GUIDELINES FOR PROVIDING SERVICES TO ADDRESS SEXUAL AND REPRODUCTIVE HEALTH

AND RIGHTS (SRHR) FOR WOMEN AND GIRLS WITH DISABILITIES

THE INSTITUTE FOR COMMUNITY DEVELOPMENT ZIMBABWE

Cover Photo: Adolescent Girls with Disabilities during SRHR Guide consultation at M Hugo High School of the Blind

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Copyright © 2020 ICOD Zimbabwe

Institute for Community Development Zimbabwe

28272 Hillside Extension
Hillside
Masvingo
Zimbabwe

Recommended citation
Institute for Community Development Zimbabwe (2020) Guidelines for providing services to address
sexual and reproductive health and rights (SRHR) for women and girls with disabilities in Zimbabwe.

Open access document

This is an open access document distributed which permits any non-commercial use, distribution
and reproduction in any medium, provided the original author and source are credited.

©Photography
All photos are courtesy of ICOD Zim. All photographs taken with participants involvement were on
a voluntary and consent basis. Other photographs are publicly available on the World Wide Web
and are appropriately acknowledged.

Produced by Andrew Chimatira, a Technical Assistance (TA) provider, Harare, Zimbabwe,

December 2020

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Abbreviations/Acronyms
ANC Ante Natal Care
ASRH Adolescent Sexual and Reproductive Health
CBD Community-Based Distribution
CBR Community-Based Rehabilitation
CEDAW Convention on Elimination of Discrimination Against Women
CRC Convention on the Rights of the Child
CRPD. United Nations (UN) Convention on the Rights of Persons with Disabilities
DPOs Disabled Persons’ Organizations
FP Family Planning
HIV & AIDS Human Immuno Virus
HPV Human Papilloma Virus
ICCPR International Covenant on Civil and Political Rights
ICESCR The International Covenant on Economic, Social, and Cultural Rights
ICPD The International Conference on Population and Development
ICT Information & Communication Technologies
MoHCC Ministry of Health and Child Care
M&E Monitoring & Evaluation
MISP Minimum Initial Service Package
MNH Maternal and Neonatal health
NASCOH National Association of Societies for the Care of the Handicapped
NGOs Non-Governmental Organizations
PNC Post Natal Care
RH Reproductive Health
SDGs Sustainable Development Goals
SGBV Sexual and Gender Based Violence
SGBV Sexual and gender based violence
SRHR Sexual Reproductive Health Rights

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STIs Sexually Transmitted Infections
UHC Universal Health Coverage
UNDP United Nations Development Fund
UNFPA, United Nations Population Fund
UNODC United Nations Office on Drugs and Crime
WGWD Women and Girls With Disabilities
WHO The World Health Organization

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Acknowledgements
The development of this guideline was made successful b the cooperation of the development partners of
ICOD- Zimbabwe. We would like to mention the invaluable support of the various disabled persons
organizations who under the auspices of the NASCOH, the coordinating body, participated in the
consultative processes

The work was also made possible by the generous funding that we received from…..our partner

We would also like to acknowledge the entire staff of the Institute for Community Development in
Zimbabwe (ICOD Zimbabwe) for supporting this exercise. The team was ably led by Ms. Talent Maphosa
the Director of ICOD Zimbabwe

Our appreciation goes to Andrew Chimatira, our consultant for facilitating and developing this model SRHR
Guideline for Women and Girls with Disability (WGWDs) in Zimbabwe.

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Table of Contents
Abbreviations/Acronyms .................................................................................................................. iii

Acknowledgements............................................................................................................................ v

Table of Contents .............................................................................................................................. vi

Background information on ICOD-Zim and the SRHR Initiative ..................................................1

1.1 Introduction ........................................................................................................................................ 1

1.2 Purpose of the guidelines ................................................................................................................... 2

1.3 Target audience .................................................................................................................................. 2

Table 1: Guidelines layout..................................................................................................................... 2

2.0 Principles Benchmark &Theory ..............................................................................................4

2.1 The Social and Human Rights Model of Disability .............................................................................. 4

2.2 Unpacking the UN CRPD ..................................................................................................................... 5

2.3 Basic elements for inclusion (Inclusive Programming) ....................................................................... 8

3.0 Inclusive Sexual and Reproductive Health and Rights in Practice ........................................9

3.1 Key SRHR Guidance ............................................................................................................................. 9

