Access to health care, reproductive health and disability: a large scale survey in Sierra Leone

Type Journal Article - Social Science & Medicine
Title Access to health care, reproductive health and disability: a large scale survey in Sierra Leone
Volume 73
Issue 10
Publication (Day/Month/Year) 2011
Page numbers 1477-1489
This is the first study to compare health status and access to health care services between disabled and
non-disabled men and women in urban and peri-urban areas of Sierra Leone. It pays particular attention
to access to reproductive health care services and maternal health care for disabled women. A crosssectional
study was conducted in 2009 in 5 districts of Sierra Leone, randomly selecting 17 clusters for
a total sample of 425 households. All adults who were identified as being disabled, as well as a control
group of randomly selected non-disabled adults, were interviewed about health and reproductive health.
As expected, we showed that people with severe disabilities had less access to public health care services
than non-disabled people after adjustment for other socioeconomic characteristics (bivariate modelling).
However, there were no significant differences in reporting use of contraception between disabled and
non-disabled people; contrary to expectations, women with disabilities were as likely to report access to
maternal health care services as did non-disabled women. Rather than disability, it is socioeconomic
inequality that governs access to such services. We also found that disabled women were as likely as
non-disabled women to report having children and to desiring another child: they are not only sexually
active, but also need access to reproductive health services. We conclude that disparity in access to
government-supported health care facilities constitutes a major and persisting health inequity between
persons with and without disabilities in Sierra Leone. Ensuring equal access will require further
strengthening of the country’s health care system. Furthermore, because the morbidity and mortality
rates of pregnant women are persistently high in Sierra Leone, assessing the quality of services received
is an important priority for future research.

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