Disability Inclusion In SRHR

Addis Ababa,
MSI Training Center
November, 2022
Outline

• Understanding Disability, and Impairment

• Discuss the magnitude of Disability
• Global & Ethiopian Context
• SRHR challenges of Women and Men living with disability
• Key points to remember
• Recommendation
Brainstorm

• Please describe human diversity.

• What do disability and impairment mean to you?
• What does inclusion mean to you???
Objective

• By the end of the workshop, participants should be able to:

• understanding of concepts
• disability,
• impairment,
• inclusion,
• Understand the situation of persons with disabilities in Ethiopia
• Understand International, Regional and National Disability Rights Law/Policy
Frameworks
• SRHR and accessibility needs and challenges of women/youth with disabilities
• To ensure disability inclusion and mainstreaming in MSI services
 Impairment

Impairments: Limited or total loss of functioning in parts of the body or organs of the body
problems in body function or participation restrictions–
alterations in body structure – activity limitations–walking or eating; discrimination in employment or
paralysis or blindness; transportation.

Disability refers to difficulties encountered in any or all three areas of functioning

Disability

• A long-term physical, mental, intellectual or sensory

(vision & hearing) impairment which in interaction
with various barriers may hinder full and effective
participation in society on an equal basis with others
(UNCRPD, 2006)
• Defining disability as an interaction means that
“disability” is not an attribute of the person. Progress
on improving social participation can be made by
addressing the barriers which hinder persons with
disabilities in their day to day lives.
Cont…
• Impairments are not disability
• Disability is not sickness
• Many people with disabilities do not have equal
access to health care, education, and employment
opportunities, do not receive the disability-related
services required, and experience exclusion from
everyday activities.
• People are viewed as being disabled by society
rather than by their bodies
Understanding • Disability is the umbrella term for impairments, activity
limitations and participation restrictions, referring to the negative
Disability aspects of the interaction between an individual (with a health
condition) and that individual’s contextual factors (environmental
and personal factors)
• “Health conditions” are diseases, injuries, and disorders, while
“impairments” are specific decrements in body functions and
structures, often identified as symptoms or signs of health
conditions.
• Environmental factors include: products and technology; the
natural and built environment; support and relationships;
attitudes; and services, systems, and policies.
• Personal factors, such as motivation and self-esteem, which can
influence how much a person participates in society. It further
distinguishes between a person’s capacities to perform actions
and the actual performance of those actions in real life,
Models of Disability
 • The medical model and the social model are often
presented as dichotomous, but disability should be viewed
neither as purely medical nor as purely social: persons with
Models Summary disabilities can often experience problems arising from their
health condition . A balanced approach is needed, giving
appropriate weight to the different aspects of disability.
 Inclusion

“Inclusion is not a programme. It

is a mindset. It is the way we treat
others and the way they treat us.
Inclusion is the opportunity to
learn together and from one
another. And we do it because it is
the right thing to do.”
Lisa Friedman (2018)
Disability and Human Rights
• People with disabilities experience inequalities –denial of equal
access to health care, employment, education, or political
participation because of their disability.
■ People with disabilities are subject to violations of dignity – for
example, when they are subjected to violence, abuse, prejudice, or
disrespect because of their disability.
■ Some people with disability are denied autonomy – for example,
when they are subjected to involuntary sterilization, or when they are
confined in institutions against their will, or when they are regarded as
legally incompetent because of their disability
Magnitude – Global
Over 1 billion people are estimated to experience disability.
Almost 80% live in Africa.

This corresponds to about 15% of the world's population, with up

to 190 million (3.8%) people aged 15 years and older having
significant difficulties in functioning, often requiring health care
services.
The number of people experiencing disability is increasing due to a
rise in chronic health conditions, demography, conflict and war, and
population ageing.

Almost everyone is likely to experience some form of disability –

temporary or permanent – at some point in life.
“Disability is a reality for some but a possibility for all of us”

Understanding the numbers of people with disabilities and their

circumstances can improve efforts to remove disabling barriers and
provide services to allow people with disabilities to participate
Persons with Disability (PWD)