3.2 SRH Rights of women and girl with disabilities ................................................................................. 10

Table 2: Strategies/Actions to ensure the enjoyment of SRHR by WGWD ........................................ 12

3.3 Family Planning (FP) services for WGWD.......................................................................................... 13

Table 3: Strategies/Actions to ensure the uptake of SRHR by WGWDs ............................................. 13

3.4 Maternal and Newborn Health ......................................................................................................... 15

Table 4: Strategies/Actions to ensure the uptake of Maternal and New-born Health by WGWDs ... 15

3.5 STI and HIV/Aids services for WGWD ............................................................................................... 16

Table 5: Strategies/Actions to ensure the uptake of information, testing, and treatment services for
STIs, including HIV/AIDS for WGWD ................................................................................................... 18

3.6 Prevention and management of cancer of the reproductive system ............................................... 18

Table 6: Strategies/Actions to ensure the uptake of cervical screening for WGWD .......................... 19

3.7 Sexual and Gender Based Violence (SGBV) services for WGWDs..................................................... 20

Table 7: Strategies/Actions to ensure the uptake of GBV service for WGWD ................................... 21

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 3. 8 Inclusive SRHR in disasters and crises (e.g. COVID-19) .................................................................... 22

Table 8: Strategies/Actions to ensure the uptake of cervical screening for WGWD .......................... 23

4.0 Making inclusive SRHR sustainable ............................................................................................. 24

4.1 Introduction ...................................................................................................................................... 24

4.2 Strategies .......................................................................................................................................... 24

4.2.1 Strengthening Community-led Approaches............................................................................... 24

4.2.3 Investment in comprehensive SRHR services ............................................................................ 25

4.2.4 Peer-led initiatives ..................................................................................................................... 25

4.2.5 Home, family and culture........................................................................................................... 25

5. 0 Cross cutting Issues- Monitoring & Evaluation ............................................................................ 26

5.1 Defining, classifying and measuring disability .................................................................................. 26

5.2 Mainstreaming disability data collection .......................................................................................... 27

5.3 Disability sensitive M&E systems ...................................................................................................... 27

Resources: Important documents &Tools ......................................................................................... 31

List of Tables

Table 1: Guidelines layout............................................................................................................................. 2

Table 2: Strategies/Actions to ensure the enjoyment of SRHR by WGWD ................................................ 12
Table 3: Strategies/Actions to ensure the uptake of SRHR by WGWDs ..................................................... 13
Table 4: Strategies/Actions to ensure the uptake of Maternal and New-born Health by WGWDs ........... 15
Table 5: Strategies/Actions to ensure the uptake of information, testing, and treatment services for STIs,
including HIV/AIDS for WGWD ................................................................................................................... 18
Table 6: Strategies/Actions to ensure the uptake of cervical screening for WGWD .................................. 19
Table 7: Strategies/Actions to ensure the uptake of GBV service for WGWD ........................................... 21
Table 8: Strategies/Actions to ensure the uptake of cervical screening for WGWD .................................. 23

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 Section A:

Background information on ICOD-Zim and the SRHR Initiative

1.1 Introduction
The Institute for Community Development in Zimbabwe (ICOD Zim) is a non-partisan, not for profit
organisation formed and led by women for women. ICOD Zim seeks to promote and advance women’s
rights and pays special attention to women with disabilities. The organisation aims to empower
women in their diversities economically, politically and socially through amplifying their voices in all
local and national processes, creating platforms for engagement, advocacy and capacity building. The
organisation focuses on creating platforms and community centred interventions which support
women to access comprehensive Sexual Reproductive Health (SRHR) services and products, counter
violence or overcome discrimination by providing counselling or legal aid, promoting democracy and
good governance.

According to World Development Indicators, around 15% of the world population over 15 years old
are persons with disabilities. Of the global population, it is estimated that approximately 3.8% live
with severe impairments, such as blindness or paraplegia; 80% of all persons with disabilities live in
developing countries. Poverty is both a cause and a consequence of disability. Across the world,
disability is more prevalent among women, older people and poor population groups. Persons with
disabilities are also more likely to experience stigma and discrimination (WHO/World Bank 2011).
Thus, disability is both a development and a human-rights issue.

Guidelines

The development of a comprehensive Sexual Reproductive Health Rights (SRHR) guideline for
women and girls with disabilities is informed by the desire to provide practical guidance to ensure
that SRHR services give full effect to the rights of women and girls with disabilities.

