Overview:

Welcome to our dedicated platform for championing the Sexual and Reproductive Health and Rights (SRHR) of persons with disabilities in Bangladesh. Our website serves as a vital resource, providing comprehensive information, support, and advocacy tailored to the unique needs of our community. We are committed to fostering a world where every individual, regardless of disability, has the opportunity to understand, advocate for, and access their sexual and reproductive rights fully.

Mission Statement:

At SRHR Bangladesh, our mission is to empower persons with disabilities by promoting inclusive and accessible sexual and reproductive health services and rights education. We strive to dismantle barriers, challenge societal norms, and advocate for policy changes that affirm the dignity and rights of all individuals. Our goal is to ensure that persons with disabilities are not only beneficiaries of health services but also active participants in and advocates for their health and rights. We work collaboratively with communities, healthcare providers, and policymakers to create sustainable change that leads to an equitable society where everyone's SRHR is protected and respected.

Join us in our journey towards a more inclusive, equitable, and healthy future. Explore our resources, participate in our programs, and become an advocate for change. Together, we can make a significant impact.

Who We Are:

Turning Point Foundation is a pioneering organization dedicated to enhancing the lives of persons with disabilities in Bangladesh. Founded with the vision to foster an inclusive society, our work spans various sectors, including inclusive education, employment, SRHR, ICT, and Climate justice, to ensure that persons with disabilities can live dignified, fulfilled lives.

Our Vision:

A society where everyone, regardless of age, gender, disability, or ethnicity, enjoys equal rights and opportunities. We envision a community that embraces diversity, allowing all individuals to develop their full potential and contribute meaningfully to humanity and the environment.

Our Mission:

Our mission at Turning Point Foundation is to advocate for the rights, inclusion, and empowerment of persons with disabilities and other marginalized people. We aim to break down social barriers, challenge discriminatory practices, and promote positive changes in policies and attitudes, ensuring that every individual has the opportunity to participate fully in society without any limitations or exclusions.

Target Groups for the SRHR:

• Children with Disabilities: Prioritizing children with disabilities and those in vulnerable situations, ensuring they have early access to appropriate SRHR education and services.
• Adolescents and Youths: Supporting adolescents and youths in vulnerable and high-risk situations with targeted SRHR information and interventions to promote safe and informed choices.
• Persons with Disabilities: With a special emphasis on women and girls with disabilities, providing tailored resources and advocacy to address their unique SRHR needs.
• Ethnic Minorities and Economically Disadvantaged Groups: Reaching out to ethnic minorities, the hardcore poor, and other marginalized sections of the community, ensuring inclusivity and equal access to SRHR services.
• Older Individuals in Disabling Situations: Addressing the specific SRHR issues faced by older people in disabling situations through specialized resources and support.
• Grassroots Organizations: Empowering Organizations of Persons with Disabilities (OPDs) and Community-Based Organizations (CBOs) to enhance their capacity to advocate for and provide SRHR services within their communities.

Our major activities:

• Capacity development of grassroots organizations on organizational development, project cycle management, administration, human resource, financial management, Human Rights, Gender and other related issues to attain their independence and sustainability.
• Advocacy to promote Human rights, Gender, Diversity, Equity and Inclusion addressing social norms and drawbacks to create amiable environment for balance social interaction and participation for both men and women.
• Promoting Inclusive Education for the children with disabilities, especially with neuro-developmental disabilities i.e. autistic, down syndrome, cerebral palsy and intellectual disability.
• Provide consultancies on disability and gender inclusion, surveys, capacity building and inclusive program design as well as Final Evaluation and Social Research on contemporary issues.
• Support to Civil Society Organizations (CSOs), Disabled Peoples Organizations (DPOs), Independent Living Centers (ILCs) and other institutions.
• Poverty Reduction and Socio-economic development of persons with disabilities, ethnic minorities and other marginalized groups.
• Promote Men-women relationship, gender equity and women empowerment to emerge them to be self dependent and empowered entity.
• Promoting Sexual and Reproductive Health and Rights (SRHR) of persons with disabilities and other marginalized people.
• Advocacy and networking from national to local level with policy makers, government and non-government organizations and other stakeholders.
• Disaster Risk Reduction (DRR) and Climate Change Mitigation and Adaptation.
• Collaborative-partnership efforts with development cooperation agencies, social, global contemporary emerging issues.

Our Impact:

Over the years, Turning Point Foundation has made significant strides towards building an inclusive society. From influencing policy changes to directly empowering thousands of persons with disabilities and other marginalized people through our programs, our impact resonates throughout Bangladesh. We remain committed to our cause and continue to expand our reach and deepen our influence.

Join Us:

We believe in the power of community and collaboration. Join us in our journey to transform lives and build a society where inclusion is not just an ideal, but a reality. Whether you are someone with a disability, a caregiver, a professional, or simply an ally, there is a place for you at Turning Point Foundation. Together, we can turn tides and make a lasting impact.

Visit our website to learn more about our programs, upcoming events, and ways you can contribute to making a difference: Turning Point Foundation

What is SRHR?

Sexual and Reproductive Health and Rights (SRHR) encompass a broad range of issues related to the sexual and reproductive health and wellbeing of individuals and communities. At its core, SRHR is about the right of all individuals, regardless of their age, gender, or disability status, to make informed and autonomous decisions about their sexual and reproductive lives. This includes access to accurate information and education, the ability to choose if and when to have children, access to quality healthcare services that are respectful and non-discriminatory, and the freedom from coercion, discrimination, and violence in all sexual and reproductive matters.

The concept of Sexual and Reproductive Health and Rights (SRHR) is vital for everyone, including those with disabilities. It covers four main areas: sexual health, sexual rights, reproductive health, and reproductive rights, all of which are interconnected. Despite its importance, understanding and access to SRHR for persons with disabilities in Bangladesh can be improved.

