Sexual and reproductive health (SRH) of young people including those with disabilities is a major public health concern globally. However, available evidence on their use of sexual and reproductive health services (SRHS) is inconsistent.
This study investigated utilisation of SRHS amongst the in-school young people with disabilities (YPWDs) in Ghana using the healthcare utilisation model.
Guided by the cross-sectional study design, a questionnaire was used to obtain data from 2114 blind and deaf pupils or students in the age group 10-24 years, sampled from 15 purposively selected special schools for the deaf and the blind in Ghana.
About seven out of every 10 respondents had ever utilised SRHS. The proportion was higher amongst the males (67.8%) compared with the females (62.8%). Young persons with disabilities in the coastal (OR = 0.03, 95% CI = 0.01–0.22) and middle (OR = 0.06, 95% CI = 0.01–0.44) zones were less likely to have ever utilised SRHS compared with those in the northern ecological zone. The blind pupils or students were more likely to have ever utilised SRHS than the deaf (OR = 1.45, 95% CI = 1.26–3.11).
Generally, SRHS utilisation amongst the in-school YPWDs in Ghana is high but significantly associated with some predisposing, need and enabling or disabling factors. This underscores the need for policymakers to consider in-school YPWDs as a heterogeneous group in the design and implementation of SRHS programmes. The Ghana Education Service in collaboration with the Ghana Health Service should adopt appropriate pragmatic measures and targeted interventions in the special schools to address the SRH needs of the pupils or students.
Globally, sexual and reproductive health (SRH) of young people has been recognised as an important public health issue (Odo et al.
Notwithstanding the enormous burden of SRH-related problems amongst young people (Shrivastava, Shrivastava & Ramasamy
Globally, the SRH of young people has been given some attention (Aninanya et al.
Evidence suggests that studies have been conducted on various aspects of SRH amongst PWDs in Ghana over the last decade. Recently, some empirical studies have focused on access (including financial) (Badu et al.
A few of the recent studies focused on SRHS amongst adolescents and young people in special schools. For instance, Obasi et al. (
The Healthcare Utilisation Model has been adapted as the conceptual framework for this study (see
Conceptual framework.
According to the model, predisposing factors are the demographic characteristics of individuals, such as age, sex, religion, education and ethnicity (Andersen
There is evidence that some scholars have critiqued the model. For instance, Wilson et al. (
In this article, SRHS utilisation is the dependent variable (
The data for this study were collected as part of a nationwide research project titled:
There were 35 public and private special schools in Ghana when the data were collected in 2017. The special schools are classified as school for the deaf, school for the blind and school for the intellectually disabled. However, some of the schools are for both the blind and the deaf. This research study targeted only the schools for the blind and the deaf. All the 16 schools for the blind, and the deaf, comprising 14 schools for the deaf (including one Senior High School [SHS]) and two schools for the blind were purposively selected but the authorities in one of the schools declined to participate in the study.
This study targeted all the pupils and the students in the 15 special schools for the blind and the deaf who consented to participate in the study. The inclusion criteria for participation in the study included being a pupil or student, aged 10–24 years in the special schools for the blind and the deaf. However, pupils or students who had multiple disabilities, that is, both deaf and blind were excluded from the study. Those who were eligible in the sampled schools at the time of the data collection and consented to participate were included in the study.
There were a total of 4180 pupils or students in the 15 sampled special schools (
Distribution of study participants by sampled special schools.