Who is a person with a disability?

‘Person with a disability’ is the person-first language used by the United Nations (UN) Convention on
the Rights of Persons with Disabilities (CRPD).

The CRPD explains that: “Persons with disabilities include those who have long-term physical,
mental, intellectual or sensory impairments which in interaction with various barriers may hinder
their full and effective participation in society on an equal basis with others”. This Guideline mimics
the use of person-first language utilized by the CRPD.

The CRPD marks a shift from viewing persons with disabilities primarily as recipients of charity,
medical treatment, special services and social protection towards recognizing them as “rights-
holders” and active members of society. It defines disability as an
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 “evolving concept, resulting from the interaction between impairments and attitudinal and
environment barriers that hinders their full and effective participation in society on an equal
basis with others” (CRPD Preamble).

These Guidelines address service delivery for people with all forms of physical, intellectual, mental,
psychosocial, cognitive or sensory impairments. These Guidelines employ the social and human
rights model of disability, which “focuses on the high barriers created by the environment (rather
than by bodily impairment), including in physical, information and communication contexts, the
attitudes and prejudices of society, policies and practices of governments, and the often-exclusionary
structures of health, welfare, education and other systems”.

1.2 Purpose of the guidelines

The aim of this guideline is to provide hands-on guidance to ensure that the rights of women and girls
with disabilities are fully integrated and understood in the provision of SRHR services by providers
in Zimbabwe. The guidelines also serve as a tool for advocacy by PWDs and Disabled Persons’
Organizations (DPOs) when negotiating their rights and inclusion in national programmes.

The document makes practical and consistent suggestions for making SRHR services more inclusive
and open to women and girls with disabilities and for prioritizing strategies to meet their unique
needs for disabilities.

1.3 Target audience

Although SRHR service providers and support staff are the primary audience of this guideline, they
are also intended as a valuable resource for all stakeholders, including those involved in the design,
development, implementation or advocacy of SRHR or SGBV programmes for PWDs/WGWDs,
including those in government, local authorities and the broader civil society.

The Guideline is grounded in international human rights standards and is the result of extensive
consultations with women and girls with disability, local disability service organizations, and SRHR
service providers. The guidelines have adopted and adapted relevant information from many
resources (annex)

Table 1: Guidelines layout

Section Description
Background Background information on ICOD-Zim and the SRHR Initiative
Theoretical framework- This section offers the theoretical framework underpinning the
guideline
Practical guide: Offers guidance on specific SRHR services. It describes:
 The issues around the specific SRHR components,
 guidance based on global standards, Proposed strategies and
actions

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  Expected outcomes and
 indicators
Making inclusive SRH Strategies for making inclusive SRH sustainable
sustainable
Cross cutting Issues – Integrating disability sensitive Monitoring & Evaluation in
programmes
Important documents Resource materials for use by stakeholders including government,
and Tools civil society and other interested parties

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 Section B:

2.0 Principles Benchmark &Theory

2.1 The Social and Human Rights Model of Disability

The Guidelines employ the social and human rights model of disability, which “focuses on the high
barriers created by the environment (rather than by bodily impairment), including in physical
structure, information and communication contexts, the attitudes and prejudices of society, policies
and practices of governments, and the often-exclusionary structures of health, welfare, education and
other systems”.

The UN Convention on the Rights of Persons with Disabilities (CRPD)

The CRPD entered into force in 2008 and has been ratified by many countries including Zimbabwe.
The convention moved away from the medical model of disability whose focus was on the
impairments of persons and their remediable nature to a social model of disability which is widened
and comprises the barriers persons with disabilities encounter. The new understanding of disability
fostered by the code thus is “Persons with disabilities include those who have long-term physical,
mental, intellectual or sensory impairments which in interaction with various barriers may hinder
their full and effective participation in society on an equal basis with others” (Part. 1)

The CRPD expands the scope of the existing human rights system: first the concept of accessibility is
further developed as a wide variety of impairments and societal barriers are taken into account. In
addition, the principle of “Respect for difference and acceptance of persons with disabilities as part
of human diversity and humanity” (Part. 3) marks a generally positive approach towards persons
with disabilities.

Persons with disabilities have long been seen as passive recipients of aid, often reduced to their
impairment-related health needs. A human rights-based approach to disability implies that all people
are active subjects with legal claims and that persons with disabilities need to participate in all
spheres of society on an equal basis with their non-disabled peers.

