Ssanyu Rebecca Advocacy Officer National Union of Women with Disabilities of Uganda

1. Sexual and Reproductive Health of Women with Disabilities and How It Underpins the STI and HIV/AIDS Debate: The Case for Uganda Ssanyu Rebecca Advocacy Officer National Union of Women with Disabilities of Uganda

2. About the National Union of Women with Disabilities of Uganda • National Union of Women with Disabilities of Uganda is abbreviated as NUWODU. • It was founded in 1999 • Mission: To promote social, cultural, economic and political advancement of girls and women with disabilities

3. Why focus on Girls and Women with Disabilities? • Girls and women with disabilities comprise 10% of all women worldwide • They comprise ¾ of PWDs globally (WHO) • In Uganda, 16% population (i.e. 5.44m people) are PWDs above the age of 15 years (UBOS, 2010) • Of these 75% (i.e. 4.08m people) are WWDs above the age of 15 years • GWWDs generally live in remote rural areas with limited, if any, access to socioeconomic services • GWWDs subjected to multiple forms of discrimination, first as women then as PWDs

4. The Sex by Choice not by Chance Intervention • Conceived by NUWODU and the Disabled People’s Organisation Denmark (DPOD) in 2009 • To respond to sexual and reproductive health rights and needs of GWWDs • GWWDs were and are still being denied their SRH rights and their corresponding needs not being addressed by service providers • GWWDs also find themselves unable to resist chancy sexual violations against them • At other times they engage in consensual yet risky / chancy sexual acts • Hence GWWDs highly prone to HIV&AIDS, STIs and sexual and reproductive ill-health

5. The Sex by Choice Intervention: Strategies Used • Promotion of disability and SRH as human rights and development issues rather than private issues • Family and community approach: participation of all parities as advocates for and promoters of SRHR for GWWDs • Using culturally sensitive approaches: working with cultural, religious, political, opinion leaders • Active involvement of men • Strategic partnerships with relevant CSOs, legal aid service providers and DPOs • Awareness creation among service providers • Research and documentation

6. The Sex by Choice Intervention: Emerging Successes • Increased knowledge, self-esteem and skills among girls with disabilities about sexuality issues • Involving affected WWDs and sometimes their spouses in planning and implementation processes has generated quicker positive response than had been anticipated • Capacity building of WWDs as counsellors and legal advisors has not only benefited PWDs but also people without disability • Referral of WWDs needing legal redress on matters of sexual violation • Increased disability awareness and sensitivity among service providers, particularly officers of the health sector and the criminal justice system

7. The Sex by Choice Intervention: Challenges • Discrepancies between SRH policy and practice • Good policy, poor commitment to implementation • Even when adopted, do not translate to local level service delivery • Inadequate in responding to needs of GWWDs • Education of healthcare professionals lacking in disability understanding management • Negative attitudes of healthcare providers • Lack of disability desegregated national data on PWD health indicators

8. Relevance of SRHR of GWWDs to the HIV/AIDS and STI debate • Sexual and reproductive ill-health and HIV share root causes • Most HIV infections are sexually transmitted or associated with pregnancy, childbirth and breastfeeding • Linking Sexual and Reproductive Health Rights and HIV and AIDS increases the effectiveness of the HIV&AIDS response • Most people with disabilities think of their sexual and reproductive lives in a holistic way with HIV and AIDS as only one consideration

9. Bridging the policy-practice gap in SRH services to GWWDs • At Policy Level • Inclusion of disability training in the curriculum of healthcare professionals • The issue of abortion needs to be addressed by governments from an objective and human rights perspective • Data: governments should (are obliged to) build a knowledge base of data and information about the situation of persons with disabilities • Recruitment of communication experts for the deaf, blind and deaf-blind in public healthcare facilities sgould be taken seriously • Physical access in healthcare facilities (beds, ramps, toilets/pits) should be addressed

10. Bridging the policy-practice gap in SRH services to GWWDs • At Implementation Level • Focus specific Sexual and Reproductive Health education to girls and women with disabilities • Promote contraception / family planning among WWDs – taking care to ensure correct information and consent • Include GWWDs in both formal and informal sexual and reproductive health education • In carrying out health education, specific attention should be put to communication needs of the deaf, blind and deaf blind persons

11. Conclusion • Because SRH and HIV&AIDS are mutually reinforcing and precipitated by the same factors, a holistic approach towards addressing these issues is the best way to go. • Linkages between the two should promote rights, address root causes of vulnerability, and reduce stigma and discrimination. • Governments should act to reduce the discrepancies between policy and practice and adhere to international standards in delivering services to women (and indeed persons) with disability. • It is then and only then that true social economic development and progress towards realisation of millennium development goals will be realised.

12. Every one, Every day, Every way … Help to Improve Sexual and Reproductive Health for girls and Women with Disabilities