No. | Name of school | Total enrolment | Number eligible | Number participated |
||
---|---|---|---|---|---|---|
Male | Female | Total | ||||
1. | Cape deaf | 364 | 296 | 112 | 81 | 193 |
2. | Salvation army | 120 | 72 | 33 | 27 | 60 |
3. | State deaf | 202 | 167 | 36 | 48 | 84 |
4. | Sekondi deaf | 250 | 168 | 79 | 68 | 147 |
936 | 703 | 260 | 224 | 484 | ||
5. | Secotech | 250 | 250 | 73 | 69 | 142 |
6. | Demodeaf | 439 | 221 | 102 | 83 | 185 |
7. | Akropong blind | 367 | 217 | 83 | 86 | 169 |
8. | Kibi deaf | 213 | 166 | 73 | 48 | 121 |
9. | Koforidua deaf | 242 | 134 | 47 | 46 | 93 |
10. | Bechem deaf | 331 | 233 | 111 | 74 | 185 |
11. | Ashanti deaf | 552 | 366 | 141 | 122 | 263 |
2394 | 1587 | 630 | 528 | 1158 | ||
12. | Wa deaf | 200 | 140 | 80 | 54 | 134 |
13. | Wa blind | 230 | 126 | 41 | 49 | 90 |
14. | Gbeogo | 300 | 204 | 111 | 64 | 175 |
15. | Savelugu deaf | 120 | 80 | 41 | 32 | 73 |
850 | 550 | 273 | 199 | 472 | ||
The information present in the consent form was shared with all those who were eligible in a classroom. Pupils or students who were not willing to take part in the study were allowed to leave. Questionnaires (with a braille version for the blind) were administered to the blind and deaf pupils or students who had consented to participate in the study in different classrooms. In the schools with blind and deaf pupils or students, the questionnaires were administered to the blind and the deaf students in different classrooms. The participants were given time to respond to each question after it had been explained before the next question. The questionnaire that was adapted from an illustrative questionnaire for interview surveys was pre-tested in a special inclusive school in Cape Coast (
Three field assistants were engaged and trained before the pre-testing of the questionnaire and the actual data collection exercise. The selection of the field assistants was based on their speciality in special education and their knowledge of SRH-related issues. One of them was a certified sign language interpreter, and two were Master of Philosophy students from the Departments of Population and Health and Special Education, University of Cape Coast.
The administered questionnaires were checked for completeness and entered into Statistical Product and Service Solutions (SPSS, Chicago, IL, USA) version 23 software and subsequently exported to Stata (Stata Corporation, College Station, TX, USA) version 14.2 for analyses. The study employed both descriptive and inferential statistics in the analysis. Three sequential logistic regression models were constructed based on the categorisation of the independent variables into predisposing factors, need, and enabling or disabling factors after the descriptive analysis (see
The Institutional Review Board of the University of Cape Coast granted ethical clearance (UCCIRB/EXT/2017/13) for the study. Young people with disabilities who were eligible for the survey were provided with the informed consent form (with a braille version for the visually impaired), which had information on the purpose of the study, confidentiality, anonymity, the right to participate or decline to participate or withdraw from participating at any stage. They were encouraged to ask questions about the study and their participation. The heads of the sampled schools consented for those who were minors (10-17 years) before they assented. Written or verbal consent or assent was given by all those who took part in the study before they were enrolled.
As shown in
Distribution of socio-demographic characteristics of respondents by sex and type of disability.
Variables | Sex and disability type |
Total ( |
|||||
---|---|---|---|---|---|---|---|
Males |
Females |
||||||
Disability type |
Disability type |
||||||
Deaf ( |
Blind ( |
Total ( |
Deaf ( |
Blind ( |
Total ( |
||
10-14 | 18.9 | 20.7 | 19.1 | 20.9 | 21.1 | 20.9 | 19.9 |
15-19 | 60.7 | 53.6 | 59.8 | 64.1 | 63.3 | 63.9 | 61.7 |
20-24 | 20.4 | 25.7 | 21.1 | 15.0 | 15.6 | 15.2 | 18.4 |
Primary | 38.2 | 40.7 | 38.5 | 35.3 | 30.6 | 34.6 | 36.8 |
JHS | 54.6 | 59.3 | 55.2 | 56.1 | 69.4 | 58.2 | 56.5 |
SHS/technical | 7.2 | - | 6.3 | 8.6 | - | 7.2 | 6.7 |
No religion | 2.4 | 5.0 | 2.8 | 1.7 | 1.4 | 1.7 | 2.3 |
Christianity | 80.2 | 80.7 | 80.2 | 83.2 | 79.6 | 82.7 | 81.3 |
Islam | 17.4 | 13.3 | 17.0 | 15.1 | 19.0 | 15.6 | 16.4 |
Northern | 22.7 | 29.3 | 23.5 | 18.7 | 33.3 | 20.9 | 22.3 |
Middle | 52.5 | 67.8 | 54.3 | 54.4 | 62.6 | 55.8 | 55.0 |
Coastal | 24.8 | 2.9 | 22.2 | 26.9 | 4.1 | 23.3 | 23.7 |
SHS, Senior High School; JHS, Junior High School.