Globally, organizations like the International Planned Parenthood Federation and the World Association for Sexual Health advocate for SRHR. Historically, SRHR discussions shifted from population control to human rights at the 1994 International Conference on Population and Development in Cairo. This conference recognized SRHR as a universal human right, focusing on individual well-being rather than economic metrics.

Sexual health involves a state of well-being in relation to sexuality, emphasizing safe and pleasurable sexual experiences, free from coercion and discrimination. Sexual rights further this by including the right to sexual pleasure and emotional expression. Reproductive health is about having a satisfying and safe sex life, with the freedom to decide if, when, and how often to reproduce, which is closely tied to reproductive rights. These rights include the ability to make decisions about one's reproductive health without facing discrimination or violence.

Cultural, social, and legal factors heavily influence SRHR access and quality. Efforts to improve SRHR include advocating for comprehensive sexual education, access to reproductive health services, and upholding reproductive rights. These are essential for empowering individuals, especially women and girls, to make informed decisions about their sexuality and reproductive health.

In Bangladesh, enhancing SRHR knowledge and services involves breaking down barriers and changing social norms. It requires the collaboration of government bodies, NGOs, and community organizations to provide accessible information and support. Addressing these needs can lead to better health outcomes and more empowered individuals and communities.

The importance of SRHR lies in its foundational role in achieving gender equality, reducing poverty, and promoting overall health and well-being. It is a crucial component of human rights and development, directly impacting individuals' ability to lead healthy, fulfilling lives. Without comprehensive SRHR, individuals face increased risks of sexually transmitted infections (STIs), unintended pregnancies, and gender-based violence, significantly impacting their health, education, and economic opportunities.

Four main areas of SRHR

Sexual Health

Sexual health is a crucial aspect of overall well-being, defined by the World Health Organization as a state of physical, emotional, mental, and social well-being in relation to sexuality. It goes beyond the absence of disease or dysfunction and encompasses the ability to enjoy and control sexual and reproductive behavior in a safe, satisfying, and informed manner. Key components include the right to have pleasurable sexual experiences, consent freely to sexual relationships, and access to comprehensive sexual education and care. Ensuring sexual health involves addressing issues like sexually transmitted infections (STIs) and unwanted pregnancies and ensuring that sexual experiences are positive and respectful.

Sexual Rights

Sexual rights protect individuals' rights to express their sexuality and enjoy sexual health with respect for their rights and dignity. These rights include the freedom from coercion, discrimination, and violence in sexual relationships, the right to sexual education, the right to privacy, and the right to choose one’s partner. Sexual rights also cover the recognition and respect of sexual diversity, ensuring that everyone, regardless of sexual orientation, gender identity, or expression, has their sexual rights upheld. Advocacy for sexual rights often focuses on pleasure and emotional, sexual expression as fundamental aspects of human existence.

Reproductive Health

Reproductive health is an integral part of overall health and well-being throughout life. It implies that people can have a responsible, satisfying, and safe sex life and that they have the capability to reproduce and the freedom to decide if, when, and how often to do so. This includes access to safe and effective birth control methods, services for pregnancy and childbirth, and the provision of health care that enables women to go safely through pregnancy and childbirth. Reproductive health also addresses the prevention and treatment of diseases related to the reproductive system, ensuring that reproduction is accomplished in a state of complete physical, mental, and social well-being.

Reproductive Rights

Reproductive rights encompass the recognition of basic rights of all couples and individuals to decide freely and responsibly the number, spacing, and timing of their children. These rights are based on the right to be informed and to have access to safe, effective, affordable, and acceptable methods of fertility regulation of their choice, as well as other methods of their choice for regulation of fertility, which are not against the law, and the right of access to appropriate health care services that enable women to go safely through pregnancy and childbirth. Reproductive rights also involve the right to make decisions concerning reproduction free of discrimination, coercion, and violence.

Overview of Disabilities

Disability is a broad term that encompasses impairments, activity limitations, and participation restrictions that an individual may experience. Disabilities can be physical, mental, intellectual, or sensory, and they can vary in severity. They may be congenital, or arise due to illness, injury, or aging. According to the World Health Organization, over a billion people worldwide live with some form of disability, making up about 15% of the global population.

Over a billion people, about 15% of the world's population, experience some form of disability and 80% of them live in developing countries . According to the estimate of 15%, around 24 million person with disabilities in Bangladesh out of its total population of 160 million. However, in the absence of a national disability census, confusion remains about the prevalence of disability. No comprehensive survey has been done yet on disability.

The government of Bangladesh tried to count how many people with disabilities live in the country from 2013 to 2016. They found about 1.5 million people, which is less than 1% of all the people in Bangladesh. But different groups have different numbers. For example, one group said they first thought there were about 1.8 million people with disabilities, and then they said it was about 1.5 million by the end of November 2015. Another report said that of the 1.8 million they first thought might have disabilities, about 1 million were men.

The statistics office in Bangladesh also has two different numbers from their studies. One says 1.4% of people in the country have disabilities, and another says it's more like 9%. An education survey from 2014 says it's about 1.3%.

So, it's pretty confusing because all these numbers don't match up. It looks like they still haven't done one big study to get the right number, and probably many people with disabilities haven't been included in these counts.

Women and girls with disabilities are particularly the most vulnerable to social discrimination and negligence due to their gender and disability. They are deprived of basic human rights, education, health, livelihood, and access to justice and at a high risk of sexual abuse.

The youth population is more than 33% of the total population within the 18-35 age group. They are facing huge challenges and are not getting guidance and motivation for their future development. Their employment is a crucial issue, where unemployment among people with disabilities is very high.

Another most vulnerable group is children with disabilities. They are prone to be victims of deprivation, abuse, and violation. Even the existing disability-related laws do not stress additional attention and protection of children with disabilities, except for education.

The proportion of the population 60 years and older is about 7% i.e. around 10 million people . By 2050, the 60+ population will account for 20% of the total population - a four-fold increase from the present time. Around 46% of older people live with single and multiple forms of disability.

