Sexual and Reproductive Rights
People with Disability
Definition of disability
The World Health Organization describes disability as an umbrella term, covering impairments (problem in body function or structure), activity limitation (difficulty in executing a task or action), and participation restriction (a problem in involvement in life situations). An impairment might have health consequences for the individual, but it is the society in which a person with disability lives that can result in them being disabled.
Social and institutional structures including the physical environment, access to information and communication, laws and policies, and service delivery models can either promote or limit the active participation of people with disability in society. Primarily it is the beliefs about disability that are the greatest barrier to enabling people to live as full participants in a community. Negative beliefs and stereotypes about disability and sexuality are far more common than positive ones and are usually inaccurate, stigmatising or discriminatory. The social model of disability was initially described by Mike Oliver in 1990.
The largest minority group in the world
The World Health Organization estimates that over a billion people in the world have some form of disability (about one in seven people worldwide). Though they have the same health care needs as others, they are twice more likely to encounter inadequate health care in terms of providers’ skills and facilities; three times more likely to be denied health care and four times more likely to be treated badly in the health care system.
According to the United Nations Population Fund, 80% of people with disability live in developing countries. Of the poor in these countries, an estimated 20% live with disability.
Negative stereotypes about disability and sexuality
There are a number of pervasive stereotypes that exist in most cultures in the world about the sexuality of people with disability. They are predominantly negative and either serve to deny their sexuality or create fear about it. One commonly held view is that people with disability are childlike, without sexual feelings and need to be protected from the adult world. Another is that they if they do have sexual feelings or are encouraged to express their sexuality they will not be able to control themselves and will behave in deviant ways and may become a danger to society. People with disability are commonly assumed to be unable to learn about sexuality, have relationships, to be a sexual partner or an effective parent, as has been shown in studies by the University of Bristol and Malmo University. These stereotypes result in discrimination and stigma and are generally untrue.
People with disability have the same sexual and reproductive rights as everyone else and these have been explicitly described in the United Nations Convention on the Rights of Persons with Disabilities which was adopted in 2006. Articles 16, 21, 23 and 25 state rights in relation to marriage, family, parenthood, relationships, fertility, access to information and SRH health services and freedom from exploitation and abuse.
In 2009 WHO/UNFPA published Guidance Notes on ways to promote the sexual and reproductive health of people with disability.
In 2011 the World Health Organization and the World Bank published the first World Report on Disability that includes sexual and reproductive health care issues. It supports the principles and implementation of the UNCRPD.
These documents are important tools in promoting the sexual and reproductive health rights of people with disability.
The sexual and reproductive health and rights of people with disability
Family planning and contraception
People with disability have the right to choose whether they will marry and/or have children. However, women with disability who live in societies that place little value on women generally have little personal autonomy to make these choices. Families may regard them as being without any value as a wife or mother, and regard them as an economic burden or they may be exploited financially and/or sexually. They are less likely to have access to family planning services and information than other women, and also to services that provide support through pregnancy, as shown in a publication from the United Nations Development Programme.
People with disability have the right to live free from illness and have access to sexual health services. However the Global Survey on HIV/AIDS and Disability in 2004 found that all risk factors for acquiring HIV are increased for people with disability. These risk factors include poverty, lack of education, information and resources to promote safer sex, increased risk of sexual violence and a subsequent lack of legal protection and substance abuse. Despite this, they have been significantly overlooked in HIV research, policy and service provision (see the United Nations Population Fund and a study by the University of KwaZulu-Natal)
Women, adolescents, people living in specialised institutions, schools or hospitals and members of ethnic and minority populations are at even greater risk of HIV infection. (See the Disability and HIV Policy Brief)
People with disability have the right to live free from abuse. However the rates of sexual and gender based violence is significantly higher for people with disability. It is experienced by both adults and children with disability. Women and girls are particularly at risk. Many people with disability are in powerless positions, dependent financially or physically on others. While they experience high levels of sexual violence they have few legal, social and economic options made available to others. (Source: United Nations Population Fund)
People with disability have the right to express their sexuality free from discrimination and abuse. Same-sex attraction appears to occur with the same prevalence among people with disability as those who do not have disability. They experience diversity in their sexual orientation and gender identity but they may not be supported to identify as same sex attracted or transgender by family or others. Harassment and bullying are a common experience. Education often fails to be comprehensive or inclusive of same-sex relationships and there is limited information available (see a World Bank study).
People with disabilities who have sexual relations with people of their gender, who identify as gay or bisexual as well as transgender people with disability can encounter double discrimination. (Source: Dominique Goblet, University of Namur)
Young people with disability and sexuality
Young people with disability have the right to receive education, services and support to become as independent as possible and live adult lives. The UNICEF Fact Sheet on Children and Young People with Disabilities summarises the particular issues that young people with disability face. These include the inaccessibility of reproductive services due to physical limitations and staff attitudes about adolescents with disability, lack of information provided in ways that are accessible to young people with learning and sensory impairments, and limited sexuality education. The consequences for young people are they are prevented from having intimate relationships, discouraged from expressing their sexuality and engage in high levels of risk taking (see a guide for professional practice).
Upholding the sexual and reproductive health rights of people with disability
People with disability have poorer health outcomes because of their experiences of neglect, abuse and discrimination. Many health workers contribute to this situation because of their negative attitudes or lack knowledge and skills in supporting people with disability. (See a University of Manchester study)
Health workers have a responsibility to work together with people with disability to uphold their sexual and reproductive health rights. UNAIDS and the World Bank recommend that Governments train health workers to be able to uphold the rights of people with disability. (See the Disability and HIV Policy Brief)
The WHO Guidance Notes outlines a number of areas of action such as:
- Including people with disabilities in planning and decision making about service planning and delivery
- Challenging negative values and attitudes of health workers
- Taking on an advocacy role in partnership with other Disabled Persons Organisations (DPOs)
- Including disability organisations in outreach work.