Inclusive Health: Addressing the Overlooked Sexual and Reproductive Needs of Adolescents with Disabilities

By Bó̩ládalẹ́ Tèmítọ́pẹ́ Maryam

Disability rights in public discourse is rarely viewed from the lens of sexual and reproductive health and as a result, a culture of silence around sexual and reproductive health for persons with disabilities has taken root in our society. Despite strong scientific evidence to the contrary, many still erroneously assume that persons with disabilities are asexual or do not have sexual and reproductive health needs. As we aim to build a more inclusive and accessible society that prioritises the needs and experiences of persons with disabilities, it is important that we draw the spotlight on the sexual and reproductive health of persons with disabilities as a critical component of disability rights and public health. In particular, this editorial focuses on adolescents as a crucial demography in promoting healthy sexual behaviours among persons with disabilities.

United Nations estimates suggest that there are between 180 and 220 million youth aged between 15 and 24 with disabilities worldwide and nearly 80 per cent of them live in developing countries. In Nigeria, the National Commission for Persons With Disabilities (NCPWD), estimates that there are 35.1 million persons currently living with disabilities in Nigeria. While there are data gaps which make it challenging to state what exact proportion of this number are adolescents, a combined reading of the quoted statistics suggest that adolescents with disabilities in Nigeria are a significant population and must be factored into public health policies and interventions.

Access to sexual and reproductive health information and services is not a privilege but a critical component of our right to health as provided in Chapter 2 of the Constitution of the Federal Republic of Nigeria and international treaties to which Nigeria is a party. Available literature shows that although adolescents are at higher risk for sexual and reproductive health (SRH) problems, they still experience limited access to life-saving health information and services. For adolescents with disabilities, the lack of access is even deeper.

The lack of access to sexual and reproductive health services for adolescents with disabilities erases their sexuality, fuels stigma, and leaves persons with disabilities without the information and services they need to make safe and informed choices about their bodies and reproductive health. While cultural norms might favour this culture of silence around SRH, silence does not help anyone.

Abuse thrives in silence and the general lack of public awareness on SRH exposes adolescents with disabilities to the continued violation of their basic human rights, unintended pregnancies, maternal health complications, sexually transmitted infections, mental health disorders, substance abuse and other preventable health risks that go far beyond individual lives and amount to a public health issue.

Adolescents with disabilities make up one of the most overlooked groups in our health system and are very unlikely to access SRH information and services that empower them to make informed decisions on their sexual and reproductive health or exercise bodily autonomy. Bridging this public health gap is necessary to improving overall health outcomes. Adolescents with disabilities are part of our population, and their exclusion undermines our national health goals. For instance, Nigeria cannot hope to achieve the Sustainable Development Goals (SDGs), target 3.7 of which focuses on sexual and reproductive health if a whole group of young people are overlooked in health policy implementation and service delivery.

Sexual and reproductive health for adolescents with disabilities must be recognised and addressed as a public health issue with the same urgency and resources we devote to other health challenges. In addressing it, we must employ creative methods and interventions that bridge the access and inclusion gap in sexual and reproductive health.

For example, public health campaigns such as the Curriculum Project can help create public awareness and challenge the stigma and misconceptions around the sexual and reproductive health needs of adolescents with disabilities. Additionally, sexual and reproductive health service delivery should be made more flexible to adapt to the needs of adolescents with disabilities by offering services in multiple accessible formats, such as sign language, braille, and easy-to-read materials. Community-based and school-based delivery of sexual and reproductive health must also be prioritised over facility-based care in order to include more persons with disabilities.

Digital health tools such as accessible mobile apps can also provide discreet, reliable SRH information for adolescents with access to digital communities. In rural communities, radio dramas and community theatre have proven effective in sparking conversations and can be adapted to reflect the realities of adolescents with disabilities. These interventions not only expand access but also build confidence and agency among young persons with disabilities.

Conclusively, addressing SRH information and services for adolescents with disabilities is not just about talking over the heads of young persons with disabilities and assuming we fully understand their needs. Every policy and programme intervention must be delivered with the meaningful involvement of young persons with disabilities. Their voices must be central in the design and implementation of SRH initiatives. Without this, we stand the risk of investing in initiatives that have little impact or are not acceptable by the intended recipients.

Public health is strongest when it is inclusive. By ensuring that adolescents with disabilities have equal access to sexual and reproductive health, we are not only protecting a vulnerable group, we are also investing in a healthier, more equitable future for all of us.

Bó̩ládalẹ́ Tèmítọ́pẹ́ Maryam is an AU Bingwa Plus Fellow and the Project Lead at Ìlera Lójù, a development organisation focused on advancing better health outcomes for Nigerians by leveraging arts, media, and storytelling.  

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