The sight of disabled women begging on the streets and accompanied by several children under five is common in Zambia. These women are among the poorest in a country where poverty stands at about 75 per cent. They are put in double jeopardy because they are also among the most poorly educated.
"Disabled women end up depending on men for money (in exchange for sex), and men abandon them after sex," says Francisca Muyenga, executive director of the Zambia National Association for Women with Disabilities.
Although family planning services are available in all government hospitals free of cost, the reason why women with disabilities continue to have a large number of children is not hard to find. Miyenga says that nurses often treat disabled women so badly that they are discouraged from visiting health centres.
While Zambia's medics are accused of being rude and uncooperative, Miriam Nambooze of the Disabled Women's Network in Uganda complains that disabled women are treated as though they have no right to sex and motherhood. These women often resort to traditional birth attendants to help them through the delivery process, and this despite the fact that they may need specialised care.
Besides, few hospitals have facilities that are tailored to the disabled. The beds are too high and there are no provisions for sign language for the deaf or Braille for the blind. "There are a number of things we would like the authorities to address for us to receive quality services," says Miyenga, "but there are no channels to air our grievances."
In Zambia, all issues to do with the disabled are handled by the Ministry of Community Development and Social Welfare. "We have tried to ask for changes to make health centres more friendly but, because of discrimination, we are always referred to the community development ministry," Miyenga adds. "We get frustrated and opt not to go there - but that's not where the solution is."
Christine Kaseba, head of the obstetric and gynaecology department at the University Teaching Hospital, expresses doubts about the health system's ability to provide quality reproductive health care for disabled women. For one, health centres do not have the facilities to meet their needs and there are few personnel skilled in handling people with special needs. Where there are health workers capable of doing this, they are often stationed in urban centres rather than the smaller health centres. There are few hospitals with the specialised equipment to handle complicated cases.
Kaseba, who is also the chairperson of the Medical Women's Association Of Zambia, proposes research into how best to meet the reproductive health needs of the disabled. This will focus on how best they can be protected from sexually transmitted diseases and gender-based violence, appropriate use of family planning methods, as well as planning on the special needs of the health caregivers.