International Perspectives on types of disabilities

Disability is increasingly viewed through a modern lens that focuses on the dynamic interaction between an individual's impairments and the societal barriers they face. This approach, endorsed by the World Health Organization (WHO) and defined under the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), shifts the focus from a purely medical model to a more inclusive social model. Here are the primary types of disabilities recognized under this contemporary framework:

1. Physical Disabilities
   These involve limitations in bodily functions and include conditions such as spinal cord injuries, amputations, and muscular dystrophy. Physical disabilities affect the physical capacity of an individual and their ability to perform certain actions.
2. Sensory Disabilities
   These impairments affect one or more of a person's senses, with the most common being visual and hearing impairments. Examples include blindness, deafness, and sensory processing disorders.
3. Intellectual Disabilities
   Characterized by limitations in intellectual functioning and adaptive behavior, intellectual disabilities affect learning, reasoning, and problem-solving. Common examples include Down syndrome and developmental delays.
4. Mental Health Disorders
   Mental health conditions can significantly affect an individual's emotional, psychological, and social well-being. Disorders like depression, bipolar disorder, and anxiety have profound impacts on day-to-day functioning.
5. Neurodevelopmental Disabilities
   This category encompasses disorders that are typically diagnosed during the developmental phase of a child, such as autism spectrum disorders, down syndrome, cerebral palsy, Attention deficit hyperactivity disorder (ADHD), etc. These conditions primarily affect personal, social, and academic achievements.
6. Communication Disabilities
   These disabilities involve challenges with communication, such as disorders of speech, language, and expression. They may range from stuttering to complex conditions that impair an individual's ability to receive, send, process, and comprehend concepts or verbal, nonverbal, and graphic information.
7. Invisible Disabilities
   Often not immediately apparent, these disabilities include conditions like diabetes, chronic fatigue syndrome, and neurological disorders, which can limit one's daily activities and overall quality of life.

This wide-ranging recognition allows for a diverse set of individuals to receive the support and acknowledgment they need.

References and Frameworks

• World Health Organization (WHO): Provides guidelines and frameworks that recognize the impact of environmental and personal factors on disability.
• United Nations Convention on the Rights of Persons with Disabilities (UNCRPD): Advocates for the rights and inclusion of disabled persons, emphasizing a shift from traditional medical models to more integrative social models.

This wide-ranging recognition allows for a diverse set of individuals to receive the support and acknowledgment they need.

Types of Disabilities Defined by Bangladeshi Law

The Persons with Disabilities Rights and Protection Act of 2013 of Bangladesh categorizes disabilities into twelve groups:

1. Autism or Autism Spectrum Disorder
2. Physical disabilities
3. Mental illnesses that lead to disability
4. Visual impairments
5. Speech impairments
6. Intellectual disabilities
7. Hearing impairments
8. Deaf-blindness
9. Cerebral palsy
10. Down syndrome
11. Multiple disabilities
12. Other types of disabilities

This wide-ranging recognition allows for a diverse set of individuals to receive the support and acknowledgment they need.

What is Inclusive SRHR?

Inclusive Sexual and Reproductive Health and Rights (SRHR) refer to the comprehensive approach to ensuring that everyone, regardless of age, gender, disability, ethnicity, or socioeconomic status, has access to sexual and reproductive health services and rights. This concept embraces the diversity of human experiences and conditions, recognizing that each individual has unique health needs and rights that must be respected and addressed.

Key Elements of Inclusive SRHR

• Accessibility: Ensuring that SRHR services and information are accessible to all, including adaptations for physical accessibility, communication needs (such as sign language or braille), and culturally sensitive approaches.
• Comprehensive Education: Providing education that covers a wide range of topics from reproductive health, consent, and safe sex practices to gender identity and sexual orientation, tailored to be understandable and relevant to diverse populations.
• Empowerment: Empowering individuals by providing them with the knowledge and tools they need to make informed decisions about their sexual and reproductive health.
• Equity: Addressing and removing systemic barriers that prevent certain groups from accessing and benefiting from SRHR services equally.
• Comprehensive Education: Providing education that covers a wide range of topics from reproductive health, consent, and safe sex practices to gender identity and sexual orientation, tailored to be understandable and relevant to diverse populations.
• Legal and Social Advocacy: Advocating for changes in laws and policies to recognize and protect the sexual and reproductive rights of all individuals and working to shift societal attitudes towards a more inclusive understanding of SRHR.
• Supportive Services: Offering a range of supportive services that cater to the specific needs of marginalized or underserved groups, including counseling, medical care, legal assistance, and community support.

Inclusive SRHR is not just about providing services but about transforming societies to respect and affirm the dignity and rights of every person. It is about creating environments where everyone can seek, receive, and impart information and services without discrimination. This approach ensures that the rights to health, autonomy, and equality are upheld in all aspects of sexual and reproductive health.

Strategic Recommendations for Advancing Inclusive SRHR in Bangladesh

To ensure inclusive Sexual and Reproductive Health and Rights (SRHR) in Bangladesh, specific and targeted recommendations are necessary to address the unique challenges faced by individuals with disabilities. Here are several key recommendations:

1. Enhance Accessibility:
   
   • Upgrade healthcare facilities to be physically accessible to all, including ramps, accessible toilets, and signage.
   • Implement accessible communication methods, such as Braille, sign language interpreters, and large print materials in health centers.
2. Train Healthcare Providers:
   
   • Provide regular training for healthcare professionals on disability awareness and inclusive practices.
   • Educate staff on the specific SRHR needs of persons with disabilities to ensure sensitive and appropriate care.
3. Policy and Legal Reform:
   
   • Review and revise national health policies to explicitly include provisions for the SRHR needs of persons with disabilities.
   • Enforce laws that protect the SRHR of persons with disabilities and ensure legal mechanisms are accessible.
4. Community Engagement and Advocacy:
   
   • Increase advocacy efforts to raise awareness about the SRHR needs of persons with disabilities.
   • Engage community leaders and stakeholders to foster a supportive environment for discussing and addressing SRHR issues.
5. Inclusive Education Programs:
   