Utilisation of sexual and reproductive health services by disability type and socio-demographic characteristics of respondents.
Variables | Sex and disability type |
Total | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Males |
Females |
% | ||||||||||||
Disability type |
Disability type |
|||||||||||||
Deaf |
Blind |
Total |
Deaf |
Blind |
Total |
|||||||||
% | % | % | % | % | % | |||||||||
658 | 68.3 | 80 | 64.5 | 738 | 67.8 | 485 | 64.3 | 77 | 54.6 | 562 | 62.8 | 1300 | 65.6 | |
10-14 | 114 | 62.0 | 21 | 77.8 | 135 | 64.0 | 105 | 65.2 | 19 | 63.3 | 124 | 64.9 | 259 | 64.4 |
15-19 | 409 | 70.3 | 42 | 61.8 | 451 | 69.4 | 297 | 61.9 | 47 | 53.4 | 344 | 60.6 | 795 | 65.3 |
20-24 | 135 | 68.2 | 17 | 54.1 | 152 | 67.0 | 83 | 73.5 | 11 | 47.8 | 94 | 69.1 | 246 | 67.8 |
Primary | 221 | 60.2 | 40 | 76.9 | 261 | 62.3 | 152 | 57.1 | 27 | 62.8 | 179 | 57.9 | 440 | 60.4 |
JHS | 383 | 72.7 | 40 | 55.6 | 423 | 70.6 | 280 | 66.0 | 50 | 51.0 | 330 | 63.2 | 753 | 67.2 |
SHS/Technical | 54 | 77.1 | - | - | 54 | 77.1 | 53 | 82.5 | - | - | 53 | 82.8 | 107 | 79.9 |
No religion | 15 | 65.2 | 4 | 66.7 | 19 | 65.5 | 9 | 69.2 | 1 | 50.0 | 10 | 66.7 | 29 | 65.9 |
Christianity | 535 | 68.5 | 68 | 69.4 | 603 | 68.6 | 409 | 65.7 | 60 | 57.4 | 469 | 63.8 | 1072 | 66.4 |
Islam | 108 | 67.5 | 8 | 40.0 | 116 | 64.4 | 67 | 56.8 | 16 | 59.3 | 83 | 57.2 | 199 | 61.2 |
Northern | 140 | 65.4 | 16 | 41.0 | 156 | 64.4 | 79 | 54.1 | 26 | 53.1 | 105 | 58.9 | 261 | 53.9 |
Middle | 361 | 71.2 | 62 | 76.5 | 423 | 71.9 | 294 | 71.4 | 47 | 54.7 | 341 | 68.5 | 764 | 70.4 |
Coastal | 157 | 64.6 | 2 | 50.0 | 159 | 67.8 | 112 | 57.1 | 4 | 66.7 | 116 | 57.4 | 275 | 61.3 |
SHS, Senior High School; JHS, Junior High School.
Out of the 1300 pupils or students who reported to have ever utilised SRHS, 1180 (90.8%) of them indicated the specific services accessed within the last 6 months preceding the survey (
Sexual and reproductive health services utilised by sex and disability type.
