Disability measurement and uptake of sexual and reproductive health services in Malawi

Abstract

Addressing the sexual and reproductive health needs of persons with disabilities has been one of the development challenges confronting the global community since the 1994 International Conference on Population and Development (ICPD). This challenge has been more critical in sub-Saharan Africa due to limited availability of disability data, poor-socio-economic status of persons with disabilities and the lack of a universally agreed upon conceptual understanding of disability. Researchers have attempted to address data limitation problems by developing impairment and functional screens that have been used to estimate the proportion of persons with disabilities. However, little has been done in the sub-Saharan African region to examine the various approaches used to measure disability and their relationship with the uptake of sexual and reproductive health services among persons with disabilities.
Using anchoring vignettes techniques and Compound Hierarchical Ordered Probit Modelling, this study has examined the self-reported measurement of disability in Malawi. The study has also examined the relationship between impairment and functional limitation as measures of disability with uptake of sexual and reproductive health services using logistic regression models. Among the sexual and reproductive health services used in the analysis are use of modern contraceptive methods, HIV counselling services, place of delivery and professional assistance during childbirth.
Controlling for demographic variables such as age and place of resident, this study has found that there are significant variations in use of HIV counselling services by severity of functional disabilities, where women with severe functional disabilities are less likely to use HIV counselling services compared to those with no functional disabilities. This study has also found that there are measurement problems related to the self-reported disabilities. For instance, the study has found that survey respondents use their health expectations and conceptual understanding of disability to respond to questions on functional disabilities. The use of individual understanding of disabilities is likely to affect the accuracy of disability estimates since there is no standardised definition of disability in the country. The low use of HIV counselling service among women with severe functional disabilities implies that most women with functional disabilities are not aware of their HIV status. This necessitates the need for intensifying the provision of HIV counselling information to women with functional disabilities.

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ORCID for A G Hill: orcid.org/0000-0002-4418-0379

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