 Organizations that advocate for the persons with disabilities among other vulnerable groups have attracted public attention against challenges that face the youth with compounded vulnerabilities in access to sexual reproductive health and rights (SRHR) in Rwanda.
In a position paper that was put together by a consortium of 20 organizations recently, it was recognized that laws and policies in Rwanda promote the universal health coverage and recognize that everyone has right to reproductive health services in terms of decision making, awareness raising and service provision without any discrimination.
However, they found that implementation of those laws and policies is to some extent jeopardized; it seems to leave behind some specific groups including the Youth with Compounded Vulnerabilities (YWCVs) and other marginalized groups for SRHR services.
They pointed a finger to some loopholes in local policies, laws and regulations where the under 18 adolescents can only have access to sexual reproductive health services, if only accompanied by their parents.
They also presented the case of service providers who largely don’t have skills to communicate with some clients like people with disabilities and to serve them due to the type of disability.
In this context, the clients will, in most of times, have to be accompanied by a third person as caregiver or a translator, which denies them their fundamental right to confidentiality and privacy in healthcare.
To bring their point home in all these challenges, the organizations which were recently convened by Save Generations organization to discuss the position paper first reminded what global and national strategic documents stipulate in relation to SRHR among the vulnerable people.
First to bring on board was the Article three and five of the Sustainable development goal which is looking forward to a universal access to sexual and reproductive health service by 2030.
They also mentioned the African disability protocol, a human rights treaty that addresses the unique forms of discrimination affecting people with disability I Africa.
The national policy of people with disability (2022) was also visited, and so was the human reproductive law of 2016.
The latter gives every person right to decide in relation to human reproductive health issues.
However, a witness of these challenges testified that people with disability are taken as people who cannot have their say on their sexual life orientation.
“For example, the case of women with disability; their family force them into family planning methods which prevent them from giving birth. For someone who have a mental disability, they take you to the hospital and decide for you. It is indecent to decide to prevent someone from having a family,” she said.
“On another side however, there are families which push a person with disability to get married so as to have a child who will help carry him/her because they are tired of him. It’s also a bad intention.”
Where do policies fall short?
Despite clear instruments, several factors affect the youth with compounded disabilities in the use of Social Reproductive Health and Rights.
The people who drafted this document understand that the universalized, top-down gender policy programs “have not furnished all women with the necessary capacity to make decisions that affect their traditionally all-important reproductive functions; to challenge the embedded gender imbalance; and to strive for a holistic wellbeing of their families, where they play a central role.”
Indeed, they said, some of the policies could have negative implications to the health of women, in particular, with sexually transmitted infections, including HIV and AIDS.
A case they mentioned is an intimate partner violence and non-partner sexual violence which they said, “can lead to unintended pregnancies, induced abortions, gynecological problems and STIs, including HIV. Intimate partner violence during pregnancy also increases the likelihood of miscarriage, stillbirth, preterm delivery and low-birth weight infants.”
The consent age which is 18 years, the challenge of accessibility to public service infrastructure like buildings, and lack of people who can translate the sign language at hospital for example, have also been presented among other hindrances.
The paper calls upon the government and stakeholders to “make an intentional effort so as to ensure that YWCVs are welcomed and treated fairly at events and in healthcare services.”
The paper recommends addressing the customer care by using user-friendly terminology; treating YWCVs adolescents; speaking directly to them without a third party(parent, aide or sign language interpreter).
In this issue of customer care, a person with disability said, that people should learn to take a person with disability as a normal person.
“Everyone should take care that they seek your consent, so that they give the right service at the right time,” she said referring on people at hospital who handle indecently women with disability in front of their husbands.
To succeed in all this, the authors recommend to Ministry of Health, to do a policy revision for improved responsiveness in strategic areas like inclusion and intersectionality, to teach the sign language to health service providers and to make it in curriculum of health providers.
They should conduct Values Clarification and Attitude Transformation (VCAT) trainings for all stakeholders involved in SRHR programmes, among others.
