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Sexual and Reproductive Health and Rights of Girls with Disabilities. a Review of Literature

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Sexual and Reproductive Health and Rights of Girls with Disabilities. a Review of Literature 2017:00083- Unrestricted Report Sexual and reproductive health and rights of girls with disabilities A review of the literature Authors Stine Hellum Braathen (SINTEF) Poul Rohleder (University of East London) Gloria Azalde (SINTEF) SINTEF Technology and Society Department of Health 2017-06-02 Table of contents 1 Background ................................................................................................................................... 4 1.1 Background to this report .............................................................................................................. 4 1.2 Introduction to the topic of research ............................................................................................ 4 2 Objectives ..................................................................................................................................... 6 3 Methodology ................................................................................................................................. 6 3.1 Identifying the research questions ................................................................................................ 6 3.2 Identifying relevant studies ........................................................................................................... 7 3.3 Study selection ............................................................................................................................... 7 3.3.1 Inclusion and exclusion criteria ......................................................................................... 7 3.3.2 Results of the literature search ......................................................................................... 8 3.4 Charting the data ........................................................................................................................... 9 3.4.1 Regions that research has been conducted in................................................................... 9 4 Summarising and reporting the results ......................................................................................... 12 4.1 Stigma .......................................................................................................................................... 12 4.2 Sexual education .......................................................................................................................... 13 4.3 Sexual and reproductive health ................................................................................................... 15 4.4 Sexual abuse ................................................................................................................................ 18 4.4.1 Vulnerability to sexual abuse ........................................................................................... 18 4.4.2 Characteristics of sexual abuse........................................................................................ 19 4.4.3 Reporting sexual abuse .................................................................................................... 20 4.4.4 Consequences of sexual abuse ........................................................................................ 21 4.5 Self-determination and control ................................................................................................... 22 4.6 Alternative sexual identities ........................................................................................................ 23 5 Gaps in knowledge and suggestions for future research ................................................................ 24 6 References .................................................................................................................................. 26 6.1 References used in Background and Methodology sections ....................................................... 26 6.2 References of research papers included in the review ................................................................ 28 6.3 References of included review papers ......................................................................................... 47 7 Appendices ................................................................................................................................. 51 APPENDICES Appendix 1: Summary Table of Research Papers Reviewed Appendix 2: Summary Table of Review Papers Included PROJECT NO. REPORT NO. VERSION 3 of 51 102015148 2017:00083 Final 1 Background 1.1 Background to this report This literature review on the sexual and reproductive health and rights of girls with disabilities was commissioned by the United Nations Office of the Special Rapporteur on the Rights of Persons with Disabilities. The review has been carried out by SINTEF Technology and Society and University of East London. The report contains an introduction to the topic of the review, objectives for the review, methodology, summary of the thematic analysis of the literature, gaps in knowledge and suggestions for future research and spreadsheets of all the included literature (research articles and review articles). 1.2 Introduction to the topic of research Two concepts are central to this review, namely 'sexual health' and 'disability'. The two concepts, their definitions and how they are interlinked, are described below. WHO (2015) describes sexual health in the following way: Sexual health today is widely understood as a state of physical, emotional, mental and social wellbeing in relation to sexuality. It encompasses not only certain aspects of reproductive health – such as being able to control one’s fertility through access to contraception and abortion, and being free from sexually transmitted infections (STIs), sexual dysfunction and sequelae related to sexual violence or female genital mutilation – but also, the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence (WHO, 2015, p. 1). In the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) (United Nations, 2006), disability is defined in the following way: Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others (United Nations, 2006, p. 4). However, disability is a complex and contested concept, in constant flux (Shakespeare, 2015; WHO et al., 2011), and with no unified definition (Iriarte, 2016). In the World Report on Disability (WHO et al., 2011), based on the International Classification of Functioning, Disability and Health (ICF) (WHO, 2001), disability is described in the following way: Disability is the umbrella term for impairments, activity limitations and participation restrictions, referring to the negative aspects of the interaction between an individual (with a health condition) and that individual's contextual factors (environmental and personal factors) (WHO et al., 2011). The strength of the ICF concept is in offering a common language to study the dynamic interaction between health condition, environmental factors and personal factors and therefore enabling to define what can improve the life situation of disabled people (Hollenweger, 2014). It looks beyond the medical condition and includes the social dimension of a person (Eide et al., 2011). PROJECT NO. REPORT NO. VERSION 4 of 51 102015148 2017:00083 Final It has been estimated that people with disabilities make up somewhere between 10% and 20% of the world's population, and of those, 80% live in low-income countries and have little or no access to basic health and social services. A higher proportion of people with disabilities live in relative poverty in both high, middle and low-income countries. It has also been estimated that there are more females than males with disabilities globally (Lancet, 2009; Shakespeare, Iezzoni, & Groce, 2009; WHO & The World Bank, 2011). People with disabilities are among the most vulnerable and marginalised groups of any population, often excluded from mainstream social, economic and health services, lacking educational and occupational opportunities to meet their full potential (Eide & Loeb, 2006; Eide et al., 2011; Eide et al., 2015; Groce, 2004; Lancet, 2009; WHO & The World Bank, 2011). Stigma and prejudice are said to be one of the greatest barriers to the inclusion of people with disabilities (Groce & Trani, 2009). Worldwide women and girls with disabilities are among the most disadvantaged, with lower self-esteem, poorer health, educational and employment outcomes, and more exposure to discrimination, exploitation and abuse compared to people without disabilities in general and men and boys with disabilities more specifically (Reinkainen, 2004; Tilley, 1998; WHO & The World Bank, 2011). 'Girls with disabilities' in this review includes female children and adolescents1 with disabilities. All human beings are protected by the Universal Declaration of Human Rights (United Nations, 1948). Despite this, people with disabilities are denied many of their basic human rights (Harpur, 2012; Officer & Groce, 2009). The achievement of optimal sexual health for any human being is dependent on realisation of basic human rights, such as the right to non-discrimination, to privacy and confidentiality, to be free from violence and coercion, as well as the right to education, information and access to health services (United Nations, 1948; WHO, 2015). The UNCRPD includes
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