A right based approach calls for programming that addresses the multiple barriers to the inclusion
of persons with disabilities – physical, attitudinal and communication barriers. As these barriers can
be found in all sectors and at all levels, a human rights-based approach to disability is relevant for
programmes in a variety of sectors, including health, infrastructure, water and sanitation, education,
social protection, employment, economic development or governance.

Why inclusion of persons with disabilities in SRHR matters;

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With the entering into force of the UN Convention on the Rights of Persons with Disabilities, the issue
of disability is now firmly established as a human rights issue. Persons with disabilities are facing a
range of discrimination and exclusion and their rights are only rarely taken into account by
development cooperation. Yet including persons with disabilities in development efforts is a crucial
part of respecting human rights.

2.2 Unpacking the UN CRPD

1. Enhancing respect for persons with disabilities
The CRPD refers to respect in two different ways: respect for the inherent dignity of every human
being and everyone’s individual autonomy, and respect for difference and acceptance of persons with
disabilities as part of human diversity. This implies that every individual, however different he or she
may be, has to be valued as a full member of society, and that persons with disabilities are considered
as autonomous persons with the freedom to make their own choices.

Strategies

Programmes can promote the respect for persons with disabilities through developing and
designing: -

 Disability awareness-raising campaign,

 Disability sensitive communication,
 Information and capacity development instruments.

2. Ensuring accessibility

The CRPD defines accessibility as a general principle (Part. 3) and a stand-alone right (Part. 9) and
mentions it in many other rights. It thus recognises that removing the multiple barriers to access in
society is a key requirement for the inclusion of persons with disabilities. There are four dimensions
of accessibility:
 physical accessibility,
 information and communication accessibility,
 institutional accessibility, and
 economic accessibility

Physical accessibility: removing barriers in the infrastructural environment. Ensuring access to

buildings, water supply and sanitation facilities, roads and transport services means designing them
in a way that they are usable by all people, including all persons with disabilities. The CRPD (part. 2)
defines such an approach as “universal design”. (Universal design is defined as a process that
increases usability, safety, health, and social participation, through design and operation of
environments, products, and systems in response to the diversity of people and abilities (World
Report on Disability, 2011).

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Information and communication accessibility: providing information that can be read or
understood by persons with disabilities; accepting and facilitating the use of sign language, Braille,
plain language, barrier-free documents and other alternative modes of communication.
Institutional accessibility: ensuring equal access to justice, property and financial services, social
services (e.g. in the health or education sector), as well as social protection and poverty reduction
programmes.

Economic accessibility: ensuring affordability of services and information and communication

Strategies to improve access to services by women and girls with disability will include

3. Addressing non-discrimination, equality of opportunity and gender equality opportunity

and gender equality: Non-discrimination is a core human rights principle that is enshrined in
different human rights treaties. The CRPD embraces both a legal perspective of non-discrimination
(article 12; equality before and under the law) and a social vision (equality of opportunities in
society).
The CRPD recognises that women with disabilities are often subject to multiple discrimination on the
grounds of gender and disability, and thus have fewer opportunities to enjoy their rights. It
emphasizes the need to incorporate a gender perspective in all efforts to promote the rights of
persons with disabilities.
Strategies
 review of laws and policies
 awareness campaigns to encourage equal opportunities for all persons with disabilities
 treatment standards that guarantee opportunities for men and women with disabilities
 internal employment standards or workplace policies that guarantee opportunities for men
and women with disabilities
 Advocacy for equal employment opportunities.
 Organizational disability policies
 Affirmative action policies for PWD

4. Promoting and ensuring the rights of children with disabilities: In many countries, the
capabilities of children and youth with disabilities are not recognised and their views not taken into
account. They are often denied access to education or vocational training and are more vulnerable to
violence and abuse than their non-disabled peers. The CRPD puts a three-fold focus on the need to
respect the identity and evolving capacities of children with disabilities, to protect them and to
include them fully in society.
Strategies
 Development organisations should make sure that the voices of children and youth with
disabilities are heard.
 Inclusion-Programmes working specifically on children and youth, in areas such as legal
protection, child health, primary and secondary education or community development
should make sure that young people with disabilities are included in the activities.

