C:\Users\G.Graham\OneDrive - Federation HI\Documents\Templates and logos_1\logo_hi_en_verti_blue_rgb.jpgThe FCDO’s approach to sexual and reproductive health:

Evidence from Humanity & Inclusion UK

18th April 2023

 

About Humanity & Inclusion

 

Humanity & Inclusion (HI) is an international non-governmental organisation working with persons with disabilities and vulnerable populations in more than 50 countries worldwide. We are a leading actor in disability inclusion in the health sector and in disability-inclusive Sexual and Reproductive Health and Rights (SRHR).

 

HI has developed inclusive SRHR-related projects in 22 countries. Examples include:

 

-          The FCDO-funded and International Planned Parenthood Federation (IPPF)-led WISH (“Women’s Integrated Sexual Health”) programme (lot 2), for which HI is the technical partner for inclusion; HI provides expertise on inclusive approaches to high-quality integrated and inclusive family planning and SRH services and information to marginalised and hard-to-reach populations, including persons with disability, across 15 countries in Africa and Asia.

-          The SARAL project, which was implemented in Nepal from 2019 to 2022 as part of the FCDO-funded and Sightsavers-led Inclusive Futures programme and which aimed to improve the wellbeing of adolescent persons with disabilities by increasing access to SRHR information and services.

-          The Ensemble project (2020-2023), which is funded by Global Affairs Canada and which we co-lead with Care International; this project aims to improve access to SRHR through inclusive social behaviour-change communication, comprehensive sexuality education and SRH services and advocacy, with a focus on women and adolescent girls, including those with disabilities, in Togo, Côte d'Ivoire and Senegal. 

-          Regional HIV and Disability projects (2017-2020) supported by the Global Fund, through which HI produced rigorous data in six West African countries showing that women with disabilities are significantly more affected by HIV/AIDS than the general female population.

-          The Gender, Sexuality and Disability in China project (2014-2019), supported by Ford Foundation, which was a pilot project implemented at the community level in partnership with Beijing-based organisations of persons with disabilities (OPDs), SRHR civil society organisations and academic institutions 

 

As part of these and other projects, HI and partners have authored and co-authored many key guidelines and documents on inclusive SRHR. These are listed in an annex to this submission.

 

Specific challenges faced by persons with disabilities with respect to SRHR

 

Despite having the same sexual and reproductive health needs and rights as any person, adolescent girls and women with disabilities face multiple barriers to accessing SRHR information, education and services. These can be physical, attitudinal, communicational or institutional.

 

Evidence shows that the consequences of these barriers are significantly detrimental to their sexual and reproductive health. Women and girls with disabilities are less likely to access contraception or to be screened and treated for sexually transmitted infections, including HIV/AIDS, or reproductive cancers. They are also more likely to be denied their right to bodily autonomy and informed consent; they are at greater risk of being forced into pregnancy or subjected to coerced procedures such as sterilisation, abortion or contraception. They are more vulnerable to violence, including sexual violence; between 40% and 68% of young women with disabilities will experience sexual violence before the age of 18.[1]  They also face higher risks of maternal and neonatal morbidity and mortality.

 

Measures required to overcome these barriers

 

These barriers can be overcome through sustained efforts, taking into account the intersection between the different aspects of inequality (including those relating not only to disability and gender, but also to age, sexuality, ethnicity, social class etc.) that hinder women and adolescent girls with disabilities from accessing SRHR information, education and services.

 

In HI’s experience, SRHR actors including government agencies, NGOs, community-based networks and private providers can benefit enormously from technical support on disability-inclusive SRHR. This can help them develop and implement disability-inclusive policies and practices, support them in making facilities more accessible and build the capacity of healthcare professionals to provide high-quality SRHR information and services in ways that are accessible to women and adolescent girls with disabilities.

 

Social behaviour-change communication is a key ingredient that has proven to be effective in raising awareness about disability and SRHR and in helping to transform beliefs and reduce stigma preventing women and adolescent girls with disabilities from accessing SRHR information and services. However, it takes time to succeed and therefore needs to be adequately and sustainably resourced.

 

Most critical is ensuring the meaningful participation of persons with disabilities and their representative organisations, including organisations led by women and youth with disabilities, in the design, implementation, monitoring and evaluation of SRHR programmes. Support for the involvement of OPD members in health structures is essential to ensuring sustainable partnerships with SRHR stakeholders and to promoting national accountability for inclusive health. However, to be fully effective, engagement with and meaningful participation of OPDs needs to go beyond this and should also strengthen their organisational and financial capacity, particularly for those organisations led by women or young people with disabilities. In HI’s extensive experience, grassroots or about-to-build OPDs face severe challenges in keeping up with requirements set by international donors; there is therefore a need for more participatory and flexible ways of channelling funding to these organisations.

