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Background: Previous research has highlighted widespread public mis/perceptions that portray women with disabilities (WWDs) as asexual, less likely to marry, and often not interested in childbearing. However, evidence from high-income settings shows that many WWDs are sexually active and do have or want to have children. Notwithstanding this, very few studies have focused on understanding childbearing desires and motivations among WWDs in low-income settings. This qualitative research explored childbearing desires and motivations among WWDs in Ghana. Methods: A cross-sectional qualitative study was conducted with WWDs aged 18-49 years in Northern Ghana. The distribution of participants by disability types were as follows: Physical disability/impairment (n = 37); visual impairment (n = 11); speech and hearing impairment (n = 14); epilepsy (n = ten); and albinism (n = five). A pre-tested open-ended thematic topic guide was designed and used to conduct in-depth interviews. Interviews were tape-recorded and later transcribed for analysis. Transcripts were coded using QSR NVivo 11 software. Thematic content analysis techniques were used to analyse and present the data. Results: Nearly all the WWDs interviewed were sexually active, desiring to have children, and intended to have as many children as they could support. Strong desire to experience the joy of motherhood; fear of social insecurity; fear of old age economic insecurity; desire to challenge stigma and negative stereotypes about disability, sexuality and motherhood; and desire for self-actualisation, were key motivations for childbearing. Conclusion: Our findings challenge existing negative public perceptions about the status of WWDs in relation to sexuality, childbearing and motherhood. More importantly, our findings suggest that if the Sustainable Development Goals related to universal access to sexual and reproductive healthcare are to be attained, WWDs must be targeted with quality sexual and reproductive healthcare information and services.
A cross-sectional qualitative study was conducted. The design formed part of a larger multi-methods study that was conducted to examine the sexual, reproductive and maternal and child healthcare needs, behaviours and challenges of WWDs aged 18–49 years in Ghana between January 2018 and June 2019. Empirical research was conducted in three districts (Central Gonja, Savelugu-Nanton, and Bunkpurugu-Yunyoo) in the Northern region of Ghana. We selected these districts because they had the highest disability rates in the region: Bunkprugu-Yunyoo (5.4%), Savelugu-Nanton (4.6%), and Central Gonja district (3.6%) [41]. At the time of this research, the northern region was the largest in Ghana in terms of land area (approx. 70,383 km2). Its population was approximately 2,779,877, representing about 10.2% of the national total population [41]. Females constituted 50.3% of the total regional population, and population growth rate was 2.9 per annum [41]. About 60% of the population identified themselves as Muslims [41]. In terms of fertility and reproduction, the region is very pro-natalist, and had a total fertility rate of 6.6 children per woman as compared to the national average of 4.2 [42]. Child-bearing begins as early as 12 years, with mean number of children ever born to a woman being 5.6 [41]. Some 54.3% of the population aged 12 years and above were married [41]. Modern contraceptive use (17%) in the region was the lowest in the country [42]. Patriarchy and patrilineal descent ideologies shaped everyday social relationships in most communities in the region. Polygyny was a common form of marriage, affecting 42 and 27% of women and men respectively [41, 43]. In many communities, husbands often made decisions about childbearing and family planning as well as decisions on when to have another child and the number of children to have [44, 45]. Adult women aged between 18 and 49 years who had a disability either from birth or before they turned age 18 constituted the participants. We focused on disability before adulthood in order to better understand how this early experience of disability affected or would affect sexual health, reproductive and childbearing decisions. In total, 77 WWDs were included in the study. These were spread across five impairment/disability types: epilepsy (n = ten), physical disability/impairment (e.g. neuromuscular diseases, spina bifida, spinal cord injury, limbs amputation, muscular dystrophy, and polio-related injuries; n = 37), visual impairment (full blindness; n = 11), speech and hearing impairment (n = 14), and albinism (n = five). A combination of purposive and snowball sampling techniques was used. The procedure for contacting and recruiting WWDs involved a number of steps. We contacted leadership of the Ghana Federation of Disability Organisations (GFD) at the regional capital (i.e. Tamale). The GFD is an umbrella civil society organization, comprising disability-specific groups in Ghana. We explained the purpose of our research and solicited support to recruit eligible participants. From this initial engagement, the research team was introduced to district-level leaders and representatives of various disability organisations in the three study districts. At the district levels, the GFD and local district assemblies had databases of PWDs. Following engagements with district-level leaders and representatives of various disability organisations, we were granted access to these databases. From these databases, we identified potentially suitable participants for inclusion in our study. The research team and Community-based