WOMEN WITH DISABILITIES AND REPRODUCTIVE HEALTH RIGHTS

Maulani A Rotinsulu

 Girls with disabilities easily suffer from harassment, torture, rape, exploitation, and also domestic violence, divorce, and other kinds of sexual violence, social stigma and discrimination, and injustice because of the unassertive laws concerning SRH for PwDs as well as the restricted programs and information of SRH accessible to PwDs, unsupportive culture, lack of knowledge, excessive worry and protection in ignorance and for the reason of safety, teenagers with disabilities have to lose their rights and many people in general assume that PwDs are asexual. 

1. Reproductive Health definition and concept

Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters, relating to the reproductive system and to its functions and processes ( Glasier et al. ,2006). Reproductive health implies that people are able to have a responsible, satisfying and safer sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.  

WHO (2002) defines that Sexuality is a central aspect of human being throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. While sexuality can include all of these dimensions, not all of them are always experienced or expressed. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, ethical, legal, historical, religious and spiritual factors. 

Moreover, Amnesty International USA(2007) stated that sexual and reproductive health  is an essential component to the universal right to the highest attainable standard of physical and mental health, enshrined in the UDHR (1948).

2.  Disability concept

WHO (2011) highlights that it is about 15% of the world population has some form of disability. These numbers will significantly increase due to not only diseases and accident, but also aging, nature disaster and human error. It’s importance to have clear understanding of the concept of disability which has moved. It is moving from medical to social terms, moving from charity to human rights framework, moving from individual to community approach, and moving from exclusion to inclusion setting.  

WHO (2001) describes disabilities as an umbrella term covering impairments, activity limitations and participation restrictions.  Impairment is a problem in body function or structure, an activity limitation is a difficulty encounters by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations. Disability is thus not just a health problem. It is a complex phenomenon, reflecting the interaction between features of a person’s body and features of the society in which he or she live. Moreover, people with disability have the same health needs as non-disabled people, but mostly people with disabilities face barriers in accessing the health and rehabilitation services they need in many settings (Disabled World, 2009).

UNCRPD (2007) addresses that disability is an evolving concept and that disability results from the interaction between persons with impairments and attitudinal and environmental barriers that hinders their full and effective participation in society on an equal basis with others, The Convention recognises  further the diversity of persons with disabilities. 

3.  Situation of Reproductive Health  in Indonesia, Lao and Vietnam

3.1 Services

The intervention work to respect, fulfil and protect the SRH rights for people in general in Indonesia, Laos and Vietnam was more supportive, such family planning, marriage, child and woman protection, health, education, criminal processing. This  existing regulations, by assumption, these supporting regulation in general could also obtain for PwDs.

Regulation intervention by the assumption was weak  and not affirmative to full enjoyment rights of PwDs. Among the supporting regulation, there was not supporting regulation which discriminate in respect, fulfilment and protection of  disability rights in general  and specifically on SRH for PwDs. This also was  justified by other data.

Regulation reviews analyst that, Indonesia: “Law number 1 of 1994 on marriage allows husband may divorce  his wife   if she has a body impairment”.

Case  reports analyst that, Vietnam: “parent loose her daughter with physical disability rights to have marriage do to disability (DPO sharing experience);  “ask the doctor, because she is disabled, should sterilise !” (sharing from the husband with physical disability)

The understanding of disability that was still in medical and social welfare term became the main gap that discriminate in respect, fulfilment and protection of SRH rights for PwDs in Indonesia, Laos and Vietnam. As the state party, even they have ratified CRPD, their disability understanding was still false and weak, such “disability is abnormal”. This became an obstacle for woman and girls with disabilities having their rights to be wives and mothers (FGD Vietnam).

Misperception and weak understanding became an obstacle to regulation intervention. The supporting regulation that Indonesia, Laos and Vietnam have could not meet the need and against the rights of PwDs in general and specifically on SRH. Added to this, unsupportive policies have made regulation intervention on SRH rights for PwDs were not priority (FGD Vietnam). The gap that regulation interventions that were not affirmative and not sensitive disability let the occurrence of other barriers, such institutional, cultural, societal, building and infrastructure, technological,  attitudinal, information and communication  barriers.

Those barriers were experienced in Indonesia, Laos and Vietnam.  It limited the activities and restricted PwD’s participation in fully enjoying their SRH rights. Further, these negative environmental factors have repealed SRH rights of PwDs especially woman and girls with disabilities.

“if they have sexual problems, it is better keeping silence and saying no, disclosure and asking for help can be threatened into the jail” (FGD Laos).

“woman with disabilities face social prejudice and social culture in having SRH” (ID Vietnam)

“a girl with physical disability becomes rape victim by the health worker when she takes care her father in the hospital. Her sister reports it to the police office but already 4 months there is no any law process” (CR Indonesia).

3.2  Access

Providing access  to SRH rights for PwDs was a hard issue of Indonesia, Laos and Vietnam,  even if they have been the CRPD state party. It was clearly that nothing accessibility, and additionally regulation intervention that did not firmly affirm  to accessibility needs, these came into the gaps and obstacles for PwDs as described below.

In Laos, SRH program for people in general has been set through book, news paper, radio, internet. Seemingly the gap was found in regard to interpret the convention statement that PwDs have rights on equal bases with others. By this, all SRH programs can be used for PwDs and PwDs as other people and students in Laos. But this understanding  was not followed by accessibilities. So it was therefore, PwDs and PwDs cannot access SRH programs. For instant, in schools, PwDs should follow SRH lessons same with their friends without learning modification and no learning accessibility. Other obstacle, PwDs cannot access hospital services since persons with physical disability cannot access the bed; persons with hearing disability cannot access doctor’s explanations. Due to the false interpretation of the convention, it seemed the Government has not understood, so that  the SRH program for PwDs was still not in a priority program.  

In Vietnam, the Government has a plenty of SRH programs in giving information and providing services. This programs particularly have been set inclusively for PwDs in general and students with disabilities. However, people in general and professional i.e. health workers, teachers were not aware that PwDs and PwDs were in the programs. Other barrier that they did not have skills in interacting with PwDs. Most of them faced difficult to communicate with people with hearing disability. PwDs in remote areas could not access due to inaccessible infrastructure and building. Further, SRH information and services that were provided by online system also  became an obstacle because of limited internet connection and lack of computer and internet skills of PwDs.

Indonesia has special SRH programs for women with disabilities. Ministry of Health has developed modules of women and girls with disabilities for health workers and parents in preventing and treating women with disabilities to meet their SRH needs. Particularly, Ministry of Education has developed SRH modules for students with visual disability and students with hearing disabilities. This modules has been applied in special schools. However, students with other disabilities such physical and mental got SRH lesson using general modules, so they cannot access it. Added to this, unfortunately SRH programs for PwDs organised on project based. In school, either special or inclusive schools, also rehabilitation centres for PwDs, SRH lessons were not part of school or rehabilitation curriculum. Other gap that most family, community, also government still viewed and treated PwDs in medical and social welfare context.

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