 

It is also important to be mindful of unintended consequences when setting quantitative targets for SRHR programmes, as greater time can sometimes be needed to secure fully informed consent from women and adolescent girls with disabilities.

 

FCDO strategies and funding

 

The FCDO has a good record in the area of disability-inclusive SRHR, as exemplified by the WISH and Inclusive Futures programmes referenced above. It has an excellent Disability Inclusion and Rights Strategy that sets out an ambition for persons with disabilities everywhere to access and use affordable, accessible, and quality health services throughout their life, including SRHR services. However, more work needs to be done to mainstream the Strategy across all FCDO programmes and to ensure that posts proactively implement its provisions.

 

The recently published International Women and Girls Strategy is another key framework shaping the UK’s work on SRHR for women and adolescent girls with disabilities. It includes welcome commitments to prioritise support for women with disabilities and to support women’s rights organisations that have a focus on disability inclusion. However, in general, disability does not feature very strongly in the Strategy and leadership will be needed to ensure that its implementation at the country level includes a consistently and reliably strong focus on disability inclusion.

 

Of course, these strategies have been published in the context of significant and rapid reductions in the UK aid budget, including funding for SRHR programmes. These have not only substantially reduced the level of ambition to which the UK can aspire, but they have also caused very heavy disruption and damage to programmes that were already running, with the result that high-impact activities have had to be abruptly ended and organisations and direct beneficiaries have lost precious support and services. These cuts have had a disproportionately harmful impact on the most marginalised groups, in particular on women and adolescent girls with disabilities.

 

Recommendations for the FCDO

 

-          Review the excellent work that it has supported in recent years on disability-inclusive SRHR, and promote internally and externally the impact that has been had and the lessons that should be carried over into future investments.

-          Promote the Disability Inclusion and Rights Strategy internally and ensure its implementation by all UK posts, including when designing and implementing SRHR programmes.

-          Establish disability-inclusion as a requirement in the implementation of the International Women & Girls Strategy, ensuring that it features clearly in all country-level plans and budgets, including and especially with respect to SRHR.

-          Ensure the meaningful participation of persons with disabilities and their representative organisations in the design, implementation, monitoring and evaluation of SRHR programmes.

-          Support long-term social behaviour-change communication about disability and SRHR in order to transform beliefs and stigma that prevent women and adolescent girls with disabilities from accessing SRH information and services.

-          Invest in adapted, flexible and sustained support for OPDs, particularly those led by women and youth, in order to support them in making long-term contributions to SRHR for women and adolescent girls with disabilities.

-          Take measures to avoid unintended consequences leading to exclusion, for example through over emphasis on quantitative targets that inadvertently reduce the likelihood of women or adolescent girls with disabilities being included in interventions.

 

Annex: Select bibliography of HI-authored / co-authored guidelines and documents on inclusive SRHR

 

•          2023, Strategic Planning Guide to Facilitate the Inclusion of Persons with Disabilities in Family Planning, High-Impact Practices (HIPs)     

•          2022, Sexual and Reproductive Health and Rights for All: Disability inclusion from theory to practice, Humanity & Inclusion. A WISH2ACTION Initiative

•          2021, Learning from a disability-inclusive sexual reproductive health and rights programme (WISH2ACTION), Humanity & Inclusion. A WISH2ACTION Initiative

•          2021, Access to Sexual and Reproductive Health and Rights Information and Services: Perspectives of women and girls with disabilities in Uganda and Bangladesh, Humanity & Inclusion. A WISH2ACTION Initiative

•          2019, HIV & Disability in West Africa: A combined analysis of 4 studies conducted in Burkina Faso, Niger, Guinea Bissau and Cape Verde, Humanity & Inclusion

•          2019, Policy Brief: Sexual and Reproductive Health and Rights of Women and Young Persons with Disabilities in China, UNFPA and Humanity & Inclusion

•          2019 “When Sexuality Meets Disability: Experiences, attitudes and practices from China”, in P. Chappell and M. de Beer (eds), Diverse Voices of Disabled Sexualities in the Global South. New York, Palgrave Macmillan. pp. 277-299

•          (2018), Seeing the Invisible: Sexuality-related knowledge, attitudes and behaviour of children and youth with disabilities in China, UNESCO and Humanity & Inclusion

[1] “Data from “We Decide”, a UNFPA-led initiative to promote gender equality and social inclusion of young people with disabilities and to prevent sexual violence.