   • Develop and implement comprehensive sexuality education that is inclusive of persons with disabilities, tailored to be understandable and accessible.
   • Include modules on rights, consent, and healthy relationships tailored for different disabilities.
6. Research and Data Collection:
   
   • Conduct research to gather data on the specific SRHR needs and barriers faced by persons with disabilities.
   • Use data to inform policies and programs, ensuring they are based on evidence and effective in addressing these needs.
7. Funding and Resources:
   
   • Allocate adequate funding for SRHR programs specifically aimed at persons with disabilities.
   • Ensure that SRHR services for persons with disabilities are funded and prioritized within national health budgets.
8. Partnerships and Collaboration:
   
   • Foster partnerships between government bodies, non-governmental organizations, disabled people’s organizations, and international agencies to collaborate on SRHR initiatives.
   • Encourage multi-sectoral approaches to comprehensively address the intersecting issues affecting SRHR for persons with disabilities.

Implementing these recommendations can significantly improve the inclusivity and effectiveness of SRHR services in Bangladesh, ensuring that persons with disabilities are not left behind and are fully included in health initiatives and rights protections.

Intersectionality: SRHR and Disabilities

The concept of intersectionality is crucial in understanding how various forms of identity, including disability, interact with each other and with systemic structures, influencing individuals' experiences and access to rights, including SRHR. Persons with disabilities may encounter additional layers of discrimination and stigma, making their access to SRHR more complex.

The intersectionality of SRHR and disabilities is a critical area of concern. Persons with disabilities often face multiple barriers in accessing sexual and reproductive health information and services. These barriers include physical accessibility challenges, communication barriers for those with sensory disabilities, stigma and discrimination, and a general lack of tailored information and services that consider their specific needs.

Moreover, societal misconceptions and stigma surrounding disability can lead to the exclusion of persons with disabilities from sexual and reproductive health education, further exacerbating their vulnerability to sexual exploitation, abuse, and unwanted pregnancies. Women with disabilities, in particular, are at a heightened risk of gender-based violence, yet they frequently encounter obstacles in accessing support services and justice.

For individuals with disabilities, SRHR encompasses not only the general scope of sexual and reproductive health and rights but also addresses specific needs and challenges. These include accessible healthcare facilities, tailored health education that considers different types of disabilities, and the dismantling of societal stigma and assumptions about the sexuality and reproductive desires of persons with disabilities.

In Bangladesh, the intersectionality of SRHR and disabilities highlights the need for a nuanced approach that considers the unique experiences of persons with disabilities. This includes recognizing the barriers they face in accessing SRHR services and information and the importance of integrating disability rights into SRHR policies and programs.

Recognizing the intersectionality of SRHR and disabilities is essential for developing inclusive policies and programs that address the unique needs of persons with disabilities. This involves ensuring physical accessibility, providing information in multiple formats, training healthcare providers on disability inclusion, and advocating for the rights of persons with disabilities to make informed decisions about their sexual and reproductive health.

In conclusion, understanding and addressing the intersectionality of SRHR and disabilities is fundamental to achieving health equity and ensuring that everyone, including persons with disabilities, has access to the sexual and reproductive health services and rights they deserve. This chapter sets the stage for a comprehensive exploration of how SRHR for persons with disabilities in Bangladesh can be realized, ensuring dignity, equality, and health for all.

Critical aspects of the intersectionality of SRHR and disability

• Diverse Needs: Recognizes that persons with disabilities have diverse sexual and reproductive health needs that are often overlooked in mainstream SRHR policies and programs.
• Barriers to Access: Highlights the multiple barriers individuals with disabilities face in accessing SRHR information and services, including physical, communicational, attitudinal, and systemic barriers.
• Inclusion and Equity: Stresses the importance of inclusive and equitable SRHR services that are tailored to the unique needs of persons with disabilities.
• Rights-Based Approach: Emphasizes a rights-based approach to SRHR, ensuring that persons with disabilities have the same rights to sexual and reproductive health as others, including the right to make informed decisions about their bodies and relationships.
• Empowerment and Participation: Advocates for the empowerment of persons with disabilities through participation in SRHR education and decision-making processes, promoting autonomy and self-determination.
• Stigma and Discrimination: Addresses the stigma and discrimination faced by persons with disabilities in the context of sexuality and reproduction, which can further marginalize them from accessing SRHR services.
• Gender Dimensions: Acknowledges the gendered aspects of SRHR and disabilities, with women and girls with disabilities facing compounded challenges due to their gender and disability status.
• Research and Data Collection: Advocates for more research and data collection on the intersectionality of SRHR and disabilities to inform policies, programs, and practices that are responsive to the needs of this population.
• Policy Integration: Encourages the integration of disability considerations into national and international SRHR policies and frameworks to ensure that persons with disabilities are not left behind in SRHR initiatives.

Importance of SRHR for persons with disabilities

The importance of Sexual and Reproductive Health and Rights (SRHR) for persons with disabilities cannot be overstated, as these rights are fundamental to their health, well-being, and inclusion in society. Understanding the unique SRHR needs of persons with disabilities is crucial for several compelling reasons:

