Barriers to Sexual and Reproductive Health Services for Adolescents and Young People with Disabilities in the Bono Region, Ghana: A Cross-Sectional Study
This cross-sectional study in Ghana's Bono Region reveals that adolescents and young people with disabilities face significant structural, informational, and physical barriers to sexual and reproductive health services, with educational attainment serving as a key protective factor against service denial while disability severity and location remain critical determinants of access challenges.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In many parts of the world, a quiet but persistent assumption shapes how society treats young people with disabilities: the belief that they do not have sexual lives or reproductive needs. This misconception often leads to their exclusion from conversations about relationships, health, and family planning. When healthcare systems operate under this false premise, they fail to provide essential services to a group that is already navigating a world not built for them. The result is a gap in care where young people with disabilities are left without the information, privacy, or physical access they need to make decisions about their own bodies. This is not just a matter of policy; it is a matter of basic human rights and health equity.
To understand the depth of this problem in Ghana, researchers set out to listen directly to the voices of adolescents and young people with disabilities. They focused on the Bono Region, a specific area in the country, to map the real-world obstacles these young people face when trying to access sexual and reproductive health services. The study involved 440 participants, all between the ages of 15 and 24, who were recruited from schools, health facilities, and community organizations in three different municipalities. The researchers did not just ask if these young people had visited a clinic; they asked what stopped them, what happened when they tried, and how their education, where they lived, and the severity of their disability influenced their experiences.
The findings reveal a landscape of barriers that are as much about attitude and information as they are about physical infrastructure. While two out of three participants reported having used sexual and reproductive health services in the year before the study, more than one in four said they had been denied information or care specifically because of their disability. The most significant hurdles were not always the visible ones, like a lack of ramps, but rather the invisible walls of ignorance and fear. The highest-rated barrier was a simple lack of knowledge: many young people did not know they had a right to these services. Closely following this was a deep-seated fear of being judged or stigmatized by family, community members, or even the healthcare workers themselves. Concerns about privacy and the ability to speak confidentially with a provider also ranked very high.
When the researchers broke down the data, a clear pattern emerged regarding who could navigate the system most successfully. Education proved to be the most powerful tool. Young people with tertiary education were far more likely to have used services and far less likely to be turned away compared to those with no formal schooling. This suggests that education provides more than just academic knowledge; it equips young people with the confidence and literacy needed to demand their rights and understand the healthcare system. Conversely, the severity of a person's disability played a major role. Those with severe or very severe disabilities faced significantly higher barriers and were less likely to access care, regardless of where they lived.
The study also uncovered that the type of barrier a person faced often depended on their specific circumstances. The researchers identified two distinct categories of obstacles. The first group included institutional and social hurdles, such as the fear of stigma, long wait times, and a lack of adapted services. These barriers were influenced by a wide range of factors, including a person's age, their education level, and the specific municipality they lived in. The second group consisted of physical and transport barriers, such as inaccessible buildings or the inability to afford a ride to a clinic. Interestingly, these physical barriers were driven almost entirely by the nature of the disability itself, particularly for those with visual impairments or very severe physical limitations, rather than by social factors like education or location.
Geography also played a nuanced role in the story. While young people in the Sunyani municipality reported fewer barriers and better service use than those in Wenchi or Dormaa, this difference largely disappeared when the researchers accounted for education and disability severity. This suggests that the advantage of living in Sunyani was not just about better clinics, but about the concentration of educated individuals and specific support structures there. However, even after adjusting for these factors, where a person lived still mattered when it came to being denied services, indicating that local attitudes and practices vary significantly from one town to another.
The study concludes that fixing this issue requires a dual approach. Because the barriers are so different—some rooted in social attitudes and information, others in physical reality—solutions must be equally varied. Improving access means not only building ramps and providing transport but also training healthcare workers to communicate effectively and respectfully, and ensuring that young people know their rights. The research highlights that while education is a strong shield against exclusion, it is not a complete cure. Without changes to the physical environment and the attitudes of service providers, even the most educated young people with disabilities will continue to face significant hurdles in getting the care they need. The path forward involves recognizing that these young people are not asexual or incapable, but are simply waiting for a system that is ready to see them and serve them.
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