This is the abstract presentation of Shibu Shrestha, which was made as part of the 11th session 10th Asia Pacific Conference on Reproductive and Sexual Health and Rights (#APCRSHR10 Virtual), on the theme of "Persons with disabilities, and sexual and reproductive health and rights (SRHR) in Asia and the Pacific". C H A I R Abia Akram, CEO, National Forum of Women with Disabilities P L E N A R Y S P E A K E R S * Setareki S Macanawai, CEO, Pacific Disability Forum | "Transforming access to sexual and reproductive health and gender-based violence services for women and young people with disabilities in the Pacific" * Tanzila Khan, Founder, Girly things, Creative Alley | "Connecting SRHR to Disability in new age of technology" A B S T R A C T P R E S E N T A T I O N S * Dakshitha Wickremarathne | We Hear You - A Sign Language Glossary on Sexual and Reproductive Health and Rights for people with hearing disability * Srei Chanda | Does the issue of sexual health outcome remain unaddressed among adults after a lower limb disability? An answer through exploratory study in India * Shibu Shrestha | Experiences of young people specifically young people with disabilities in accessing FP services in Nepal * An Nguyen | Accessing Reproductive Health Care Services For Women With Physical Disabilities In Ho Chi Minh City, Vietnam V O I C E F R O M T H E F R O N T L I N E Phyu Nwe Win, Colorful Girls, Myanmar For more information on the session, please visit www.bit.ly/apcrshr10virtual11 Official conference website: www.apcrshr10cambodia.org Thanks

1. EXPERIENCES OF YOUNG PEOPLE
SPECIFICALLY YOUNG PEOPLE WITH
DISABILITIES IN ACCESSING FP SERVICES
IN NEPAL
Shibu Shrestha, Medha Sharma, Sabina Pokhrel
Visible Impact

2. ▪ Unmet need for family planning in Nepal is high.
▪ Only a quarter (25%) of 15-19 years young
women have their demand satisfied for modern
family planning.
▪ Misconception exists that suggests that people
with disabilities are either asexual or
hypersexual.
▪ Assumed that persons with disabilities are not
sexually active and therefore do not need SRH
and FP services.

3. ▪ A study carried out by MSI showed that 96.5%of the young people with
disabilities are not aware of all modern FP methods, 94% have heard of safe
abortion, while 39% are unaware of legal status of abortion.
▪ People with disabilities are twice as likely to be on the receiving end of
inadequately skilled healthcare providers at improper facilities, and are
three times more likely to be denied health care and four times more likely
to be treated badly by health care systems.
▪ Around 80% respondents had one or more myth or misconception
associated with FP and abortion.

4. ▪ Only 28% ever consulted with the service providers. In addition, 54%
considered their service centers were not friendly to their disability
because of lack of infrastructure—for example, lack of wheelchair
accessibility (57%), service providers’ negative attitude or lack of
understanding of their need (29%) and absence of sign language
interpreter (12%).

5. ▪ To explore the experience and barriers of people with disabilities
when accessing family planning related services and information.

6. ▪ Study Design: Qualitative study design
▪ Study Area: Kathmandu
▪ Study participants: 45 young people (15-30 years), representing different
ethnic backgrounds and forms of disabilities from three provinces, Province
1 (Sunsari),3 (Kathmandu) and 5 (Nepalgunj) in Nepal
▪ Data collection methods: 4 focus group discussions and 6 in depth
interviews
▪ Data Collection Tool: The data were collected using Interview guidelines
and FGD guidelines.
▪ Data management and Analysis: The data was obtained through
recordings of the discussion along with the notes from the note taker. Verbal
and non-verbal interaction of the participants were also noted.
▪ Thematic analysis was performed to identify the main themes from the data
obtained.

