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

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....

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Bibliographic Details
Published in:Social science & medicine 2011-11, Vol.73 (10), p.1477-1489
Main Authors: Trani, Jean-Francois, Browne, Joyce, Kett, Maria, Bah, Osman, Morlai, Teddy, Bailey, Nicki, Groce, Nora
Format: Article
Language:English
Subjects:
Access
Access to health care
Adolescent
Adult
Biological and medical sciences
Children
Cross-Sectional Studies
Disability
Disability Evaluation
Disabled Persons
Epidemiology
Female
Females
General aspects
Handicapped
Health care access
Health Care Services
Health Care Surveys
Health inequality
Health services
Health Services Accessibility
Health Services Needs and Demand
Health Status
Health Status Disparities
Humanities and Social Sciences
Humans
Male
Maternal health care
Maternal Health Services - statistics & numerical data
Maternal Health Services - utilization
Medical sciences
Miscellaneous
Mortality
People with disabilities
Physically Handicapped
Pregnancy
Public health. Hygiene
Public health. Hygiene-occupational medicine
Quality standards
Reproductive Health
Reproductive Health Services - statistics & numerical data
Reproductive Health Services - utilization
Sex Factors
Sexual Reproduction
Sierra Leone
Sociology
Statistics as Topic
Surveys and Questionnaires
Women's Health
Womens Health Care
Young Adult
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Summary: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 cross-sectional 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. ► The first study on disability and access to health care in Sierra Leone. ► The first large scale survey on maternal health care and disability. ► Identifies differences in access to general health care services, but not access to maternal health care services, for disabled and non-disabled persons. ► Finds similar reproductive health outcomes between disabled and non-disabled women.
ISSN:0277-9536
0037-7856
1873-5347
DOI:10.1016/j.socscimed.2011.08.040