1. Health Equity: Persons with disabilities often face significant disparities in health outcomes compared to the general population. Access to comprehensive SRHR services ensures that these individuals can achieve the highest possible standard of sexual and reproductive health, which is a key component of overall health equity.
2. Prevention of Abuse: Individuals with disabilities are at a higher risk of sexual abuse and exploitation. Education on SRHR empowers them with knowledge about their bodies, sexual rights, and safe practices, which can help prevent abuse and enable them to seek help when needed.
3. Autonomy and Independence: SRHR education and services equip persons with disabilities with the knowledge and tools they need to make informed decisions about their bodies, relationships, and reproductive choices. This fosters greater autonomy and independence, which are vital for their self-esteem and quality of life.
4. Reducing Health Complications: Persons with disabilities may experience unique health challenges related to pregnancy, childbirth, and sexual health that require specialized care. Access to tailored SRHR services helps prevent complications and ensures appropriate and timely medical intervention.
5. Social Inclusion: By addressing the SRHR needs of persons with disabilities, society acknowledges their right to participate fully in social life. Inclusion in SRHR initiatives helps combat stigma and discrimination, promoting a more inclusive community where everyone’s rights and needs are respected.
6. Legal and Human Rights: Access to SRHR is recognized internationally as a human right. Ensuring that persons with disabilities have equal access to these rights upholds their legal protections under various international conventions, such as the UN Convention on the Rights of Persons with Disabilities (UNCRPD).
7. Empowerment Through Information: Providing accurate and accessible information about SRHR empowers persons with disabilities to advocate for themselves in healthcare settings and beyond. It enables them to challenge discriminatory practices and policies that may hinder their access to necessary health services.
8. Enhancing Family Planning: SRHR services include family planning and contraceptive advice that is crucial for persons with disabilities, allowing them to plan if and when they wish to start a family under conditions that align with their health needs and life goals.
9. Support Systems: SRHR services for persons with disabilities often incorporate broader support systems, including counseling and social support, which are essential for dealing with the psychological aspects of SRHR issues like fertility concerns, sexual dysfunction, and navigating relationships.
10. Equality and Non-discrimination: Inclusive SRHR services promote equality and help prevent discrimination in healthcare and society, ensuring that persons with disabilities are not excluded from receiving appropriate care tailored to their needs.

By prioritizing SRHR for persons with disabilities, communities and healthcare providers can create more equitable, supportive, and healthy environments. It is not just about providing medical services; it is about affirming dignity, promoting independence, and ensuring that every individual has the opportunity to lead a fulfilling and informed life.

SRHR of Women and Girls with Disabilities

Addressing the Sexual and Reproductive Health and Rights (SRHR) of women and girls with disabilities in Bangladesh necessitates a targeted approach that recognizes the intersectionality of gender, disability, socio-economic status, geographical location, and experiences of violence. Women and girls with disabilities face compounded challenges that affect their access to and quality of SRHR services. This chapter outlines strategies and considerations for addressing the unique needs of this group, ensuring their rights are protected and promoted across all spectrums of disability and societal context.

Recognizing the Unique Challenges

Women and girls with disabilities face multiple layers of discrimination and exclusion that affect their access to SRHR services. These challenges include:

• Socio-Economic Barriers: Poverty disproportionately affects persons with disabilities, limiting their access to healthcare services, including SRHR. Women and girls from ultra-poor backgrounds often lack the financial resources to seek medical help or travel to healthcare facilities.
• Severe Disabilities: Those with severe disabilities may require specialized care that is not readily available in their community, making access to SRHR services particularly challenging.
• Geographical Isolation: Women and girls living in remote areas of Bangladesh may have limited access to healthcare facilities. The lack of transportation and the distance to the nearest healthcare provider can further hinder their access to SRHR services.
• Sexual Violence: Women and girls with disabilities are at a higher risk of sexual exploitation, abuse, harassment, and rape. These experiences not only have a profound impact on their physical and mental health but also create barriers to accessing SRHR services due to stigma, fear, and lack of supportive services.

Strategies for Inclusive SRHR Services

To address these challenges and ensure that women and girls with disabilities have access to comprehensive SRHR services, the following strategies are recommended:

• Targeted Outreach and Support: Implement targeted outreach programs to reach women and girls with disabilities, especially those who are ultra-poor, living with severe disabilities, or in remote areas. Mobile clinics, telemedicine, and community health workers can play a crucial role in bridging the gap between these individuals and SRHR services.
• Comprehensive Care: Ensure that SRHR services for women and girls with disabilities are comprehensive and holistic, addressing not only their sexual and reproductive health needs but also providing support for those who have experienced sexual violence. This includes access to emergency contraception, safe abortion services, mental health support, and legal assistance.
• Training for Healthcare Providers: Train healthcare providers on the specific needs of women and girls with disabilities, focusing on communication, consent, and respectful care. Healthcare providers should also be trained to recognize and respond to signs of sexual violence and provide appropriate support and referrals.
• Community Education and Awareness: Raise awareness in communities about the rights and needs of women and girls with disabilities, focusing on reducing stigma and promoting gender equality. Education campaigns can also help to inform women and girls with disabilities about their SRHR and available services.
• Inclusive Policy Development: Advocate for and develop policies that specifically address the SRHR needs of women and girls with disabilities. These policies should be developed in consultation with women and girls with disabilities to ensure their experiences and needs are accurately represented.

Addressing the Needs Across All Types of Disabilities

Efforts to improve SRHR for women and girls with disabilities must be inclusive of all types of disabilities, including physical, sensory, intellectual, and psychological disabilities. Services and information should be accessible and tailored to meet the diverse needs of individuals, recognizing that each type of disability may require different accommodations or approaches. Training for healthcare providers should include specific modules on how to effectively communicate and provide care to women and girls with various disabilities.

Socio-economic Backgrounds and the Ultra-poor

Economic barriers significantly impact the ability of women and girls with disabilities, particularly those from ultra-poor backgrounds, to access SRHR services. Financial assistance programs, sliding scale fees for services, and transportation support can help alleviate some of these barriers. Community-based interventions should also focus on reaching out to the ultra-poor, ensuring they are aware of and can access available SRHR services and support.

Women and Girls Living with Severe Disabilities

Those living with severe disabilities may require specialized care and support. Healthcare facilities should be equipped with the necessary tools and staff trained to address the complex health needs of these individuals. Care coordination among specialists, primary care providers, and support services is crucial to ensure comprehensive care covering all aspects of SRHR, including preventive care, family planning, and maternal health services.

Reaching Those in Remote Areas

Women and girls with disabilities living in remote areas face significant challenges in accessing SRHR services due to geographical isolation and limited healthcare infrastructure. Mobile health clinics, telehealth services, and community health worker programs can be effective strategies to extend SRHR services to these populations. Ensuring that remote healthcare providers are trained in disability inclusivity and have access to resources and referral systems is also essential.

