Sexual Health

"We don't see a future in them…" barriers to accessing sexual and reproductive health information and services among young people with disabilities in Kyotera border district.

TL;DR

Young people with disabilities in Kyotera border district face multilevel barriers to accessing sexual and reproductive health information and services, including individual barriers (limited awareness and low self-esteem), community barriers (beliefs and practices), and health facility barriers (communication challenges, commodity shortages, and negative provider attitudes).

Key Findings

Limited awareness about the availability of SRH information and services was identified as a key individual-level barrier among young people with disabilities.

  • Young people with disabilities were often unaware that SRH services and information existed or were available to them.
  • This lack of awareness contributed to low uptake of services even when services were theoretically accessible.
  • The study was conducted among 12 male and female YPWD aged 10–24 years with physical disabilities in Kyotera border district, Uganda.
  • Data were collected through In-Depth Interviews and analyzed using thematic analysis.

Low self-esteem among young people with disabilities was identified as an individual-level barrier to seeking SRH information and services.

  • Low self-esteem was reported as contributing to reluctance to seek healthcare among YPWD.
  • This finding aligns with the study's broader observation that stigma and discrimination related to disability discourage health-seeking behavior.
  • The barrier was identified through In-Depth Interviews with 12 YPWD with physical disabilities.
  • This was categorized under individual-level barriers in the three-level thematic framework identified by the study.

Community-level beliefs and practices constituted a major barrier to YPWD accessing SRH information and services.

  • Community beliefs and practices were identified as one of three major thematic barrier categories.
  • The study title references the belief expressed by community members that they 'don't see a future' in young people with disabilities, reflecting deep-seated negative attitudes.
  • These community-level barriers operated alongside individual and health facility barriers to create a multifaceted system of exclusion.
  • Key Informant Interviews with 7 key informants provided additional context on community-level dynamics.

Health facility-level barriers included communication challenges, shortages of commodities, and negative provider attitudes toward young people with disabilities.

  • Communication challenges at health facilities made it difficult for YPWD to access and understand SRH information and services.
  • Shortages of commodities such as contraceptives and other SRH supplies were reported as barriers at the facility level.
  • Negative provider attitudes were explicitly identified as a barrier, consistent with broader literature on stigma within healthcare settings.
  • These three facility-level sub-barriers were reported directly by YPWD participants in In-Depth Interviews.
  • The study was set in Kyotera border district, described as a context known for high rates of early sexual initiation.

The study was conducted in a Ugandan border district context characterized by high rates of early sexual initiation, which adds urgency to addressing SRH barriers for YPWD.

  • Kyotera border district was selected specifically because it is known for high rates of early sexual initiation.
  • The border context was framed as a unique and heightened risk environment for young people, including those with disabilities.
  • 12 YPWD with physical disabilities (male and female, aged 10–24) and 7 key informants participated in the study.
  • The study used a qualitative design with In-Depth Interviews and Key Informant Interviews, with thematic analysis of transcripts.

The study identified that comprehensive, multilevel interventions are urgently needed to create a more inclusive and accessible SRH environment for young people with disabilities.

  • Barriers operated at individual, community, and health facility levels simultaneously, requiring interventions spanning all levels.
  • The findings are intended to support development of inclusive healthcare policies aligned with SDG commitments to 'leave no one behind.'
  • The authors characterize the challenges as 'intricate' and 'multifaceted,' underscoring that no single-level intervention would be sufficient.
  • The study population included YPWD with physical disabilities specifically, which may limit generalizability to those with other disability types.

What This Means

This research explores why young people with disabilities (ages 10–24) in Kyotera, a border district in Uganda, struggle to access sexual and reproductive health (SRH) information and services. Researchers conducted in-depth interviews with 12 young people with physical disabilities and 7 community and health experts. They found that barriers exist at three levels: personal, community, and healthcare facility. Personally, many young people with disabilities did not know SRH services were available to them, and low self-esteem made them reluctant to seek help. At the community level, negative beliefs about the futures and worth of people with disabilities — captured in the phrase 'we don't see a future in them' — prevented families and communities from supporting access to SRH care. At the health facility level, poor communication between providers and patients with disabilities, shortages of essential supplies, and dismissive or negative attitudes from healthcare workers all made it harder for YPWD to receive care. This research matters because it highlights that young people with disabilities are often overlooked in sexual and reproductive health programs, even in high-risk settings like border districts where early sexual activity is more common. The combination of social stigma, personal barriers, and inadequate health services creates a compounding disadvantage for this group. This suggests that simply making clinics available is not enough — meaningful change requires addressing attitudes in communities and among health workers, improving communication accessibility, ensuring adequate supplies, and raising awareness among YPWD themselves about what services exist and that they are entitled to them. The findings point toward the need for inclusive health policies that specifically account for the needs of young people with disabilities, in line with global goals to ensure no one is left behind in development progress. This research suggests that interventions should target all three levels — individual, community, and facility — simultaneously to be effective, and that the voices and experiences of young people with disabilities themselves should be central to designing those interventions.

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Citation

Odo L, Ndugga P, Kwagala B. (2025). "We don't see a future in them…" barriers to accessing sexual and reproductive health information and services among young people with disabilities in Kyotera border district.. BMC public health. https://doi.org/10.1186/s12889-025-25008-w