Barriers to healthcare access during pregnancy and after birth for adolescent girls living with disability in Sierra Leone: a qualitative study

Abstract

Abstract

BACKGROUND AND OBJECTIVE: In 2017, Lifeline Nehemiah Projects in Sierra Leone launched 2YoungLives, a mentoring initiative for vulnerable pregnant adolescents, including those living with disabilities. Drawing from the social model of disability, we aimed to investigate the exacerbated disabling barriers which prevent these girls and their babies from accessing available healthcare and develop comprehensive solutions to improve their access. DESIGN: Qualitative methods were used in this study. SETTING: Participants were invited to participate in face-to-face interviews in one district in Sierra Leone. PARTICIPANTS: Six pregnant or postnatal adolescents living with disability, alongside four caregivers and five stakeholders from various organisations participated in semi-structured interviews employing thematic analysis. RESULTS: We identified four key themes: (1) discrimination and financial barriers within the healthcare system, despite laws ensuring free healthcare for persons living with disabilities, (2) societal stigma manifested through abandonment by families and inadequate support, (3) lack of understanding of disability issues, particularly of those with intellectual impairments, leading to stigmatisation and exclusion, and (4) infrastructural limitations which hinder accessibility to essential services, with many facilities remaining non-compliant with disability regulations. CONCLUSION: Adolescent girls living with disability during pregnancy and after birth in Sierra Leone face barriers to accessing healthcare, including caregiver ignorance, lack of autonomy, disabling services, social stigma and ineffective policy implementation, despite existing supportive laws. These findings keep those women who are arguably the most vulnerable, adolescent and living with a disability, from accessing perinatal healthcare, exacerbating their risk and that of their babies. Solutions include the need to enforce disability-inclusive policies and infrastructure adaptations, awareness and training for healthcare providers and community advocacy to break down social stigma.