REPRODUCTIVE HEALTH SERVICE UTILIZATION AND BURDEN OF PROBLEMS AMONG WOMEN WITH DISABILITIES IN SIDAMA REGION, ETHIOPIA

Abstract

Background: Women with disabilities are more likely to experience unintended pregnancy and sexual violence. However, there is no enough evidence about contraceptive utilization, unintended pregnancy, sexual violence and determinant factors among reproductive-age women with disabilities in Ethiopia. This knowledge gap is particularly pronounced in rural settings and among individuals with disabilities beyond the categories of the young, blind, and deaf. Additionally, the influence of contextual factors on these aspects remains inadequately explored. Therefore, this study aimed to assess reproductive health service utilization and burden of problems among women with disabilities in Central Sidama (Dale and Wonsho districts and Yirgalem city administration) Region, Ethiopia. Methods: A community-based disability-specific house-to-house census was conducted from May 1-30, 2022, to determine the reproductive-age of women with disabilities. After the census, a cross-sectional study design was used from June 20 to July 15, 2022, to investigate reproductive health service utilization and burden of problems, and their determinants (Objectives I, II, and III). The sample sizes were determined independently for each objective. Specifically, 620 reproductive-age females with disabilities participated in Objective I, 363 women with disabilities participated in Objective II, and 652 reproductive-age females with disabilities participated in Objective III. I allocated the sample size proportionally to the 30 randomly selected kebeles. A multi-stage stratified cluster sampling technique was used to select the study participants. Pretested structured and unstructured data collection tools were used, and face-to-face interview was conducted. The data was collected using the Kobo Collect application version 2021.3.4. After collection, the data were imported into Stata version 16 for analysis. A descriptive and multilevel binary logistic regression analysis model was applied. Then, bi-variable multilevel logistic regression was done to identify eligible variables (P-value<0.20) for multivariable multilevel logistic regression analysis. A P-value of <0.05 and a 95% confidence level were used to determine statistical significance. Results: Among reproductive-age females with disabilities, 27.3 % (95% CI: 23.8 %, 31.0 %) were current contraceptive users. Of the users, 82 (48.5%) used implants. The odds of contraceptive utilization is (AOR=9.03; 95% CI: 4.39, 18.6) times higher among reproductive age women who have good contraceptive knowledge compared to their counterparts. Reproductive -age women with disabilities who have transport accessibility to health facilities are (AOR=2.28; 95% CI: 1.32, 3.94) times more likely to use contraceptives compared to those who have no transport access to health facilities. Compared to young reproductive-age (15 to 24 years old) women with disabilities, those aged 25 to 34 years are (AOR=3.04; 95% CI: 1.53, 6.04) times higher odds of contraceptive utilization. Reproductive-age women with a hearing disability have (AOR = 0.38; 95% CI: 0.18, 0.79) lower chance of contraceptive utilization. Similarly, those with paralysis of the extremities (AOR = 0.06; 95% CI: 0.03, 0.12) demonstrate a lower chance of contraceptive utilization, while reproductive-age women using a wheelchair also showed (AOR = 0.10; 95% CI: 0.05, 0.22) lower chance of contraceptive utilization compared to reproductive-age women with vision disability (Objective I). The prevalence of current (most recent) unintended pregnancy among women with disabilities was 65.6% (95% CI: 60.4, 70.6). Compared with poor income tercile, women who have a middle-income tercile have (AOR = 2.07; 95% CI: 1.02, 4.20) times higher risk for unintended pregnancy. Women with disabilities who gave birth (AOR = 2.20; 95% CI: 1.21, 3.99) have a higher risk of unintended pregnancy compared to those who have not given birth. The risk of unintended pregnancy is (AOR = 0.26; 95% CI: 0.12, 0.57) lower among women with extremity paralysis compared with vision disability. Compared with rural resident women with urban residents have (AOR = 0.22; 95% CI: 0.12, 0.40) a lower risk of unintended pregnancy. Women with disabilities who drink alcohol have (AOR = 0.28; 95% CI: 0.11, 0.74) a lower risk of unintended pregnancy when compared with those who did not drink alcohol (Objective II). On the other hand, the prevalence of lifetime sexual violence among reproductive-age females with disabilities was 59.8% (95% CI: 56, 63.56). Reproductive-age women with disabilities who reside in urban settings have (AOR = 0.51; 95% CI: 0.29, 0.88) a lower risk of sexual violence compared to their counterparts in rural settings. Compared with young (15 to 24 years old) reproductive-age women with disabilities, those aged 25 to 34 years have (AOR = 5.9; CI: 3.01, 11.6) times higher risk of sexual violence. Similarly, reproductive-age women with disabilities aged 35 to 49 years have (AOR = 3.47; CI: 1.48, 8.14) times higher risk of sexual violence. Reproductive-age women with disabilities having no sexuality information have (AOR = 11.3; CI: 6.24, 20.5) times higher risk of sexual violence compared to their counterparts who have sexuality information. and having hearing disabilities (AOR = 3.19; CI: 1.49, 6.83) were factors associated with sexual violence (Objective III). Conclusion: This study revealed that the burden of unintended pregnancy and sexual violence among reproductive-age women with disabilities are high. Moreover, contraceptive utilization among reproductive-age females with disabilities is low. Contraceptive knowledge, age, transport accessibility, and types of disability determine contraceptive utilization. On the other hand, parity, residency, income, alcohol utilization, and types of disability were the determinant risk factors of unintended pregnancy. Also, age, residency, sexuality information, and types of disability were the determinant factors of sexual violence. Therefore, it is essential to design and implement strategies for raising contraceptive awareness and incorporating at-home contraceptive provision strategies into health extension programs to enhance contraceptive utilization. Furthermore, strengthening education and information dissemination about contraceptive utilization, reproductive health problems and its prevention strategies in rural settings are vital to mitigate unintended pregnancy and sexual violence.