Social Support and Resilience to Accessing Reproductive Health Services among Women with Physical Disabilities in Greater Accra Region.

Abstract

Access to reproductive healthcare services for women with physical disabilities remains a significant challenge, particularly in developing countries. Despite efforts, such as policy initiatives, awareness campaigns, and inclusive healthcare programs aimed at improving accessibility, these women face numerous barriers, including economic, emotional, attitudinal, institutional, and physical obstacles. While existing research has primarily focused on these challenges, there is a limited exploration of the role of social support and resilience in enhancing access to reproductive healthcare. A mixed-methods design was employed, incorporating both quantitative and qualitative approaches. Quantitative data were collected through a survey of 203 women with physical disabilities aged 18 to 49 years from various communities, specifically Korle-Gonno, La, Ashiaman, Korle-Bu, Chorkor and Kpone in the Greater Accra Region. Univariate analysis was used to describe the socio-demographic characteristics of the participants. Bivariate analysis was conducted to identify relationships between socio-demographic factors and resilience. Regression analysis was utilized to determine the predictors of resilience and the impact of social support. Qualitative data were gathered from twenty-two (22) of the study participants through in-depth interviews and analyzed thematically to gain insights into the challenges and support systems experienced by the participants, and also resilient strategies. The quantitative study identified significant economic, emotional, attitudinal, institutional, and physical barriers to accessing reproductive health services. Social support, primarily from parents, plays a crucial role in overcoming these barriers. Educational attainment and stable employment emerged as key predictors of resilience, with higher education levels and secure jobs associated with greater resilience. Despite the positive impact of informational and instrumental support, emotional support showed a negative impact on resilience. The qualitative study revealed that women with physical disabilities faced challenges of funds, partner rejection, long waiting hours, lack of appropriate public transport, distance to a health facility, and lack of early information and education on reproductive health services in accessing reproductive health services. Additionally, stigma and discrimination, verbal abuse, fragmented services and mobility challenges in accessing reproductive health services were identified. The study identified that women with physical disabilities receive social support, specifically instrumental, informational and emotional to overcome the challenge of access to reproductive health services. Finally, religious practice, a sense of gratitude, problem-solving, personal determination, a desire for motherhood and self-advocacy were identified as resilient strategies used by women with physical disabilities. The findings underscore the importance of enhancing educational and employment opportunities for women with physical disabilities to build resilience. The study recommended the need for the Disability Act to be fully operationalized by ensuring all health facilities are mobility-friendly, inclusive, and provide non-discriminatory care to better support women with physical disabilities in accessing reproductive healthcare services in Ghana. It is recommended that counseling units include establishing support units in healthcare settings and strengthening disability-sensitive care in reproductive health policies to help women with physical disabilities overcome challenges in accessing reproductive health services. Future research should focus on healthcare providers’ perspectives on the impact of social support on the resilience of women with physical disabilities to the challenges in accessing reproductive health services. The impact of religious factors on reproductive health services among women with physical disabilities can be considered.