Abortion Access: The Key to Health-Care Improvement for People with Disabilities

By Nissia Benghazi

The truth is, not much is known about how many people with disabilities get abortions, and it’s no surprise. According to Imelda Salifou, “People with long-term impairments are often excluded from vital conversations about sexuality.” Imelda is a talented entrepreneur and inspirational health activist from Benin who has a motor disability but refuses to let it get in the way of her dreams. She advocates for her community through the youth-led sexual and reproductive health rights organization MAJ Benin and actively supports the cause on social media.

Last week, we had the opportunity to talk to her to learn more about health-care equity and inclusion for people like her. As a woman, a minority group, living with a physical disability in a developing country, she is at the intersection of multiple marginalized identities (1).

Through this story, our hope is that people realize that an individual with disabilities may hold other marginalized identities and that the overlap of these stigmatized identities may exacerbate health inequities and create unique hurdles. These challenges keep such individuals from being able to make or communicate decisions about their physical health, care, and rights. By expanding the conversation to people like Imelda who face unique hurdles, we as a global community can help optimize access to equitable and inclusive health care and highlight why it is especially important for people with disabilities in resource-poor settings.

Key Issues that Must be Addressed

Access to safe and legal abortion is a critical component of reproductive health care, particularly for people with disabilities in Benin. Imelda affirms that low-quality health care in her country drastically increases the burden of unwanted pregnancies for people with uteruses, especially those with disabilities. She believes it is time Benin substantially scales up its reproductive health infrastructures to protect and save lives. However, despite its groundbreaking new law to expand abortion access in the country, this health intervention is still heavily frowned upon due to religious and morally embedded beliefs. In 2021, Benin officially legalized abortion in most circumstances and now has one of the most liberal abortion laws in Africa.

“It’s a milestone for reproductive health activists, but the fight doesn’t stop here,” says Imelda. Benin still doesn’t have the necessary resources and facilities to carry out these procedures using the World Health Organization (WHO) guidelines, forcing thousands of women to resort to clandestine abortions. According to Imelda, illegal and unsafe abortions are often the result of social stigma ascribed to those who seek to terminate a pregnancy, low-quality services making abortion unreliable, and family pressure, to name a few.

Delving deeper into this issue, she opens up about the hardships of living with disabilities. “It’s even harder for people with disabilities to expose themselves to others, so they keep a lot inside because the fear of being judged by others is too big. Disabilities can affect a person’s physical, mental, and emotional well-being; everything is harder to do and accomplish and can also impact our ability to care for a child,” she claims. She describes how challenging it is to confront health professionals who deny them care by telling them to “take responsibility” for their actions and who speak to them with frustration and contempt.

“It’s always a shock to them to see a pregnant person with disabilities,” she adds. In spite of the new legal context, abortion remains a deeply divisive moral and ethical issue in her culture. In Imelda’s own words, the moral significance of abortion and people’s reaction to it represents an immense “psychological obstacle” and “mental block”. She urges health centers to consider people with disabilities by tailoring their care operations and language accordingly. Now, more than ever before, system transformation in the global health sector is needed. Frontline workers who provide essential services, such as medical and surgical abortions, need to undergo paradigm shifts. Key individuals, such as gynecologists, midwives, and facility staff, need to remove deeply rooted prejudiced views and effectively adapt their modes of operation to include the disabled community. This would consist of stigma-free emotional support and assistance to gain their trust and make sure they know they have the right to these reproductive services too.

Imelda also pushes for awareness-raising through medical training such as via Values Clarification and Attitudes Transformation (VCAT), an effective workshop for improving abortion attitudes and behavioral intentions within the health sector.

Accessing Reproductive Health Care

Adding to this barrier are stigma and discrimination. People with disabilities, especially in places like Benin, face major social exclusion and ostracization as they are often regarded as undesirable or as a burden to society (1).
This state of marginalization can make it challenging to access health-care services and discourage them from seeking the services they require (2). These preconceived ideas often stem from a deeply rooted culture of false assumptions regarding people with disabilities, such as that they are seen as asexual or unable to have sex and therefore do not need reproductive health care. Explicit and implicit discriminatory bias and behavior from health-care professionals is common and represents a pervasive virus against people with lifelong impairments. Judgment and fear of judgment can be a serious barrier for this community and can increase their pre-existing fear of rejection when seeking reproductive health-care services.

She adds, “Many women with disabilities are unlucky in every possible way. They tell themselves, ‘I’m already alive and with the lack of adequate medical care, why would I risk my life for an abortion?’ ”

Further on in our discussion, Imelda addresses the complications of aborting when you have physical disabilities. “For example, not everyone has a pelvis. When a woman without disabilities goes to the gynecologist, all her organs are accessible. But some people don’t have their organs presentable in the same way, so it can lead to other problems or impediments.” Similarly, the fear of not being accepted and of dying as a result of bad care are two major factors that discourage incapacitated people from terminating a pregnancy.

Amongst the many hurdles, Imelda draws our attention to the parallel between high-risk pregnancy and why abortion access is especially important for the disabled community. Indeed, people with disabilities in low-income countries are exposed to higher chances of pregnancy complications due to a severe lack of appropriate health-care services, inadequate access to maternal care, and social exclusion (3). These complications often arise during pregnancy, childbirth, and the postpartum period, which could result in maternal morbidity and mortality. This signifies that specific health concerns can be exacerbated and require specialized medical care.

Additionally, these individuals may struggle to understand the implications of pregnancy and may not have the support they need to make informed decisions about their reproductive health. Due to their physical conditions, they can encounter unique difficulties carrying a pregnancy to term or caring for a newborn without support. Many societies today fail to understand how much a person with a mental health condition may struggle with the emotional and psychological demands of pregnancy and parenting. Some disabilities can be hereditary, and a person should have the right to freely abort in order to prevent passing on a genetic condition to a child.

Later on in our conversation, Imelda mentions how people with disabilities, in general, are more likely to experience sexual violence and abuse. She says, “In many cases, the perpetrators of these crimes are caregivers, family members, or people in positions of power.” People with disabilities often have limited access to justice systems and may be afraid to speak out due to the fear of retaliation or the associated stigma. For those who become pregnant as a result of sexual violence, access to safe and legal abortion is crucial and should be actively supported by the government.

In countries like Senegal, for instance, the law is uncompromising and does not permit recourse to abortion under any circumstances. Understanding that rape culture is prevalent, and sometimes even normalized, and how traumatic it can be should truly revolutionize how governments approach sexual and reproductive justice. The emotional repercussions can be debilitating, and fully legalizing recourse to abortion should be the first step in demonstrating compassion and support towards victims of sexual violence.

In the same vein as the previous point, this community often suffers from limited access to reproductive health-care services, including family planning and abortion services (1). This is due to physical, financial, and social hurdles that are common for these individuals. People with disabilities may face financial and social barriers, such as inaccessible health care, prenatal care, and child-rearing and a lower quality of life overall. They may also have limited access to comprehensive sex education, transportation, and employment (3). This naturally increases the risk of unintended pregnancies, which can be difficult to manage for people with disabilities. Access to free abortion care can help prevent these negative outcomes and challenges related to pregnancy and parenting and should be made available to all.

In conclusion, ensuring access to safe and legal abortion services is essential in order to meet the reproductive health needs of people with disabilities. It is important to note that denying the disabled community access to safe and legal abortion is an outright violation of their fundamental human rights and limits their self-determination and bodily autonomy (2). Giving them the same reproductive health-care options as anyone else should be a necessity so that they can make informed decisions about their own bodies and futures.