• PWD are diverse and heterogeneous, while stereotypical views of disability emphasize wheelchair
users and a few other “classic” groups such as blind people and deaf people
• PWD have diverse personal factors with differences in gender, age, socioeconomic status, ethnicity, or
cultural heritage.
• Women and young persons with disabilities are more likely to face gender-based violence and
less likely to have full and equal access to prevention and response services. So when they
experience violence, they often can’t access services
• Disability correlates with disadvantage, however, not all people with disabilities are equally
disadvantaged. Women with disabilities experience the combined disadvantages associated with
gender as well as disability.
Ethiopia
• The Population and Housing Census (2007) estimated that PWDs constitute 1.09% of
the population, which at that time was 73,918.505. No data in the Census re children
with disabilities.
• The World Report on Disability (2011), on the other hand, says PWDs constitute at
least 17.6% of the Ethiopian population (WHO, World Bank, 2011).
• The National Plan of Action for Persons with Disabilities (NPA) states that 95% of
persons with disabilities in Ethiopia live in poverty (see p.2) presumably majority
living in rural areas where access to services are minimal.
• According to the Situation and Access to Services of Persons with Disabilities in Addis
Ababa – a UNICEF report (2019), about 1% of children under the age of 18 in Addis
Ababa have a severe disability. There is, however, a likelihood that child disability is
underreported.
Dagnachew B. Wakene (August, 2021). Seminar on Disability Inclusion (ppt).
National
• The National Plan of Action for Persons with Disabilities (2012-2021)
• Proclamation No. 1097/2018 (initially adopted in 2010 and revised in 2018) determines the
power, duties, responsibilities and decision-making orders of the executive organs of the FDRE.
Regarding persons with disabilities, Article 10/4
• The Federal Civil Servants Proclamation, No. 1064/2018 (initially adopted in 2007, revised in
2018)
• Proclamation concerning the Rights to Employment for Persons with Disabilities, No. 568/2008
• Building Proclamation, No. 624/2009
• Framework Document on Special Needs Education (SNE), Technical and Vocational Education and
Training (TVET), 2009
• The National Social Policy Protection Policy Framework, 2012
• The Growth and Transformation Plan (GTP) 1 & 2: Section 8
• The Ten-Year National Perspective Plan (2020-2030)
 General: Barriers to healthcare
Attitudinal barriers • prejudice, stigma and discrimination by health service providers and other staff at health facilities
• HCP’s limited knowledge and understanding of the rights of PWD and their health needs and have inadequate training
and professional development about disability
• Many health services do not have policies in place to accommodate the needs of PWD such as allowing longer and
flexible appointment times, providing outreach services and reducing costs.
• Health workers often make the inaccurate assumption that women with disability are asexual or are unfit to be
mothers.
• People with disability are rarely asked for their opinion or involved in decision-making about the provision of health
services to people with disability

Physical barriers • Far distance, inaccessible transport

• Stairs at the entrance or services and activities located on floors with no elevator access are inaccessible.
• Inaccessible toilets, passages, doorways and rooms that do not accommodate wheelchair users, or are difficult to
navigate for people with mobility impairments, are common.
• Fixed-height furniture, including examination beds and chairs,
• poorly lit, do not have clear signage, or are laid out in a confusing way

Communication barriers • limited availability of written material or sign language interpreters at health services.
• Health information or prescriptions may not be provided in accessible formats, including Braille or large print, which
presents a barrier for people with vision impairment.
• Health information may be presented in complicated ways or use a lot of jargon. Making health information available
in easy-to-follow formats – including plain language and pictures or other visual cues – can make it easier for people
with cognitive impairments to follow.

Financial barriers • Over half of all people with disability in low-income countries cannot afford proper health care.
• Many people with disability also report being unable to afford the costs associated with travelling to a health service
and paying for medicine, let alone the cost of paying to see a health service provider.
SRHR challenges of WWD

HCPs may be reluctant to discuss SRHR with WWD

• Uncomfortable to discuss
• Unaware of how to address needs
• The degree of disability and the client’s underlying health conditions
• WWD may not bring the issue of sexual health to the HCPs
• HCPs have a negative stereotype towards the sexuality of WWD
Possible actions ….
SRHR services for Women With Disability (WWD)
• Prioritize/Schedule a longer appointment
• Select the most accessible exam room and have the necessary
equipment available
• Orient and Practice with staff
• Ask for the patient’s preferences
• Provide assistance
• Safe transfer techniques
• Work to minimize the effects of other barriers
Contraception Considerations
• WWD often do not get appropriate contraception information
• When making recommendations and prescribing contraception –
• Determine if the method can be administered when needed by the woman or
coordinated with home/partner assistance
• Consider needing for legal consent
Cont.
• Contraception options should be discussed with all women with
disabilities.
• Considerations involve:
• The physical and pharmacological interaction of the contraception method
• The actual or potential conditions of the woman
• The amount of assistance available to and required by the woman
• Her lifestyle and self-care needs
• Her goals for pregnancy
Tips to reach and provide SRHR services for
PWD
• Involve PWD and Organizations people with Disability (Nothing
without us about Us)
• Avoid derogatory language
• Ensure Universal and/ or equitable access to skilled and
comprehensive sexual, reproductive and maternal health services
(SDG 3)
Reference
• World Health Organization. World report on disability 2011. World Health Organization;
2011.
• Population Reference Bureau (2019).Presentation Guidelines: The Path To Equality For
Women And Young Persons With Disabilities: Realizing Sexual And Reproductive Health
And Rights And Ending Gender-based Violence.
• Dagnachew B. Wakene (2021). Seminar on Disability Inclusion.
• Ganle JK, Baatiema L, Quansah R, Danso-Appiah A (2020) Barriers facing persons with
disability in accessing sexual and reproductive health services in sub-Saharan Africa: A
systematic review. PLoS ONE 15(10): e0238585.
https://doi.org/10.1371/journal.pone.0238585
• World Health Organization (2009). Promoting Sexual and Reproductive Health for
Persons with Disabilities: WHO/UNFPA guidance note. WHO
• American College of Obstetricians and Gynecologists (2010). Reproductive Health Care
for Women With Disabilities.