Variables | Sex and disability type |
Total ( |
|||||
---|---|---|---|---|---|---|---|
Males |
Females |
||||||
Disability type |
Disability type |
||||||
Deaf ( |
Blind ( |
Total ( |
Deaf ( |
Blind ( |
Total ( |
||
Contraceptives | 33.6 | 37.8 | 42.7 | 14.2 | 9.0 | 13.5 | 17.0 |
STI treatment | 24.6 | 31.1 | 25.4 | 27.7 | 37.3 | 29.0 | 26.8 |
Gynaecological services | - | - | - | 15.4 | 31.3 | 17.6 | 15.8 |
Pregnancy test | - | - | - | 14.9 | 7.4 | 13.9 | 13.1 |
Pregnancy termination | - | - | - | 6.4 | 1.5 | 5.7 | 5.5 |
MCH | - | - | - | 5.2 | 1.6 | 4.7 | 4.7 |
HIV testing | 41.8 | 31.1 | 31.9 | 16.2 | 11.9 | 15.6 | 17.1 |
MCH, maternal and child health; HIV, human immunodeficiency virus; STI, sexually transmitted infection.
Three sequential logistic regression models were built based on the conceptual framework employed for the study. As shown in
Logistic regression analysis of sexual and reproductive health services utilisation.
Variables | Model I |
Model II |
Model III |
|||
---|---|---|---|---|---|---|
OR | CI | OR | CI | OR | CI | |
10-14 | Ref | - | Ref | - | Ref | - |
15-19 | 0.85 | 0.65–1.10 | 1.05 | 0.68–1.62 | 0.97 | 0.49–1.89 |
20-24 | 0.76 | 0.53–1.08 | 1.35 | 0.72–2.54 | 1.37 | 0.55–3.37 |
Males | Ref | - | Ref | - | Ref | - |
Females | 0.77 |
0.64–0.93 | 0.79 | 0.57–1.10 | 1.08 | 0.66–1.75 |
Primary | Ref | - | Ref | - | Ref | - |
JHS | 1.48 |
1.18–1.84 | 1.24 | 0.84–1.84 | 1.02 | 0.63–1.85 |
SHS/technical | 2.53 |
1.52–4.22 | 0.91 | 0.44–1.89 | 0.55 | 0.22–1.40 |
No religion | Ref | - | Ref | - | Ref | - |
Christianity | 1.14 | 0.60–2.17 | 1.63 | 0.66–3.99 | 2.70 | 0.91–7.99 |
Islam | 0.99 | 0.50–1.93 | 1.51 | 0.58–3.93 | 4.07 | 1.10–15.11 |
Northern | Ref | - | Ref | - | Ref | - |
Middle | 1.54 |
1.21–1.96 | 0.71 | 0.43–1.18 | 0.07 |
0.01–0.51 |
Coastal | 1.13 | 0.85–1.49 | 0.40 |
0.23–0.70 | 0.03 |
0.01–0.25 |
Deaf | - | - | Ref | - | Ref | - |
Blind | - | - | 2.87 |
1.28–6.44 | 1.94 |
1.17–5.75 |
Very good | - | - | Ref | - | Ref | - |
Good | - | - | 1.46 |
1.02–2.09 | 1.69 | 0.99–2.87 |
Very bad | - | - | 1.80 | 0.85–3.79 | 1.54 |
1.12–3.97 |
Bad | - | - | 1.06 | 0.56–2.01 | 0.75 | 0.31–1.79 |
Yes | - | - | - | - | Ref | - |
No | - | - | - | - | 0.63 |
0.32–0.95 |
Yes | - | - | - | - | Ref | - |
No | - | - | - | - | 0.58 |
0.30–0.91 |
Pseudo |
0.02 | - | 0.04 | - | 0.11 | - |
Ref, reference category; OR, odds ratio; CI, confidence interval; SHS, Senior High School; JHS, Junior High School.