Victims of Sexual Exploitation, Abuse, Harassment, and Rape Violence

Women and girls with disabilities are at a higher risk of sexual violence and exploitation. It is critical to establish and promote safe, accessible, and confidential reporting mechanisms for survivors. Services for survivors should be comprehensive, including medical care, psychological support, legal assistance, and social reintegration programs. Training for law enforcement, healthcare providers, and social service workers should emphasize the rights and needs of survivors with disabilities, ensuring they are treated with dignity and respect.

Implementing a Holistic Approach

• Policy Advocacy: Advocate for policies that specifically address the SRHR needs of women and girls with disabilities, including protections against violence and exploitation.
• Inclusive Education: Include SRHR education in school curriculums that is accessible and relevant to girls with disabilities, covering topics such as consent, body autonomy, and healthy relationships.
• Community Engagement: Engage communities in discussions about disability, gender, and SRHR to challenge stereotypes, reduce stigma, and promote inclusivity.
• Partnerships: Collaborate with organizations specializing in disability rights, women's rights, and SRHR to develop and implement comprehensive programs.

Moving Forward

Ensuring the SRHR of women and girls with disabilities in Bangladesh requires a concerted effort from the government, healthcare providers, civil society organizations, and communities. By recognizing the unique challenges faced by this group and implementing targeted strategies to address these challenges, Bangladesh can move closer to achieving SRHR for all, regardless of disability. This chapter underscores the importance of a focused and inclusive approach to SRHR, highlighting the need for specialized services and support for women and girls with disabilities.

SRHR Empowerment for Adolescents with Disabilities

Adolescents with disabilities face distinct challenges in accessing Sexual and Reproductive Health and Rights (SRHR) services. These challenges are often compounded by their stage of life, which involves significant physical, emotional, and social development. To ensure the SRHR needs of adolescents with disabilities are met, it's essential to adopt a nuanced approach that considers various types of disabilities, socio-economic backgrounds, and specific vulnerabilities, including those who are ultra-poor, living with severe disabilities, residing in remote areas, or have been victims of sexual violence.

Understanding the Unique Needs of Adolescents with Disabilities

Adolescents with disabilities encounter several barriers that impede their access to SRHR information and services, including:

• Lack of Tailored SRHR Education: Many adolescents with disabilities do not receive comprehensive sexual education that is accessible and tailored to their needs, leaving them vulnerable to misinformation and health risks.
• Socio-Economic Challenges: Adolescents from ultra-poor backgrounds may lack the resources to access SRHR services or travel to healthcare facilities, significantly affecting their ability to seek care.
• Accessible Healthcare Services: Facilities must be physically accessible and staffed by professionals trained to communicate effectively with adolescents with different types of disabilities. Services should be confidential, respecting the rights and dignity of adolescent clients.
• Severe Disabilities: Those living with severe disabilities might require specialized SRHR services that are often not available, particularly in remote or rural areas.
• Geographical Barriers: Adolescents in remote areas face difficulty accessing healthcare facilities due to distance and lack of transportation.
• Risk of Sexual Violence: Adolescents with disabilities are at an increased risk of sexual exploitation, abuse, harassment, and rape, making it imperative to provide them with protective services and support.
• Support for Victims of Sexual Violence: Adolescents with disabilities are at increased risk of sexual exploitation and abuse. It's crucial to provide accessible support services, including counselling and legal assistance, and to incorporate preventive education about recognizing and reporting abuse.

Strategies for Addressing SRHR Needs of Adolescents with Disabilities

To effectively address the SRHR needs of adolescents with disabilities, several strategies can be employed:

• Inclusive Policy Development: Policies related to SRHR should explicitly include provisions for adolescents with disabilities, ensuring their access to education and healthcare services is guaranteed and prioritized.
• Community-Based Approaches: Engage communities in creating supportive environments for adolescents with disabilities. This involves raising awareness about disability rights and SRHR, reducing stigma, and promoting inclusivity.
• Accessible SRHR Education: Develop and provide SRHR education programs that are accessible to adolescents with various types of disabilities. This can include using sign language, braille, and simplified language in educational materials.
• Training for Healthcare Providers and Educators: Professionals working with adolescents should receive specific training on the intersection of disability and SRHR. This includes understanding the diverse needs of adolescents with disabilities and adopting inclusive and respectful approaches to care and education.
• Peer Support Networks: Facilitate the creation of peer support networks for adolescents with disabilities, providing a platform for sharing experiences, offering mutual support, and disseminating SRHR information in an accessible and relatable manner.
• Outreach and Services: Implement targeted outreach programs to reach adolescents with disabilities who are ultra-poor, live in remote areas, or have severe disabilities. This may include mobile health services, online resources, and community health initiatives designed to bring SRHR services closer to those in need.
• Inclusive Healthcare Services: Ensure that healthcare facilities are physically accessible and that staff are trained to provide inclusive and respectful care to adolescents with disabilities. Services should be sensitive to the needs of those who have experienced sexual violence.
• Empowerment and Advocacy: Empower adolescents with disabilities through peer support groups and advocacy training, enabling them to advocate for their SRHR needs and rights.
• Protection and Legal Support: Ensure that adolescents with disabilities have access to legal support and protection services, particularly those who have experienced sexual violence. This includes making reporting mechanisms accessible and providing comprehensive care and support for survivors.