Surveillance Volunteers (CBSVs) visited potentially eligible WWDs in their respective communities, where the purpose of the study and sampling procedures were explained. Our initial engagement with potential participants allowed them to ask questions about the study, which the research team gladly answered. Each potential participant was given 1 week (from the date of this initial meeting) to decide whether to participate in the study. This was particularly important for those who were married, cohabiting or depended on their parents or other family members. Each participant was re-contacted by the volunteers after the one-week period. When the decision was in favour of participation, interview date, venue, time and language were agreed. We initially approached 75 eligible participants. Eight of them refused participation mainly due to husband’s/partner’s/guardian’s disapproval. However, a number of those who refused participation suggested and directed us to a total of ten other potential participants, most of whom were not registered with either their local district assembly or the GFD in the district. Our final sample was 77 WWDs. We collected data using in-depth interviews (IDIs). Many (n = 52) of the interviews were conducted in the local dialects: Gonja and Twi in Central Gonja district; Dagbaani in Savelugu-Nanton district; and Moar and Komba in Bunkpurugu-Yunyoo district. Four research assistants (two females with disabilities; one male with disability; and one male without disability) were trained to conduct the interviews in the local dialects. We also recruited and trained one female research assistant from the Ghana Association of the Deaf to conduct interviews using Sign Language with 14 participants who had speech/hearing impairments. All our research assistants were teachers with either Teacher Training College qualification or a university first degree. A few (n = 11) of the interviews were however conducted in English. Except five interviews, all participants gave permission for the interviews to be recorded with an audio-tape recorder. Hand-written field notes were also taken. An open-ended thematic topic guide was designed and used to conduct IDIs. The guide covered several topics, including awareness and knowledge about sexual, reproductive and maternal health rights, access to healthcare services, and specific sexual, reproductive and maternal healthcare needs of women with different disabilities. Generally, the guide captured both positive and negative childbearing motivations. Positive motivations disposed WWDs toward having a child, while negative motivations disposed them toward avoiding childbearing [29]. Specific questions that were asked in relation to desire and motivation for childbearing included: “Is it important to have your own child?”; “Do you want to have your own child, and why and why not?”; “Why did you have a child?”; “Did you plan to have a child or it was unplanned?”; “Looking into the future, do you want to have a (or: another) child of your own?”; “How many children would you like altogether, and why?”; “If it were possible, would you want to have a child of your own; How many and why?” The questions were often adjusted to address the specific needs of participants with different impairments. The guide was first developed in English. Our four research assistants translated it into the five local dialects. An independent language specialist (one per dialect) then checked the quality of the translation. All corrections were made before the guide was pretested. Following the pretest, further corrections were made before a final guide was agreed upon and used to collect data. Thematic content analysis approach was used to analyse the data. This involved several steps. To begin, independent language translation specialists were engaged to transcribe all audio recorded interviews in the original interview language (i.e. Gonja, Twi, Dagbaani, Moar, Komba or English). All non-English transcripts were translated into English. The sign language expert also transcribed the sign language interviews into English. To ensure transcription quality, the first author and all the research assistants performed back-to-back translations on selected transcripts. All errors were corrected. All transcripts were edited to correct grammatical mistakes without altering original meanings. We read the edited transcripts severally to gain general understanding of the data. All transcripts were imported into QSR NVivo 11 software for data coding. The coding process involved critical review of each transcript, followed by coding into emerging themes. Finally, the themes were presented, and relevant quotes from the transcripts were used to support identified themes. In order to ensure data quality and analytic rigour, a number of measures were implemented. Firstly, our research assistants were trained on several aspects of the research and data collection tools, including explaining the main objective of the study and the data collection technique. Secondly, the interview guide was pre-tested, which helped us to reframe unclear questions. Thirdly, the PI (first author) was actively involved in supervising the research assistants during the data collection process to ensure data quality. Finally, we regularly held meetings with research assistants to review the data collection process as well as reflect on how our individual biases could affect the data. This process of continuous reflexivity during the data collection process ensured that questions were appropriately asked and that our personal biases were minimised.
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