Access to sexual and reproductive health and rights services among women with disabilities: a cross-sectional study from Murang’a South, Central Kenya

Abstract

Abstract

BACKGROUND: Sexual and Reproductive Health and Rights (SRHR) are fundamental human rights. However, Women with Disabilities (WWDs) experience persistent barriers limiting equitable access. Despite efforts toward inclusivity, empirical evidence on service utilisation patterns and determinants in sub-national Kenyan contexts, remains limited. This study examined access to SRHR services among WWDs in Murang'a South, Central Kenya. METHODS: An analytical cross-sectional study design was employed, with a sample size of 325 WWDs aged 15-49 years. Data were collected using structured questionnaires and analysed using Kobo Toolbox (v2021.2.4) and Python (v3.13.1). The data were presented in tables. Descriptive statistics summarised participant characteristics using frequencies and percentages. Access to SRHR services was treated as a binary outcome (≥ 1 visit vs. none in the past year) and bivariate logistic regression analysis was conducted to examine associations between variables, with results reported as crude odds ratios (CORs) at 95% confidence intervals. RESULTS: Overall, 67.69% of WWDs reported access to SRHR services, while 32.31% reported none. Family planning services were the most accessed (89.09%). Access to HIV/STI testing and prevention (20%), Maternal Health Services (9.55%), safe and post-abortion care (2.27%) and Reproductive cancer screening (4.09%), were relatively low. Access was significantly associated with disability type, age, education, marital status, income, sexual activity, and religion. Women with mental disabilities had the lowest access odds (COR = 0.94; 95% CI: 0.39-2.26). Access increased with age. WWDs aged 36-42 years (COR = 36.67; 95% CI: 12.96-103.73) and 43-49 years (COR = 21.50; 95% CI: 7.06-65.45) had significantly higher odds of accessing SRHR services. WWDs who had attained tertiary education (COR = 5.66; 95% CI: 1.23-25.98), who were married (COR = 6.89; 95% CI: 3.27-14.50), were protestants (COR = 2.36; 95% CI: 1.44-3.87) and who were sexually active (COR = 6.49; 95% CI: 3.98-10.58), were significantly more likely to access SRHR services. Stigma (COR = 0.07; 95% CI: 0.02-0.22), restrictive norms (COR = 0.22; 95% CI: 0.11-0.45), and gender power dynamics (COR = 0.55; 95% CI: 0.28-1.07) markedly reduced access. Health-facility factors, including provider communication, privacy, confidentiality practices, physical accessibility, distance to facilities, and availability of disability-inclusive information, were also significant determinants. CONCLUSION: SRHR service access among WWDs in Murang'a South, Central Kenya remains highly uneven, highlighting persistent inequities that warrant the need to engage with healthcare providers to understand their perspectives and barriers to inclusive care; strengthen disability-inclusive training and cultural competence to improve knowledge, address negative attitudes, and ensure privacy, thereby making clinical environments safe and comfortable for WWDs.