Top tips to Address SRHR of Adolescents with Disabilities

• Ensure Accessibility: Tailor SRHR education and services to be physically accessible and understandable for adolescents with disabilities. This includes facilities that are disability-friendly and learning materials in formats like Braille, large print, sign language, and easy-to-understand language.
• Promote Inclusivity: Design SRHR programs that are inclusive, considering the varied experiences and needs of adolescents with disabilities. Avoid a one-size-fits-all approach and recognize the diversity within the disability community.
• Strengthen Legal Frameworks: Advocate for and enforce laws and policies that protect and promote the SRHR of adolescents with disabilities. Ensure these laws are implemented effectively and inclusively.
• Comprehensive Education: Provide comprehensive sexuality education that covers a wide range of topics, from anatomy and reproductive health to consent and healthy relationships, tailored to be accessible for all adolescents, including those with disabilities.
• Encourage Participation: Involve adolescents with disabilities in the development, implementation, and evaluation of SRHR programs and policies. Their firsthand experiences can provide valuable insights for creating more effective services.
• Train Healthcare Providers: Educate and train healthcare providers on the specific SRHR needs of adolescents with disabilities. Focus on improving communication skills, empathy, and understanding to provide better support and care.
• Combat Stigma and Discrimination: Address societal stigma and discrimination through awareness campaigns that challenge misconceptions about disability and sexuality. Promote a positive narrative around the capabilities and rights of adolescents with disabilities.
• Foster Safe Spaces: Create safe, confidential, and supportive environments where adolescents with disabilities can seek SRHR information and services without fear of judgment or violation of privacy.
• Parental and Caregiver Support: Educate parents and caregivers about the SRHR needs of adolescents with disabilities, providing them with the knowledge and tools to support their children’s health and wellbeing.
• Monitor and Evaluate: Regularly monitor and evaluate SRHR programs for effectiveness and inclusivity. Use feedback from adolescents with disabilities to continually improve and adapt services to meet their needs better.

Moving Forward with Inclusion and Safety

Providing adolescents with disabilities in Bangladesh access to comprehensive SRHR services requires collaboration across sectors and levels of society. By understanding the unique challenges faced by this group and implementing targeted, inclusive strategies, Bangladesh can ensure that all adolescents, regardless of disability, have the knowledge and resources they need to make informed decisions about their sexual and reproductive health. This chapter emphasizes the importance of tailored educational programs, accessible healthcare services, and supportive policies to create a safe and inclusive environment for adolescents with disabilities to explore and understand their SRHR needs.

Societal Attitudes Towards Disability and Sexuality in Bangladesh

In Bangladesh, as in many other countries, disability and sexuality are often enveloped in layers of silence, stigma, and misunderstanding. Societal attitudes towards disability and sexuality can significantly impact individuals' access to information and services related to sexual and reproductive health and rights (SRHR). Societal attitudes towards disability can vary widely, but many are rooted in traditional beliefs that view disabilities as a consequence of misfortune, divine will, or familial karma. Traditionally, disability is often viewed through a lens of pity, charity, or as a medical problem to be fixed, rather than a matter of rights and societal inclusion. This perspective can lead to the marginalization of persons with disabilities, making it difficult for them to assert their rights, including SRHR. These perceptions can lead to the marginalization and exclusion of persons with disabilities from various aspects of community life, including education, employment, and socialization, thereby compounding the challenges they face in accessing sexual and reproductive health and rights (SRHR).

Similarly, discussions around sexuality are generally considered taboo in the conservative societal fabric of Bangladesh. Discussions around sexual health and rights are typically avoided in public and even within families, leading to a lack of awareness and misconceptions. When the topics of disability and sexuality intersect, the challenges are compounded, leaving persons with disabilities particularly vulnerable to misinformation, exclusion, and abuse. This cultural reticence extends to the realm of disability, where individuals with disabilities are often desexualized and perceived as being asexual or incapable of having sexual and reproductive health needs and rights. Such misconceptions can significantly hinder the ability of persons with disabilities to seek and receive appropriate SRHR information and services.

Cultural Barriers to Accessing SRHR Information and Services

Cultural barriers significantly hinder access to SRHR information and services for persons with disabilities in Bangladesh. These barriers include:

• Stigma and Shame: The stigma attached to both disability and sexuality can prevent individuals from seeking necessary health services or information. Families may also feel shame, fearing societal judgment, which can lead to further isolation of persons with disabilities.
• Gender Norms and Expectations: Traditional gender roles and expectations can particularly disadvantage women with disabilities, who may be viewed as unfit for marriage or motherhood, thereby denying them their reproductive rights and access to relevant health services.
• Lack of Privacy and Autonomy: Persons with disabilities may have limited opportunities for private consultations with healthcare providers due to physical dependency on others. This lack of privacy can deter them from discussing or seeking help for their sexual and reproductive health needs.
• Communication Barriers: For individuals with hearing, visual, or intellectual disabilities, the lack of SRHR information in accessible formats (such as sign language, Braille, or easy-to-understand language) poses a significant obstacle.

Strategies for Community Engagement and Awareness-Raising

A multi-pronged approach to community engagement and awareness-raising is essential to overcome these cultural and societal barriers. Strategies may include:

• Educational Programs: Implementing comprehensive, inclusive SRHR education programs within schools and communities can help break the silence around disability and sexuality. These programs should be designed to be accessible to individuals with various types of disabilities and should aim to challenge and change harmful stereotypes and norms.
• Community Dialogues: Facilitating open dialogues within communities, involving leaders, families, and persons with disabilities, can promote a better understanding of the SRHR needs of individuals with disabilities. These discussions can serve as a platform for challenging misconceptions and advocating for inclusive practices.
• Training for Healthcare Providers: Providing training to healthcare providers on disability inclusion and sensitivity can help ensure that SRHR services are accessible and respectful of the rights and dignity of persons with disabilities.
• Inclusive Communication: Developing and disseminating SRHR information in various accessible formats can address communication barriers and ensure that individuals with disabilities have the information they need to make informed decisions.
• Engagement of Persons with Disabilities: Actively involving persons with disabilities in the design, implementation, and evaluation of SRHR programs and policies can ensure that these initiatives are truly inclusive and responsive to their needs.

Addressing the cultural and social context is crucial for improving access to SRHR for persons with disabilities in Bangladesh. By fostering a more inclusive and understanding society, we can ensure that all individuals, regardless of disability, have the opportunity to lead healthy and fulfilling sexual and reproductive lives.

