W-DARE: a three-year program of participatory action research to improve the sexual and reproductive health of women with disabilities in the Philippines

Abstract

BackgroundIn many contexts, women with disability have less access to sexual and reproductive health information, screening, prevention, and care services than women without disability. Women with disability are also known to be more likely to experience physical and sexual violence than women without disability. In the Philippines, health service providers often have little awareness of the sexual and reproductive experiences of women with disability and limited capacity to provide services in response to their needs. Very limited data are available to inform development of disability-inclusive sexual and reproductive health, and violence prevention and response, services in the country. This paper presents the protocol for W-DARE (Women with Disability taking Action on REproductive and sexual health), a three-year program of participatory action research that aims to improve the sexual and reproductive health of women with disability in the Philippines.DesignW-DARE is a disability-inclusive program that will use mixed methods to 1) increase understanding of factors influencing the sexual and reproductive health of women with disability, and 2) develop, implement and evaluate local interventions to increase supply of and demand for services. W-DARE will generate data on the prevalence of disability in two districts; the wellbeing and community participation of people with and without disability, and identify barriers to community; and describe the sexual and reproductive health needs and experiences, and service-related experiences of women with disability. These data will inform the development and evaluation of interventions aiming to improve access to sexual and reproductive health services, and violence prevention and response services, for women with disability. Local women with disabilities, their representative organisations, and SRH service providers will be involved as members of the research team across all stages of the research.DiscussionThis three-year study will provide evidence about factors undermining the sexual and reproductive health of women with disability in a lower-middle income country, and provide new insights about what may be effective in increasing access to services in settings of limited resources. Findings will be relevant across Asia and the Pacific. Analysis of the program will also provide evidence about disability-inclusion in participatory action research approaches.

‘You’re disabled, why did you have sex in the first place?’ An intersectional analysis of experiences of disabled women with regard to their sexual and reproductive health and rights in Gujarat State, India

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SRH services include but are not limited to: maternal and child health services; family planning services; S.T.I screening; and gynaecology services.​

Limited access derives from similar social, infrastructural, and economic barriers that ‘non-disabled’ women typically experience. However, some studies argue that these issues are compounded when they intersect with negative stereotypes of disabled women’s sexuality [2–5,8–12,42]. A study in north India with disabled women identified similar barriers in that context, though differences within the group of disabled women were underexplored [8].…”

“…Neglect of SRH is a violation of disabled women’s rights [6]. In addition, disabled women often face numerous demand- and supply-side barriers in accessing SRH care, including physical barriers, lack of adaptable equipment, negative treatment from staff, unequal allocation of time and money within the household for their care, and lack of affordability of care through exclusion from employment or income-generating activity [2,7–12]. At the same time, gendered norms in India place an expectation on women to become childbearing wives, but the stigma disabled women face frequently excludes them from performing this social role [13,14].…”

Sex care robots

“…WHO [10] concluded that people with disabilities are more likely to find inadequate healthcare provider skills and equipment to meet their needs (twice as much), to be denied care (three times as much), to be poorly treated as non-disabled (four times as much) and to experience catastrophic health expenditure (50% more). Other quantitative studies show that nondisabled people perceive people with physical disabilities as having fewer sexual and reproductive rights [34], sometimes even as asexual [11], especially women [35].…”

“Freedom to go where I want”: improving access to sexual and reproductive health for women with disabilities in the Philippines

“…There is also limited evidence and capacity on how best to address barriers to inclusion in sexual and reproductive health programmes. Further, Disabled People's Organisation (DPOs) and the disability sector more broadly do not often specifically focus on the sexual and reproductive health needs of people with disabilities 2,10,11 .…”

“…The W-DARE project (Women with Disability taking Action on REproductive and sexual health) was a three-year programme of participatory action research designed to improve access to quality sexual and reproductive health, including violence response services, for women with disabilities in the Philippines 10 . W-DARE was implemented by researchers from the School of Population and Global Health at the University of Melbourne and the Social Development Research Center at De La Salle University (Manila).…”