Health care providers should treat people with disabilities in the same way that they should treat people without disabilities: with respect. People with disabilities have the same sexual and reproductive health needs and rights as people without disabilities, but often they are not given information about reproductive and sexual health or adequate care. People with disabilities are more vulnerable to abuse than non-disabled people. They are at increased risk of being infected with HIV and other STIs. Many have been sterilized against their will, forced to have abortions, or forced into unwanted marriages, and many have experienced gender-based violence. Health care programs, including family planning programs, need to follow the relevant articles of the UN Convention on the Rights of Persons with Disabilities, especially the articles that address health, family life, and legal rights.
To counsel clients with disabilities, health care providers need to consider their preferences and the nature of their disability. For example, barrier methods may be difficult for some people with a physical disability, and women with an intellectual disability may have trouble remembering to take a pill each day or dealing with changes in monthly bleeding.
Like all clients, people with disabilities need sexual and reproductive health education to make informed choices. People with intellectual disabilities have the same rights as other people to make their own decisions about contraception, including sterilization. They may need special support to do so. For a client with an intellectual disability who is unable to communicate her or his preferences clearly, someone whom the client trusts should participate and help to make an informed choice that is as consistent as possible with the client’s preference. Especially for the choice of sterilization, health care systems should ensure that a process of supported decision-making is available.
To care for people with disabilities, programs should make it known in the community that they serve people with disabilities without discrimination. Facilities should be made physically accessible—for example, with ramps for wheelchairs and large bathrooms with grab bars. Outreach programs should make a special effort to identify and reach people in the community who have limited mobility. Print materials should have simple graphics, large print, and Braille, if possible, and information should be available in audio formats, such as CD or cassette tape, as well as in print. Providers may need especially to demonstrate actions as well as describing them, to speak slowly, and to pause often and check comprehension.
Learning to respect the rights of people with disabilities and to care for them should be part of pre-service training for health care providers, and it should be reinforced with in-service training periodically. Moreover, meeting and talking with people with disabilities can give providers valuable information about how to make services more respectful and accessible. Often, the changes needed are easy.
What is supported decision-making? In supported decision-making, supporters, advocates, or others help people with disabilitie s to make their own decisions, free of conflict of interest or undue influence, and without giving decision-making power to someone else. This process may include documenting informed consent. (See Ensuring Informed Choice in Chapter 12 – Female Sterilization.)