7. ▪ Hesitant to share about their behavior and perception regarding family
planning.
▪ The male participants in province 5 were hesitant to spell out family planning
themselves.They used word like 'that thing' or 'like that' while referring to
family planning.
"They ask us to mind our own business, and that they would take care of
their children in and we should not show our concern for it“.
“The word sex cannot be pronounced out loud in the society.”
(Male, Sunsari)

8. ▪ Respondents with prior participation in trainings, workshops related to
sexual and reproductive health were more open to discuss on such
issues.
▪ All of the informants shared that such issues were still not discussed out
in the open among the people with disabilities.

9. METHODS USED
▪ The participants had limited
knowledge on the family planning
methods used by other peers.
▪ The male participants stated that the
main method of family planning
among the unmarried was emergency
contraceptive pills.

10. ▪ "I think I will have to guess on the type of family planning device being
used. I think its pills among the women. (Oral contraceptive pills).”
(Female with blindness, Kathmandu)
▪ The participant share about how about certain contraceptives cannot
be effectively used by people with physical disabilities. “Since we don’t
feel any pain below the spine therefore if any dislocation or something
else happens with such externally placed devices than people with spinal
cord injury will not feel anything.”

11. The participants shared that the decision of the usage of family planning should
be made through discussion and consensus among the couples.
However, one of the married female participant in Sunsari highlighted that men
are usually the sole decision maker in terms of the type of the family planning
medium to be used after marriage, which is similar to what the female
participants had shared in Nepalgunj.
"When there is no discussion,there is no question of decision.But,the males often
offer us to buy after pills the next day,and we have to agree as we usually do not
have other alternatives.We do not have time or confidence to go buy
contraceptives,so we willingly allow unprotected sex.They buy us the after pill the
next day" (Female, Nepalgunj)

12. ▪ The myth associated with contraceptives did exist. For eg: condom and
IUD do not give sexual satisfaction, vasectomy makes a man weak, and
the patriarchal perception led to women using family planning. Pills and
Depo Provera Injection are the most commonly used methods, which is
similar to what women use throughout the country.

13. ACCESS TO
SERVICES
▪ The attitude of the service providers was
highlighted as a major hindrance for
accessing the services.The participants
shared that the attitude of the service
providers was judgmental and not youth
friendly when young people sought family
planning services.
“ It’s difficult to identify which rooms are
where.We have to go to the hospitals along
with an assistant. Not everyone can afford an
assistant.The problem is graver in terms of
rural health facilities.” (Female with
blindness, Kathmandu)

14. “Firstly family planning topics are not discussed out in the open and when it
is concerned with persons with disability then health service providers often
say. Even they need these devices. We are often questioned and viewed in
such way. Once I went to buy Kamal chaki ( vaginal tablets) the pharmacist
looked at me in such a way like I’ve committed a murder. Since then I have
never gone to buy contraceptive device on my own.”
(Female with physical disability, Kathmandu)

15. ▪ The opening hours of the gynecology clinic was also not suitable for
young people as shared by the female participants in Nepalgunj. “The
gynecology clinic is open only twice a week, and it is often crowded with
married females. The time during which the clinic runs is also not favorable
for us since we have to go to school”, shared a female participant. Though
the behavior of the service provider is friendly, youth are hesitant to go
because of fear or privacy breach.

16. ▪ All CSOs should include people with disabilities centred approaches in their
interventions.
▪ Existing SRHR related act, regulation, policies have to be revisited
considering SRHR needs and issues from accessibility perspectives of
persons with disabilities.
▪ The government should make adjustments to its reporting templates
accommodating disability group alongside of a plan with definite target to
reach out to.
▪ The existing health curriculum aimed at various levels of medical education
should also include SRH in connection with disability.

17. ▪ All information and services must be equipped with accessibility
standards, and these for example includes provision of ramps, larger
bathrooms with grab bars, lowered examination tables, easy to read
versions and simple languages, sign language interpreters, tactile
communication provision, captioning, materials in large prints, audio
format and braille script including pictorial form for persons with
intellectual disabilities and autism spectrum disorder.
▪ Research on SRH of persons with disabilities needs to be promoted and
such research should include disaggregated data on disability category.

18. shresthashibs@gmail.com mail.visim@gmail.com