Breaking barriers to SRHR for disabled women

By Michael Martin//MALAWI

Women and girls with disabilities in Malawi continue to face profound barriers in accessing sexual and reproductive health and rights (SRHR) despite the country’s progressive laws and policy commitments.

Speaking in an interview, Hastings Saka, National Coordinator of the Malawi Sexual and Reproductive Health Rights Alliance, said that for many women with disabilities the promise of equal access to health care remains distant.

He observed that discrimination, poverty and inaccessible health systems continue to overshadow existing policy gains.

According to Saka, physical access to health facilities is one of the most persistent challenges affecting women with disabilities across the country.

He noted that many public clinics and hospitals still lack ramps, paved pathways, accessible toilets and adjustable examination beds.

“Women who use wheelchairs or have mobility impairments often struggle just to enter health facilities, let alone receive appropriate care,” Saka said.

He further explained that the situation is worse in rural areas, where long distances to health centres and high transport costs significantly limit access to SRHR services for women with disabilities.

Saka pointed out that women with disabilities face both individual and systemic challenges when seeking SRHR services, adding that these barriers often reinforce each other.

Communication, he said, is another major obstacle within the health system.

Saka explained that very few health workers are trained in sign language, making it difficult for women with hearing impairments to communicate effectively with service providers.

He added that most SRHR information materials are produced only in print form, which excludes women with visual impairments who require Braille or audio formats to access information.

“Access to information is a right, not a privilege,” Saka emphasized, noting that inaccessible information denies women with disabilities the power to make informed decisions about their bodies.

Saka also highlighted that discriminatory attitudes among some health service providers remain widespread.

He said women with disabilities often report being laughed at, ignored, or questioned about why they need contraception, HIV services, or maternal health care.

According to him, such attitudes are rooted in harmful social norms that wrongly assume women with disabilities are asexual or incapable of motherhood.

Economic hardship, Saka explained, further compounds these barriers.

Many women with disabilities live in poverty and cannot afford transport, assistive devices or accommodation costs associated with accessing health services.

As a result, he said, they often depend on caregivers, a situation that compromises privacy, autonomy and informed consent when seeking SRHR services.

Saka noted that SRHR services in Malawi are largely delivered through a one size fits all approach, with little consideration for adaptive services tailored to women with visual, hearing, intellectual or physical disabilities.

Although a few hospitals have trained staff in sign language, he observed that such initiatives remain isolated and insufficient to meet national needs.

On the legal front, Saka acknowledged that legal framework provides a strong foundation for protecting the rights of women with disabilities in Malawi.

He cited the 1994 Constitution, which guarantees gender equality and access to adequate health care for women and people with disabilities.

He also pointed to the 2013 Gender Equality Act, which reinforces these protections by affirming equal health rights for all and the 2024 Disability Act, which explicitly guarantees access to health care and rehabilitation services.

However, Saka noted that legal contradictions persist within the system.

He explained that Malawi’s Penal Code restricts access to safe abortion to cases where a woman’s life is at risk.

“This restriction disproportionately affects women with disabilities who face higher risks of rape and incest,” Saka said.

He added that women with intellectual and psychosocial disabilities are among the most vulnerable to sexual violence yet current laws offer them limited protection.

Saka further observed that implementation of disability and health related policies remains weak.

Many health workers, he said they lack training in a rights based approach to service delivery.

He also noted that monitoring mechanisms to track access to SRHR services for women with disabilities are inadequate, making enforcement of laws and policies difficult.

According to Saka, outreach programmes in rural areas rarely include affirmative action for people with disabilities. Communication during outreach activities is often audio or print based, excluding women with hearing or visual impairments.

He said women with disabilities are sometimes exposed to public ridicule during community SRHR activities, reinforcing stigma and discouraging service uptake.

Maternal health services, Saka explained, present additional challenges.

Women with disabilities are often required to queue and stand for long hours without priority or reasonable accommodation.

He added that hospital infrastructure, including delivery rooms, toilets and beds, is rarely designed to meet the needs of women with disabilities, compromising safety and dignity.

Despite these challenges, Saka acknowledged that some positive developments are emerging within the health sector.

He cited the introduction of hospital ombudsmen to address grievances raised by service users, including people with disabilities.

He also welcomed the 2024–2028 National SRHR Policy which explicitly guarantees access to SRHR information and services for people with disabilities.

According to Saka, partner supported projects have contributed to improvements by installing ramps, providing wheelchairs and training some health workers in basic sign language.

He further noted that civil society organisations, women’s rights groups and organisations of persons with disabilities continue to play a critical role in filling service gaps.

Saka said it shows that targeted outreach and community based education can significantly improve SRHR awareness among women with disabilities.

Media organisations, he added, have also contributed by amplifying disability rights issues and challenging stigma through public awareness programmes.

However, Saka cautioned that most of these interventions remain underfunded and unsustainable.

“We need investment that matches policy commitments,” he said, stressing that rights cannot be realised without adequate resources.

He called for increased financing for SRHR programmes to enable the production of materials in Braille, audio, print and digital formats.

Saka also emphasized the importance of economic and social empowerment of women with disabilities to improve access to services and strengthen self-advocacy.

According to the 2018 Population Census, 11.6 percent of Malawi’s population lives with disabilities and more than half are women and girls.

As Malawi works toward Universal Health Coverage by 2030, Saka said ensuring full access to SRHR services for women with disabilities will be a defining test of whether the country truly leaves no one behind.