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Whereas YPWDs have the same range of SRH needs and desires just like anyone else, they may encounter another layer of obstacle in assessing healthcare services as well as asserting their SRH rights because of the disabilities they have. This study sought to investigate SRHS utilisation amongst in-school young people who are blind and deaf in Ghana. The results show high levels of SRHS utilisation amongst the respondents studied. On the contrary, it was observed in a study conducted amongst PWDs in Accra that only one-fifth of them had utilised healthcare facilities (Abraham et al.
Young people with disabilities in the Coastal and Middle Ecological Zones were less likely to use SRHS compared with those in the Northern Zone. There are existing north-south disparities in several development indicators in Ghana, which tend to favour the latter generally. Owing to this imbalance, several health interventions, including SRH, are ongoing in many communities in the Northern Zone. There is evidence that the government is collaborating with some NGOs to address the equity gaps in access to healthcare services, especially in the Northern Zone. Notable amongst the NGOs are Catholic Relief Services, West Africa AIDS Foundation and Alliance for Reproductive Health Rights (Hushie
The blind pupils or students were more likely to use SRHS compared with the deaf students. Even though persons with blindness may experience some physical accessibility challenges in seeking healthcare services, they are at an advantage in terms of effective communication with the providers. For the deaf, the space for communication is constricted, given the general lack of sign language experts in many healthcare facilities (Mprah
Self-rated health has been noted in the literature as a measure that predicts the utilisation of healthcare services (Tamayo-Fonseca et al.
Young people with disabilities who had subscribed to health insurance recorded a higher probability of SRHS utilisation compared with those who had not subscribed. This finding confirms those of other previous studies, which revealed that ownership of health insurance affects utilisation of healthcare services (Boachie
Treatment of STIs was the main SRHS received by both the male and the female respondents, although the main SRHS received amongst the males was contraceptives. Probably, it is because YPWDs are susceptible and vulnerable to such infections (Suzanna et al.
The survey, with a sample size of 2114, was conducted in selected special schools across the country. However, some limitations need to be acknowledged. Firstly, the study targeted in-school young people who are deaf or blind, and therefore, not representative of all YPWDs in the country. Secondly, the reporting of some behaviours could be biased in an attempt to provide culturally and socially desirable responses, despite the assurance of confidentiality and anonymity before the administration of the questionnaires. Thirdly, as discussed by Mprah (
Generally, utilisation of SRHS amongst the in-school YPWDs in Ghana is high but significantly associated with some factors. These included predisposing (ecological zone), need for care (type of disability and self-rated health status) and enabling or disabling (health insurance subscription and ever faced a challenge) factors. The main SRHS received by YPWDs was STI treatment. For both the deaf and the blind male pupils or students, the main SRHS received was contraceptives compared with STI treatment amongst their female counterparts. The percentage distributions of the SRHS received by the deaf and the blind male students were about the same but varied amongst the female students.
The conclusion that SRHS utilisation amongst the in-school YPWDs is associated with some factors has policy implications. This underscores the need for policymakers to consider in-school YPWDs as a heterogeneous group in the design and implementation of SRH programmes. The range of SRHS received by the YPWDs suggests that they have SRH needs. The Ghana Education Service in collaboration with the Ghana Health Service should adopt appropriate pragmatic measures and targeted interventions in the special schools to address the SRH needs of all the pupils or students. These measures may include alerting pupils or students in the special schools about the range of SRHS available in healthcare facilities. Furthermore, healthcare providers could organise routine outreach SRHS for pupils or students in the special schools. For service providers, people who identify strongly with YPWDs may be drawn into frontline roles in the delivery of SRHS in the special schools.
The author would like to thank Abdul-Aziz Seidu for his contribution towards data collection, data entry and processing.
The author has declared that no competing interest exists.
The author declares that he is the sole author for this article.
The data for this research study were collected under the project entitled Sexual and Reproductive Health and Leisure Needs of Young People with Disabilities in Ghana, which was supported by the Directorate of Research, Innovation and Consultancy (DRIC), University of Cape Coast.
Data sharing is not applicable to this research article as no new data were created or analysed in this study.
The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of any affiliated agency of the author.