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Sexual reproductive health case study

In this video, Lorraine Wapling provides examples of improving access to sexual reproductive health services and personal perspectives are provided.
LORRAINE WAPLING: (In British Sign Language) Hello, my name is Lorraine Wappling and I work in international development.
LORRAINE WAPLING: In the field of sexual and reproductive health, disabled people have the right to expect the same level of support and treatment as their non-disabled peers. They have the same needs for information about developing their sexuality, about safer sex and contraception, about developing healthy relationships, having children, or knowing about infections and diseases. However, disabled people can experience considerable barriers when trying to access these services. Whilst both men and women may face challenges in relation to sexual reproductive health, it’s women who are at particular risk, partly because of their increased needs for reproductive health services, but also because of discrimination and prejudice.
I’ve worked with disabled people in low income countries for almost 20 years, and I’ve heard many accounts of the difficulties disabled girls and women can face when they try to seek treatment. It’s still hard even for professional health care workers in many low income countries to believe that disabled people might be sexually active or that disabled women would want to have children. There are so many taboos and myths surrounding disability that it can be hard for disabled people to be taken seriously in relation to sexual health.
Some of the myths I’ve encountered include that disabled people have no sexual desires, that disabled women cannot get pregnant, that disabled people shouldn’t have children because they’d pass on their disability to their offspring, including those who’ve become disabled as a result of an accident or trauma, or that they wouldn’t be able to look after their children properly. In some cases, disabled women are being systematically denied opportunities to make decisions in relation to their own sexual health. Women with intellectual disabilities and mental health conditions in particular are still at high risk of being made to undergo sterilisation, abortions, or be put onto contraception without their knowledge or consent.
I’ve encountered stories from disabled girls and women who’ve experienced prejudice and discrimination from health care workers who were not well informed or trained on how to accommodate their specific needs. They have experienced not being fully aware of what to expect during pregnancy and childbirth because meetings with their midwives didn’t include sign language support, or feeling ashamed at having to rely on relatives to relay sensitive or personal information. In some cases, having support with communication is specifically denied because of the need to maintain patient confidentiality. I’ve seen this happen in particular with HIV/AIDS services which won’t allow sign interpreters or advocates for those with intellectual impairments into consultations on the grounds of confidentiality.
This lack of awareness around the sexual and reproductive needs of disabled people and their exclusion from health information programmes means they can be more vulnerable. Schools that cater for deaf and disabled students often don’t routinely run sex education sessions. Public programmes on sexual reproductive health often don’t target disabled people or take their communication needs into consideration. I met a group of young deaf people in East Africa not long ago who thought being infected with HIV would protect you from getting AIDS.
Just as alarmingly, I’ve talked with young disabled women in communities where they are being specifically targeted by men for sex because of the assumption that they will be clear of HIV or that having sex with a disabled woman will cure HIV. The fact that sexual reproductive health services and information is often inaccessible is also a contributory factor in the vulnerability of disabled girls and women to gender based violence. In many contexts, gender based violence can be a difficult issue to confront. But for disabled girls and women, there are additional attitudinal, environmental, and legal barriers to overcome. Can a woman with an intellectual impairment be believed when she claims she has been raped?
How does a deaf woman understand or communicate that she has been forced to have sex? And how does a visually impaired woman provide evidence on the perpetrator of a sexual crime against her when she cannot visually identify him? All these questions are real examples recounted for me by disabled women’s groups I’ve met with over the years. So what can we do to improve the situation? It comes mostly down to attitudes and awareness. Firstly, it’s about acknowledging that disabled people have sexual reproductive health needs. Disabled people want to be treated with respect and dignity and not to have assumptions made about them.
After that, it’s mostly about ensuring sexual reproductive health programmes are designed and implemented in ways that accommodate impairment needs and that health care professionals are well briefed on the needs of disabled people and are aware of and challenge any discrimination or prejudices experienced by disabled people seeking to access sexual reproductive health services.
MYROSLAVA: Does disability affect my sexual health? Not directly. So I have, physically I’m healthy, and no. However, I think that there is a link between perception, other people’s perception of my sexuality, my sexual activity, whether I am or am not. There are a lot of misperceptions around disability and sexuality. I think that also, in an intimate setting there’s a certain amount of anxiety in a new relationship that I am not sure if I would have if I wasn’t disabled. Again, I grew up this way. I don’t know what I would be like without it. It’s part of who I am. But I think in any relationship we are self-conscious. We may want somebody to like us.
We don’t know how they will perceive us in an intimate setting. And I am sure that there are elements of that insecurity that interacts with my disability and scars that I have and the way certain parts of my body move. But it does not affect my sexual health per se.
RICHARD: Yes, having a disability affects my sexual health in that when I was in the peak of my OCD and depression, I wasn’t interested in sexual relationships with my wife. And that was very problematic, because we got married and she was expecting to have good, healthy sexual relationships. And I was in such a low state that I didn’t. And then, on medication, when I’ve got the right medication, you think everything’s going to be hunky-dory. But it’s not, because you have the side effects of the medication that make you lack libido, loss of libido. And so my sexual life has not been as sexually exciting and sexually stimulating as what it should have been, firstly because of my symptomology, my symptoms.
And then, secondly, because I’m on medication.
CHRISTELLE: Having a disability does not affect my sexual health. Yeah, I think people shy away from that question.
RIDA: Disability and sexual health, it is something that normal society– I say ‘normal’ in a very uncomfortable way, because the perception is that people with disabilities are asexual or they do not have the inclination towards being sexual. This is untrue, because I feel that love is something that people feel irrespective of anything. And I think that if there is love in a relationship, sexual activity does not need to be spoken about that much. Because I think the attraction between people is more important there. I’m taking away from sexual health because I feel that we don’t need to look at it like sex when it comes to people with disabilities, but more about the connection, the relationships, people falling in love.
And I think that needs to be the emphasis when it comes to people with differences.
BRANDON: It’s a bit of a different way of looking at it when you think of a sexual life with someone with a disability, because the person needs to be open. You need to be open to new things. You need to be willing to try new things. You need to be understanding. Because it is a little bit different. Like it’s a fact that, funny enough, many girls ask me, and just in common conversation. And it’s a great icebreaker, the fact that for me it works perfectly, I just can’t feel a thing. So I would say for me, the fact that I can’t feel much sensation, it’s more of an emotional connection.

Our next activity introduces why people with disabilities might experience difficulty in accessing health services. In our first case study, an overview of sexual reproductive health and disability is provided by Lorraine Wapling, an International Disability Inclusive Development Consultant and Doctoral student in Department of Epidemiology and Public Health at UCL. This is then followed people with disabilities sharing their perspectives answering the question “Does disability affect your sexual health?”

In the first part of this video, Lorraine discusses the importance of access to sexual reproductive health for people with disabilities. She highlights some of the barriers that are encountered in low and middle income countries and the importance of improving accessibility to sexual and reproductive health services.

In the second part of the video, Myroslava, Richard, Christelle, Rida and Brandon discuss their answers to the question “Does disability affect your sexual health?”

Enjoy listening to the information and their reflections and please respond in the comments section below if you want to share your thoughts and/or what you have learned in this Step. Please remember not to reveal any confidential information when posting your comments.

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Global Health and Disability

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