adolescent girl child with disabilities in Nigeria, the importance of a legal framework and policies, the many challenges, the best practices from some developed countries and suggests the way forward. The chapter takes a critical look at these important yet often neglected and not so recognized citizens of the society and their peculiar problems. It seeks to find a way whereby policies could provide the enabling atmosphere for the protection of these girls through the teaching of sexual and reproductive health and how this can be done.
Adolescents with visual impairmentsā education on sexual reproductive health and rights present a distinct set of challenges as shown in Chap. 10. Generally, education for such a group in both formal and informal settings presents a range of unique needs relating to pedagogy, organization, management and contextual factors. Challenges arise in relation to communication of information, learning processes and safe and successful negotiation of the learning conditions. Little is known about the individual and institutional factors which influence the sexual reproductive and health educational needs and experiences of adolescents with visual impairments in resource constrained, both formal and informal settings. Additionally, there is a glaring absence of literature examining sexual reproductive health and rights education and broadly service provision among adolescents with visual impairments in such contexts. Chapter 10 utilizes the experience of various service providers in Zimbabwe from an international human rights law perspective to exploratory review the effectiveness of initiatives aimed at improving adolescents with visual impairments access to and utilization of sexual reproductive health and rights education and other essential services in resource constrained contexts. The chapter assesses three sexual reproductive health and rights intervention types: formal, informal, and interventions directly targeted at adolescents with visual impairments. They have been significant efforts aimed at enhancing sexual reproductive health and rights education and other services for adolescents in Zimbabwe. However, further evaluation of such initiatives is needed to clarify mechanisms, innovations and impact, especially of specific components aimed at addressing needs of such groups as adolescents with visual impairments. Quality research is also needed to determine dependable means to deliver services in such contexts, to reach such group of adolescents, and to determine effective sexual reproductive health and rights education approaches.
Social media has become an avenue of alternative learning for other groups that had previously been marginalized. Chapter 11 shows how people with disabilities are benefitting from social media platforms in the area of SRH information. Social media is providing alternative sources of information and learning platforms to women with disabilities.
References
- Rugoho, T., & Maphosa, F. (2017). Challenges faced by women with disabilities in accessing sexual and reproductive health in Zimbabwe: The case of Chitungwiza town. African Journal of Disability, 6, 1ā8.Crossref