National Laws and Policies Related to SRHR and Disability Rights

Bangladesh has made significant strides in enacting laws and policies to protect the rights of persons with disabilities and to ensure their access to sexual and reproductive health and rights (SRHR). One of the cornerstone pieces of legislation is the Rights and Protection of Persons with Disabilities Act, 2013. This act aims to ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities. It addresses various aspects of social life, including health, education, employment, access to justice, and the right to live independently. Under this act, the government is mandated to take steps to provide healthcare, rehabilitation, and support services to persons with disabilities, as well as to ensure their inclusion in public life.

Additionally, the National Health Policy 2011 and the Reproductive Health Policy 2014 emphasize the importance of providing comprehensive healthcare services to all citizens, including vulnerable populations such as persons with disabilities. These policies acknowledge the need for special attention to ensure that sexual and reproductive health services are accessible and responsive to the needs of persons with disabilities.

International Conventions and Treaties

Bangladesh is a signatory to several international conventions and treaties that advocate for the rights of persons with disabilities and underscore the importance of SRHR. Notably, the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), ratified by Bangladesh in 2007, marks a significant commitment to promoting, protecting, and ensuring the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities. The UNCRPD is a landmark international treaty that promotes the rights and dignity of persons with disabilities, including their right to health, education, employment, and participation in political and public life. It explicitly includes the rights of persons with disabilities to access the same range, quality, and standard of free or affordable health care and programs as provided to other persons, including in the area of sexual and reproductive health. The UNCRPD explicitly mentions the importance of access to health services, including those related to sexual and reproductive health, and the right of persons with disabilities to respect for their home and family.

Other international frameworks, such as the Sustainable Development Goals (SDGs), particularly Goal 3 (Good Health and Wellbeing) and Goal 5 (Gender Equality), provide a broader context within which the rights to health and gender equality, including SRHR for persons with disabilities, are emphasized.

Gaps Between Policy and Implementation

Despite the progressive legal and policy framework in place, there remains a significant gap between policy and implementation. Challenges include:

• Lack of Awareness and Enforcement: There is often a lack of awareness among healthcare providers, policymakers, and the public about the specific needs and rights of persons with disabilities concerning SRHR. This gap in knowledge leads to inadequate enforcement of existing laws and policies.
• Accessibility Issues: Physical barriers in healthcare facilities, lack of sign language interpreters, and insufficient information in accessible formats prevent persons with disabilities from fully accessing SRHR services.
• Stigma and Discrimination: Societal attitudes and stigma towards disability can further marginalize persons with disabilities, affecting their ability to access and utilize SRHR services.
• Limited Training for Healthcare Providers: Healthcare providers often lack the training to address the unique SRHR needs of persons with disabilities, leading to inadequate or insensitive care.

Addressing these gaps requires a multi-faceted approach involving the enhancement of awareness, training, and infrastructure, as well as the active involvement of persons with disabilities in policy development and monitoring. Strengthening partnerships between the government, civil society, healthcare providers, and the disability community is crucial for ensuring that the rights and needs of persons with disabilities are met, thereby moving closer to the goal of universal access to sexual and reproductive health and rights.

While Bangladesh has made significant strides in establishing a legal and policy framework that supports the SRHR of persons with disabilities, bridging the gap between policy and practice remains a key challenge. Addressing these gaps requires concerted effort, resources, and commitment from all stakeholders to ensure that no one is left behind in the pursuit of health equity and rights for all.

Q1: Why is it important for healthcare providers to have training in disability awareness in the context of SRHR?

Training helps providers deliver sensitive and appropriate care, understand specific needs, and communicate effectively, ensuring that services are accessible and respectful.

Q2: Can persons with disabilities become parents?

Yes, many persons with disabilities can and do become parents. They have the right to reproductive health services and parenting support tailored to their needs.

Q3: How can SRHR education be made more accessible?

SRHR education can be adapted through the use of accessible teaching methods, such as sign language, braille, and easy-to-understand formats, ensuring all individuals can receive and understand vital information.

Q4: What should I do if I feel my SRHR needs are not being met?

Advocacy is key. Contact local disability advocacy organizations, seek legal advice, or reach out to healthcare providers trained in inclusive practices. Your rights matter and there are resources available to help enforce them.

Q5: What are some common barriers that persons with disabilities face in accessing SRHR services?

Barriers can include physical inaccessibility of healthcare facilities, lack of disability-aware health providers, insufficient tailored information, and societal stigma around sexuality and disability.

Q6: Are there specific SRHR issues that affect women with disabilities more than others?

Yes, women with disabilities may face increased risks of sexual abuse, lack of menstrual management resources, challenges in prenatal and postnatal care, and barriers in accessing family planning services.

Q7: How can technology improve SRHR access for persons with disabilities?

Technology can offer solutions like telemedicine for easier access to specialists, mobile apps for health tracking and information, and websites with accessible SRHR resources, all of which can help bridge the gap in service delivery.

Q8: What role do family members and caregivers play in supporting the SRHR of persons with disabilities?

Family members and caregivers can provide crucial support by facilitating access to healthcare, helping communicate needs with health providers, and ensuring that the rights of their loved ones are respected.

Q9: How can persons with disabilities ensure their SRHR needs are included in national health policies?

Advocacy is critical. Engaging with policy makers, participating in public consultations, and collaborating with disability and health rights organizations can influence policy to be more inclusive.

Q10: What should be considered when developing SRHR educational materials for persons with intellectual disabilities?

Materials should be designed in easy-to-understand language, use clear and simple visuals, and offer concrete examples. Interactive formats that engage learners can also enhance understanding and retention.

Q11: How can healthcare facilities become more inclusive for persons with disabilities?

Facilities can improve by implementing physical accessibility features, providing disability sensitivity training for staff, offering different communication formats for consultations, and having inclusive policy frameworks.

Q12: Where can persons with disabilities find trained healthcare providers who understand their SRHR needs?

Many organizations that advocate for persons with disabilities maintain directories of trained healthcare providers. Additionally, hospital and clinic websites often list specialists trained in disability care.

Turning Point Foundation