“Only some Deaf women make their own decisions when seeing a doctor. … The doctors and nurses would make the decision for me which family planning method to take, even though I choose another family planning method. However, the doctor would tell me to take the one they choose, because it’s better.” – 27-year-old Deaf woman from Fiji
Women and young people in general, both globally and in the Pacific countries, often face barriers that prevent them from realizing their sexual and reproductive health and reproductive rights and from receiving support in the face of gender-based violence (GBV). Those with disabilities face even more accentuated barriers in this regard. A new UNFPA Pacific initiative sets out to address this issue.
The pilot outreach project entitled Women and Young People with Disabilities in Fiji, Samoa, and Vanuatu – A Needs Assessment of Sexual and Reproductive Health and Rights, Gender-Based Violence, and Access to Essential Services brings together sexual and reproductive health (SRH) officers with disabilities from the Fiji Disabled Peoples Federation and representatives from Fiji’s Ministry of Health and Medical Services to raise awareness in communities on SRH information and services and to increase demand for family planning among persons with disabilities.
The project stems from three recently launched needs assessments, produced jointly by UNFPA Pacific, Women Enabled International (WEI), and the Pacific Disability Forum (PDF), that identified the challenges women and youth with disabilities face in accessing SRH services and provide recommendations for how programming can tackle them. This project and the country-specific reports were developed under UNFPA Pacific’s flagship programme, the Transformative Agenda for Women, Adolescents and Youth in the Pacific. This programme has been supported by an AUD 30 million investment by the Government of Australia Department of Foreign Affairs and Trade (DFAT) aimed at reducing unmet need for family planning in the Pacific region.
“Reports only scratch the surface”
During the launch of the three needs assessments on 23 August 2022, UNFPA, WEI and PDF presented the wide array of challenges faced by persons with disabilities in accessing SRH and GBV information and services. In addition to tangible barriers, such as a poor physical environment (e.g., no ramps) and inadequate information supply (e.g., no braille or sign language), less tangible barriers were also discussed including an unfavourable policy landscape. For example, women with disabilities are often deemed unable or unreliable when making decisions or entering into a legal relationship, and as a result are subjected to situations where someone other than the person with the disability can be authorised to make legally binding decisions that impact that person’s life. Usually, the person with a disability has limited avenues that can challenge the loss of their legal capacity.
“When I was pregnant, I was so looking forward to taking care of my baby because I was experienced in taking care of my other cousins and siblings. However, I didn’t know my parents had pre-arranged for a cousin of mine to take my baby and care for her. My family told me I cannot look after my baby. I felt so sad.” – Deaf woman in Samoa, age 23
Another immense challenge for women and girls with disabilities in the Pacific is negative attitudes from other people, including their family. Women and young people with disabilities have the same sexual and reproductive rights as people without disabilities, and they are just as likely to be sexually active as their peers without disabilities. However, oftentimes, health care workers and family members do not think it necessary to support women and young girls with disabilities to access family planning, because of their false presumption that it would not be useful for them. Worse, many women and girls with disabilities face derision when they try to access contraception. These negative attitudes often prevent persons with disabilities from accessing SRH services.
The findings of the reports prompted candid discussions during the launch. Faaolo Utumapu-Utailesolo, a Samoa-based consultant, who led data collection for the report, concluded that “the reports only scratch the surface of the seriousness of the situation. Change needs to happen now.”
Creating change through outreach
The Government of Fiji is bringing about such a change - by initiating a pilot outreach project to address the reports’ recommendations. As part of the project, SRH officers with disabilities will partner the Ministry of Health and Medical Services to conduct outreach efforts aimed at discussing sexual and reproductive health and reproductive rights related issues at the community level, addressing stigma around SRH services, including contraception, and disseminating practical information about SRH services available in the community and how to access these services.
Anaseini Vakaidia of the Fiji Disabled Peoples Federation, who is one of the SRH officers, emphasised that the project also includes a focus on carers and family members. “We believe SRH information and training is not only for persons with disabilities,” she said, “but should also address how we can educate their family members, carers and support persons for better support for persons with disability.”
The first three community outreach sessions took place immediately after the launch of the needs assessment reports in August and September 2022. One hundred and twenty-one participants, including persons with disabilities, support persons and family members attended from different communities across Fiji. Sessions included information on family planning and other aspects of SRH, STI/HIV, sexuality, and menopause. Participants also received SRH/FP counselling services.
Divisional Officers and other health workers were sensitised on topics including the appropriate terms to use when referring to different impairments and exploring the various barriers that persons with disabilities may face.
