ACCESS TO FAMILY PLANNING SERVICES BY WOMEN WITH DISABILITIES IN MUKONGORO SUB COUNTY, KUMI DISTRICT
CHAPTER ONE
Having a disability places one in the world’s largest minority group. An estimated 10 percent of the world’s population lives with disability. The World Bank (2004) estimates that 20 percent of the world’s poorest people have some kind of disability, and tend to be regarded in their own communities as the most disadvantaged.
Globally, Disabled people comprise approximately 10% of the world’s population, 75% of whom live in developing countries, and constitute one of the most poor, marginalised and socially excluded groups in any society. Disabled people, irrespective of where they live, are statistically more likely to be unemployed, illiterate, to have less formal education, and have less access to developed support networks and social capital than their able-bodied counterparts (Munene, 2012).
According to the World Health organization-Department of Reproductive Health and research (WHO, 2007), there is a global concern about Reproductive Health Programmes/ Care (Family planning Services) for all women irrespective of their reproductive age and disability. It further suggests that Family planning remains unfinished.
Family planning refers to practices that help couples to avoid unwanted child birth, to regulate the intervals between pregnancies and to determine the number of children in the family. It is also the process of controlling the number of children you have by using family planning methods. According to Bankole et al. (2006), the role of family planning methods is to help women and men reconcile their sexual lives and their desire for children.
According to Alcala (2013), in developing countries today, particularly in Africa, couples have concluded that it is in their best interest to plan and limit the number at birth. Unfortunately, in situation particularly in Sub-Sahara Africa, extreme poverty, profound inequalities between men and women, and early marriages, severely limit women’s ability to achieve their child bearing goals.
Uganda, like any other developing country has challenges in making Family Planning Services accessible by all women (Uganda Service Provision Assessment – UPSA, 2007). Despite USPA’s struggle to make Family Planning services accessible by women, 6.9% of Ugandan women still have about 7 children average. According to United Nations (2015) the government support for long term and permanent methods of Family Planning has been present since the time of introduction of services in Uganda. The feasibility of this government support through media and community based advocacy events has been limited.
Women with disability often cannot obtain even the most basic information about sexual and reproductive health (SRH). Thus they remain ignorant of basic facts about themselves, their bodies, and their rights to define what they do and do not want. They may have little experience relating to and negotiating with potential partners. Women with disability may be denied the right to establish relationships. They fit the common pattern of structural risks for HIV/AIDS and other sexually transmitted infections – e.g. high rates of poverty, high rates of illiteracy, lack of access to health resources or information, and lack of power when negotiating safer sex (Tonny, 2015). Women with disability face many barriers to care and information about SRH. There is the frequent assumption that persons with disabilities are not sexually active and therefore do not need SRH services. However, research shows that persons with disabilities are as sexually active as persons without disabilities (World Bank, 2004).
Uganda has several laws and policies that it has put across to ensure that women with disabilities have access to health services just like any other woman for example the PWD Act (2006) which stipulates that the government shall provide special health services required by PWDs including providing access to reproductive health services which are relevant to women with disabilities. However, family planning services are often inaccessible to women with disability for many reasons, including physical barriers, the lack of appropriate clinical services, and stigma and discrimination. In many situations, barriers to health services include: lack of physical access, including transportation and/or proximity to clinics and, within clinics, lack of ramps and adapted examination tables; lack of information and communication materials (e.g. lack of materials in Braille, large print, simple language and pictures, lack of sign language interpreters); health-care providers’ negative attitudes and; providers’ lack of knowledge and skills about persons with disabilities (Mosha, 2015).
Mukongoro is a sub county in Kumi County in Kumi district in Eastern region in Uganda. It has about 16 parishes and 46 villages. Kumi district has 2 hospitals, 1 health IV, 5 health centre IIIs and 8 health centre IIs with a total of 16 health facilities. Access to health facility has increased slightly to 85% and the general service delivery and primary health care in the district has improved over the years. Mukongoro has 1 health centre III and 1 NGO health centre II, these are accessed by both women with and without disability. It’s upon this background that the study will be carried out in Mukongoro Sub County to investigate the access to family planning services by women with disabilities.
Problem statement
Slightly less than half (46%) of currently married women are using some method of contraception and only 15.6 percent of married women with disability use any type of family planning. There are disparities in contraceptive use among all women and women with disability. Several studies have associated increased level of unmet need for contraceptive use to increased levels of fertility. Women with disability, like all people, should enjoy human rights that are secured by laws and policies in Uganda for example the PWD Act (2006) which stipulates that the government shall provide special health services required by PWDs including providing access to reproductive health services which are relevant to women with disabilities.
The Government of Uganda, being a signatory to international laws and policies, needs to ensure that women with disability enjoy their rights. The disparity in contraceptive use between women with and without disability also needs to be addressed. If not, Government’s efforts to reduce fertility levels in Uganda may not be achieved. Thus, the study will be carried out in Mukongoro Sub County to assess the access to family planning services by women with disabilities.
Purpose of the study
The main purpose of the study is to investigate the access to family planning services by women with disabilities in Mukongoro Sub County, Kumi District.
- To find out the social-economic factors that influence the access to family planning services by women with disability Mukongoro Sub County, Kumi District.
- To assess the challenges faced by women with disabilities in accessing family planning services in Mukongoro Sub County, Kumi District.
- To suggest strategies to improve family planning services offered to women with disabilities in Mukongoro Sub County, Kumi District.
- What social-economic factors influence the access to family planning services among women with disability Mukongoro Sub County, Kumi District?
- What challenges are encountered by women with disabilities in accessing family planning services in Mukongoro Sub County, Kumi District?
- What strategies can be adopted to improve family planning services offered to women with disabilities in Mukongoro Sub County, Kumi District?
Scope of study
Content scope
The study will investigate accessibility of family planning services by women with disabilities. Specifically, the study will identify family planning services offered to women with disabilities, challenges faced by women with disabilities in accessing family planning services and suggest strategies to improve family planning services offered to women with disabilities.
Geographical scope
The study will be carried out in Mukongoro Sub County, Kumi District. This is due to the easy access to the area.
Time scope
The study will be carried out for a period of four months in 2017.
Significance of the study
To policy makers, the study will provide relevant information for them to put more effort on improving on the methods of family planning and increase their accessibility to women with disabilities.
To health care providers, the study will enable them realize the factors that hinder the accessibility of family planning services by women with disabilities.
NGOs will find the findings of this study important since it will provide them with relevant information that they can use to act upon improving health of women with disabilities.
Women with disabilities will be availed with information on what family planning services that they can use.
The study will be relevant to the scholars in that it will add more literature base on the existing body of knowledge.
Limitation of the study
Financial resources will be inadequate since the University will not be in position to facilitate the resources to the researcher with funds for typing, binding and other expenses like transport fees when using the area of investigation.
A hostile respondent is also another problem the researcher will face. It is known that in communities they very many people which very loud and are not associate able this will greatly affect the researcher.
This unrealistic expectation from the respondents is also another problem the researcher will face. It is argued that very many people will expect too much thing from researcher for example money etc, yet the researcher is totally student who does not have money.
Delimitation
The researcher will obtain fund from family members i.e. parents and guardians plus friends to solve the problem of limited financial resources.
In order to solve problem of hostile respondent’s researcher the researcher will use community leaders to approach those respondents to get the required information from them.
The researcher will use the local leaders to convince the community members that researcher is here to gather information on the given problem which will help to use in future but don’t expect much things like money from him.
