Table 5 Triangulation of study findings

Conceptualisation of SRH

Types of SRH services and STIs

The majority of the respondents indicated that they have ever heard about SRH (94.3%), Sexually transmitted infections (92.5%) and HIV/AIDS (97%)

“I also know that SRH is also about having a healthy sexual life. There are some people who engage in multiple sexual partnerships even when they are married. You don’t know the kind of disease the person has. So, if you are not lucky, you can contract diseases like gonorrhoea and HIV”. [Physically Disabled, Kumasi, Male, 56 years]

This indicates that the majority of the respondents were aware of the concept of SRH, STIs, and HIV/AIDS. However, there are still misconceptions surrounding some of the SRH commodities. This calls for tailored education to address these misconceptions

Active engagement in SRH information seeking

Sources of information on SRH services

Radio/TV was the most common source of information on SRH, reported by 91.4% of the respondents

68.8% indicated that health workers was their source of SRH information

“I normally listen to the radio. So, whenever I hear anything about SRH being discussed on radio, I will tune in to it and listen. Usually, I listen to XXX FM every Saturday being 12:30 pm and 2:30 pm. They have a health show called “you and your health”. They invite nurses to come on board to explain such issues to us. XXX too has a similar programme on health. They discuss adolescent issues and sexually transmitted infections. They also talk about personal hygiene and menstrual hygiene. Personally, I organised a programme on community water, sanitation, and hygiene. Because of my condition, I don’t normally go to the internet. Growing up, we were not well-versed in ICT. We were not even having phones. It was the radio station that was serving us. So, I rely on the radio. If not, I have to rely on my children to read out information to me because I cannot read for myself. It is the radio stations who are helping”. [Visually Impaired, Kumasi, Male, 41 years]

Radio and television were the major sources of SRH information among PwDs. Some of the PwDs also indicated that their source of SRH information was healthcare providers. This represents a great opportunity for qualified individuals to provide appropriate education on SRH to persons with disabilities. This could also help reduce misconceptions surrounding some SRH products

Tensions between knowledge and religious beliefs

“I heard it, but I have one friend who did family planning, she put something in the arm, I think for 5 years but I think she has removed it now. I advised her to remove it because you know that as a lady you have to get your monthly flow if only you are not pregnant and because of that she doesn’t get her monthly flow, maybe if she gets it this month, it takes 3 months before she gets another one. So, what is the essence of putting it there? Just protect yourself but don’t use that, me I will not advise them to use that thing. It can cause fibroid, if you are not able to get your monthly flow it can cause fibroid. Because it is something that it is dirty, so that is why every month it has to come out, if the egg is not fertilized then it has to turn to blood and come out so if you are avoiding it to be fertilized and it is not coming out, what do you expect? It can be like blood clot so when it happens like that it can cause fibroid. And fibroid too is a serious condition among females”. [Visually Impaired, Kumasi, Female, 25 years]

“I see it as a sin to be practicing family planning. Plus, I have seen people who have used it and then they put on a lot of weight. Because I am already overweight, I would not want to add more weight. Also, I have heard people say that when you do family planning, it affects your menstrual cycle and leads to heavily bleeding”. [Physically Disabled, Offinso, Female, 36 years]

Although the awareness level is high, there are still some inherent misconceptions and religious beliefs that need to be addressed in order to increase the utilization of sexual and reproductive health services

Perceived utility of SRH services

STIs prevention

– 95% indicated that condom use is a main strategy to prevent STIs

– The most frequently reported importance was getting educated about STIs (98.9%)

“Also, if you use the condom, you will protect yourself from Gonorrhoea and other STIs. Mostly, a lot of beautiful women have STIs because a lot of men have sex with them”. [Physically disabled, Kumasi, Male, 36 years]

This shows that the majority of the respondents were knowledgeable about the use of condoms and their effectiveness in preventing STIs

Prevent unintended pregnancy

– 93.4% indicated that access to contraceptives is an important aspect of SRH services and this could prevent unintended pregnancy

“Sexual and reproductive health information helps me delay childbirth or prevent me from getting pregnant so that I can have time to finish the seamstress work because I just started. When you space your birth, it helps you to be emotionally stable and stress free because when the children are many it makes it difficult for the parents to take care of the children when the parents are poor”. [Physically disabled, Kumasi, Female, 27 years]

Preventing unintended pregnancies is a key strategy for many women to achieve their economic aspirations. It is also a means to empower women with disabilities and promote their economic wellbeing which invariably improves their overall quality of life

Safe delivery

“Also, through SRH services, women are advised to seek medical care from the hospital when they are pregnant. That alone helps them have safe delivery. I remember one of my sisters delivered at home and she ended up getting complications. But because the birth attendant was an old woman, she did not know what to do. At the end of the day, we rushed her to the hospital, but she died on arrival at the facility. So, from that experience, I learnt that it is important to always ensure that the women deliver at the hospital”

[Physically Disabled, Kumasi, Male, 47 years]

The utilization of sexual and reproductive health services such as antenatal care, health facility delivery, and postnatal care plays a crucial role in improving maternal health outcomes

Perceived functionality of SRH services

– The overall functionality score was 15 ± 4.9

– The visually impaired (16.6 ± 5.0, p < 0.001), those with Senior High School/Tertiary level of education (16.7 ± 5.3, p < 0.001) and those who earn GHC300 or more (14.6 ± 4.9, p < 0.001) perceived SRH to be unfunctional

“If you only seek for SRH services, you will get it. It doesn’t matter your disability status. You will be provided family planning if you ask for it. No one can stop you from doing family planning”. [Physically Disabled, Offinso, 46 years]

This shows that the ability of PwDs to access SRH services depends on their level of self-efficacy. Additionally, perceptions of the functionality of the health system vary based on the demographic characteristics of PwDs. However, not all PwDs are sufficiently empowered to easily seek SRH services. Therefore, it is important to enhance the functionality of the health system

“I don’t think it is functioning effectively. The last time, I was going to renew my health insurance, but I never knew that renewal of health insurance was free for PwDs until one of our members in the disability association informed me. So just imagine”. [Physically Disabled, Kumasi, Male, 47 years]

“…But I am sceptical about the extent to which the SRH services meet our needs as PwDs. I know my rights and so, I will always insist that you go by that. But for those who don’t know their rights, it is easy for them to face challenges”. Physically Disabled, Kumasi, Male, 56 years]

Most of the respondents perceived the health system as dysfunctional in meeting their sexual and reproductive health needs. This calls for a multisectoral approach to make the health system more user-friendly, thereby increasing the accessibility of SRH services for PwDs