Dr. Pravineel Singh, one of the health workers, was happy with the session. “We got a good opportunity to learn about how to interact with persons with disabilities,” he said. “We even had a brief but useful session on how to do sign language, and some of us were motivated to take up sign language courses in the future to facilitate better communication. Everyone had a lot of questions and we had to extend our session from 2 to 3 hours, to answer all the questions!”
UNFPA Director and Representative, Iori Kato, said: “We as UNFPA will continue to do all we can to help Pacific Island countries reflect on and implement the reports’ recommendations. Working together, we can jointly create, embrace and cherish a more inclusive society where everyone, including women and youth with disabilities, can feel more empowered to make decisions regarding their own bodies and their sexual and reproductive health and rights, and can enjoy lives free of discrimination and violence, truly leaving no one behind.”
Watch this space for regular updates and inside stories from the outreach pilot.
The reports are available at the links below.
Fiji: https://pacific.unfpa.org/en/publications/needs-assessment-people-disab…;
Samoa: https://pacific.unfpa.org/en/publications/needs-assessment-people-disab…;
Vanuatu: https://pacific.unfpa.org/en/publications/needs-assessment-people-disab…
Q&A with launch participants
Question: If you had to articulate three recommendations that should be implemented, what would you choose and why?
Sara Sua, UNFPA Samoa office
Develop disability-specific values clarification training for a wide range of SRH and GBV service providers and for police and justice sector personnel.
Create and expand rights-based awareness raising programmes on disability rights and inclusion grounded in the Convention on the Rights of Persons with Disabilities (CRPD) framework and in consultation with Disabled People’s Organisations (DPOs).
Address the under-diagnosis of intellectual disabilities and invest in early intervention and support services for people with disabilities and their families.
“I chose these recommendations because, I feel and believe that no matter how well developed the legal and policy frameworks are, or whether systems are well established to respond to the rights and needs of PWDs, we need to change the mindsets and attitudes of people towards these vulnerable groups. It cannot be done overnight, but it needs to be consistent and sustainable. There are still not enough programs and interventions targeting families, communities, service providers who are directly involved and dealing with PWDs. More emphasis and investment need to be focused on families/carers, communities, service providers etc, educating them on the needs of PWDs and changing attitudes and mindsets towards this key population. Training them on how to communicate with them, and understand their needs, behaviours and importance in society. Making them feel wanted, and giving them that sense of belonging and inclusiveness. So, unless we work on the mindsets and attitudes of people who are running systems and implementing programs and developing policies and legislations, programs and interventions will not be sustainable and will always fail in one way or the other.”
Roslyn David, UNFPA Vanuatu Office:
“The report highlighted the need to truly integrate programs to better address the needs of PWD. While the recommendations from the report were few, they were all very strategic. The recommendation on the adoption of policies to address the marginalisation of PWD, is in my opinion, one of the first recommendations that government and stakeholders should adopt. The value of policies is that they can be costed - a much-needed component in the implementation of programmes for PWD. Without a budget, policies are just ideas on pieces of paper. With funding, we can start to create positive opportunities for PWD.”
Sofia Mineri, Women Enabled International:
“As the reports reveal, organisations of persons with disabilities and individual activists from across the region are calling States to collaborate with them in recruiting and mentoring women and young people with and without disabilities to work together as leaders of support groups and peer-to-peer networks in their communities. In Fiji, this intersectional and collaborative strategy is already proving to be key to successfully disseminating information on disability and women’s rights, including around SRH and GBV; addressing the persisting stigma around these rights, and improving access to SRH and GBV services.”
Anaseini Vakaidia, Fiji Disabled People’s Federation:
“We need to do more to reach out to women and young people with disabilities in rural areas, and not just focus on those in urban areas. Many people with disabilities at the community level do not know that these services are available to them.
Sexual and reproductive health is a sensitive topic for us women with disabilities. In urban areas, we are still able to talk about it. But for women and young people with disabilities in rural areas, especially those based in villages or community settings, it’s a challenge for them to talk about these issues and access these services.
The SRH pilot program will have even more impact if we are able to focus on areas in Fiji that have not been touched. Another issue relates to gender-based violence (GBV). We are trying to get counsellors to come with us during outreach efforts. But many people with disabilities are worried about what will happen to them if they speak with counsellors about the GBV they are facing at home. So, we don’t know what they’re going through at home. If they are victims of GBV, this could also lead to pregnancy, which means they would also need access to SRH services.
We are also learning to look at things from the perspectives of health workers, not just people with disabilities. For health professionals working in the area of family health, we are working on issues like how can they service people with disabilities without judging them? How can they provide reasonable accommodations? How can they be more accessible?”
