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Disability is not limited to the body, it is also about mindsets

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Shobha Shukla - CNS

Disability Rights cannot be on blind-spot if we are to deliver on the promise of sustainable development for ALL
Disability Rights cannot be on blind-spot if we are to deliver on the promise of sustainable development for ALL
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Very often it is our disabling attitudes that make life difficult for people with disabilities, rather than their own physical impairments. More than the disability itself, it is its psychological effects that take a bigger toll on the person, says wheelchair bound Tanzila Khan, a disability rights activist who founded GirlyThings.pk.

Tanzila shared her anguish in lead up to the International Day of Persons with Disabilities, while delivering the plenary talk at the 11th virtual session of the ongoing 10th Asia Pacific Conference on Reproductive and Sexual Health and Rights (APCRSHR10).

"Persons with disabilities struggle a lot with their identity. We do not find ourselves fit in society. All
the buildings are made accessible only to the able-bodied. The same applies to policies and legislation. Sometimes attitudes can disable an entire nation or community that has a perfectly able-body with no impairments", she said.

There are 690 million persons with disabilities in the Asia Pacific region. While many countries of the region have focused on improving access of persons with disabilities to employment and education, limited attention is given to their sexual and reproductive health needs. Sexual and reproductive health rights of women still remain a taboo subject and the challenge becomes even bigger in the context of women with physical disabilities. Any talks around this important issue are difficult to digest for many people, including policy makers and leaders. Even healthcare providers very often turn a blind eye to it.

The insensitive attitude of service providers is a major hindrance for persons with disabilities in accessing sexual and reproductive health services. In Nepal, young people, especially women, with disabilities face several problems on this front, shared Shibu Shrestha, who is a senior programme manager at Visible Impact. As it is, the unmet need for family planning in Nepal is high for young women. On top of this, it is assumed that those with disability are either asexual or not sexually active and therefore do not need sexual and reproductive health services like family planning.

According to one study, persons with disabilities in Nepal are twice as likely to be on the receiving end of inadequately skilled healthcare providers at improper facilities. They are three times more likely to be denied healthcare and four times more likely to be treated badly by healthcare systems.

In another recent study conducted on young persons with disabilities in 3 cities of Nepal (Kathmandu, Sunsari and Nepalganj) participants shared that the attitude of the health service providers was judgmental and not friendly when young people sought family planning services, to the extent that the service providers often remarked- "Even these people need these devices?"

The study participants were hesitant to share about their behaviour and perceptions regarding family planning. All of them said that such family planning issues were still not discussed in the open. No wonder they had limited knowledge of family planning methods, with the male participants stating that the main family planning method among the unmarried was the emergency contraceptive pill.

While all agreed that decisions on the usage of family planning methods should be made through consensus among the couples, the female participants highlighted that men are usually the sole decision makers for the type of the family planning method to be used after marriage.

"When there is no discussion, there is no question of decision. But, they (males) offer to buy us the 'morning-after' pills the next day, and we have to agree as we do not have other alternatives. We do not have the confidence to buy contraceptives, so we willingly allow unprotected sex", said a female participant.

Another woman with disabilities in Kathmandu confided that, "Once when I went to buy vaginal tablets, the pharmacist looked at me in such a way as if I have committed a murder. Since then I have never gone to buy any contraceptive device on my own."

Myths associated with contraceptive use also exist. Many persons with disabilities think that condoms and intra-uterine devices do not give sexual satisfaction, or that vasectomy makes a man sexually weak.

If this is the attitude and level of understanding in the big cities, one can imagine the situation in small towns and rural areas.

Shibu wants all information and services for persons with disabilities to be equipped with accessibility standards - like provision of ramps, larger bathrooms with grab bars, lowered examination tables, easy to read versions, sign language interpreters, tactile communication provision, audio formats and braille script, including pictorial form for persons with intellectual disabilities and autism disorder.

Srei Chanda, who is a research scholar at the International Institute for Population Sciences, did a study in two metropolitan cities of India which explored the plight of people with acquired locomotor disability due to lower limb amputation (as a result of accidents or some underlying health condition). According to Srei, amputees not only have to battle physical, psychological, social and economic changes, but their sexual and reproductive health needs also remain largely unaddressed.

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