Affirming Disability Rights in Sexual and Reproductive Health Care

In recent years, the international community has increasingly affirmed its commitment to adolescent girls’ sexual and reproductive health and rights, and prioritized the elimination of barriers that prevent girls from accessing services and education. However, young women with disabilities have been consistently left behind.

People with disabilities experience stigma in most aspects of their lives. This stigma, combined with gendered discrimination and the assumption that people with disabilities have no sexuality, creates a stranglehold of prejudice. As a result, the majority of adolescent girls with physical, intellectual, and psychosocial disabilities are denied access to reproductive health care and sexuality education. Yet, adolescent girls with disabilities are, like all girls, entitled to sexual and reproductive health and rights under international law. And, regardless of the nature of their disability, they possess the same legal capacity as their peers to act on their rights and make personal health decisions.

There are between 180 and 200 million persons aged 10-24 with disabilities worldwide, the majority of which live in a developing country. For women with disabilities, gendered discrimination begins at infancy. Infant girls with disabilities are more likely to die through so-called “mercy killing” than infant boys, and as children, girls are less likely to receive assistive devices or be sent to school than their male counterparts. Girls and women with disabilities are also four times more likely to experience sexual violence than their non-disabled peers, and have a harder time accessing justice for rights violations.

Despite empirical studies demonstrating that young people with physical, intellectual, and psychosocial disabilities develop sexual interest and desire at the same rate as their peers, health care providers and educators maintain biased attitudes that negatively impact quality of care. As a recent United Nations Population Fund (UNFPA) report describes, “service providers often fail to provide information to young persons with disabilities due to stereotypical beliefs that persons with disabilities are asexual, uninterested, or incapable of consenting.” Likewise, Catalina Devandas Aguilar, the UN Special Rapporteur on the Rights of Persons with Disabilities, emphasizes that the sexuality of girls with disabilities is rarely respected, acknowledged, or discussed with disabled girls themselves. When providers exclude girls with disabilities from crucial self-knowledge, they not only violate their fundamental rights, but also leave them unable to advocate for themselves.

The assumption that girls with disabilities are not sexually active and do not have the capacity to make informed decisions affects not only the information they receive, but also the services. Doctors and other medical providers routinely neglect to screen girls with disabilities for sexually transmitted infections, according to UNFPA. This alarming omission is particularly prevalent in developing countries and especially dangerous in regions with high HIV/AIDS incidence. Even when girls with disabilities proactively seek out reproductive health services, providers engage in discrimination. One study found that providers openly questioned the possibility that their patients—South African women with disabilities—were engaging in sexual activity and did not offer them choices about birth control methods. Girls with intellectual and psychosocial disabilities are particularly likely to be denied their legal right to make health care decisions for themselves, which increases their vulnerability to sexual abuse.

Just as providers refuse reproductive health services and information, so too do they continue to subject girls with disabilities to forced and involuntary sterilizations and abortions. In both situations, health care professionals violate the fundamental human rights of girls with disabilities by overriding their freedom and capacity to make their own decisions about sexuality and reproduction.

The exclusion of girls with disabilities from school and school-based sexuality education, the physical inaccessibility of health care facilities and equipment, and the absence of sign language interpreters and braille alternatives to public health messaging are also fundamental obstacles that prevent girls with disabilities from receiving adequate health care. These impediments intersect with and exacerbate the prejudicial behaviors of service providers, particularly affecting sexual and reproductive health care.

Governments around the world must recognize the sexual and reproductive health and rights of girls with disabilities, and commit to integrating disability measures into all relevant laws, policies, and educational programs. This includes ensuring the accessibility of health care facilities and services, training health care providers and teachers on the reproductive rights of girls and women with disabilities, and, perhaps most importantly, consulting adolescent girls with disabilities at every step along the way. Furthermore, governments should collect data disaggregated by age, gender, and disability that can be used to identify and measure areas for improvement.

Efforts to acknowledge and involve adolescent girls with disabilities must extend beyond government—it is essential that feminist organizations consider and include all women and girls. To this end, the International Women’s Health Coalition is invested in the powerful alignment of both the women’s and the disability rights movements. From the UN, where IWHC worked extensively on the first resolution addressing women and girls with disabilities, to grassroots organizations around the world, disability rights must become a key tenet of sexual and reproductive health and rights.

Photo: Charlotte Jones for NYC Mayor’s Office

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