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5. Promoting and ensuring participation and empowerment of persons with disabilities:
Participation is both a means (participatory approach) and an aim (the right to participate). It entails
empowering rights-holders such as persons with disabilities to articulate their expectations towards
the State and other duty bearers, and to claim their rights. This principle is summarised in the central
slogan of the disability rights movement “Nothing about us without us”. In this way, participation
goes beyond a methodology for quality programming and becomes the central idea of disability-
inclusive programming.
Strategies
 Provide resources and develop the capacity of persons with disabilities and their
organisations to participate in decision-making processes at local, regional and national level
in a meaningful way.
 Participatory mechanisms like encouraging government and partners to involve disabled
people’s organisations whenever the local population is consulted.

6. Strengthening accountability: Accountability can be defined as the process which requires duty-
bearers to show, explain and justify how they have discharged their obligations. There are several
types of accountability mechanisms, ranging from judicial mechanisms (e.g. obliging the government
to review discriminatory laws) and administrative mechanisms (e.g. complaint mechanisms enabling
persons with disabilities to file grievances) to social mechanisms (e.g. involvement of civil society in
budget monitoring).

Accountability can be fostered both by enhancing the capacity of persons with disabilities to hold
their governments accountable, and by strengthening or establishing disability-inclusive
accountability mechanisms. Monitoring is a crucial part of accountability enabling the measuring and
checking of whether governments or development programmes are complying with human rights
obligations and determining the impact of activities on persons with disabilities.

The rights-based approach will work when the following points are considered:
• Small steps count: Starting with those steps towards inclusion which are most relevant and
feasible for your situation.
• Trust your creativity: Come up with simple and creative solutions that contribute to strengthening
the rights of persons with disabilities, rather than looking for a silver bullet that might use up too
many resources.
• Involve your leadership: Ask the leadership of your organisation to serve as an example for
disability inclusion and to lead from the top.
• Let persons with disabilities help you: Consider participation as a way to improve your work and
ask the people who are experts on disability that is PWDs themselves.
• Celebrate your successes: Help change attitudes towards persons with disabilities by sharing the
positive experiences that you had through implementing inclusive activities.

The human rights-based approach to disability is not an add-on activity, but fundamentally changes
the way in which development organisations plan and implement their programmes. It contributes

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to a more open, more inclusive and more effective development cooperation and thus benefits not
only persons with disabilities, but society as a whole.

The CRPD considers awareness-raising as a key measure to enhance respect for and acceptance of
persons with disabilities.

2.3 Basic elements for inclusion (Inclusive Programming)

Inclusive programming should consider the following main entry points for development
programmes and projects to promote behaviour change.
 Awareness-raising,
 Information, Communication and
 Capacity development
Awareness-raising,

Article 8 of the CRPD states that State Parties undertake to adopt immediate, effective and
appropriate measures:

a) To raise awareness throughout society, including at the family level, regarding persons with
disabilities, and to foster respect for the rights and dignity of persons with disabilities;

b) To combat stereotypes, prejudices and harmful practices relating to persons with disabilities,
including those based on sex and age, in all areas of life;

c) To promote awareness of the capabilities and contributions of persons with disabilities

Information, Communication Technologies

Information and communication technologies (ICTs) provide a model to allow people with
disabilities to better integrate socially and economically into their communities by supporting
personal access to information and knowledge, learning and teaching situations, personal
communication and interaction and access to other services including SRHR.

Capacity Development

Individual capacity building is critical for PWDs, their families and support networks because it
enhances their knowledge and skill potential to bring about personal change and contribute to
change at a broader level.

It is also critical to build capacity of service providers like healthcare workers, police and justice
departments as well as disability services programmers so they can be able to deliver appropriate
services and overcome stigma and discrimination or selective service.

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 Section C: Practical guide –

3.0 Inclusive Sexual and Reproductive Health and Rights in

Practice

Women and girls with disabilities have the same right to reproductive and sexual health as persons
without disabilities, but they are regularly excluded from services necessary to achieve their
reproductive and sexual health because of a variety of factors.
Reproductive health refers to the “state of complete physical, mental and social well-being, not
merely the absence of disease or infirmity, in all matters relating to the reproductive system and to
its functions and processes.

3.1 Key SRHR Guidance

The Guttmacher–Lancet Commission Report (2018) intimates that WGWD have similar SRHR needs
to their counterparts without disability. They are however far more likely to be victims of physical
and sexual assault and rape, including in certain cases by their closest caregivers. They are much
more likely to be subjected to forced procedures, such as abortion, and contraception. Inadequate
data and a lack of targeted services contribute to this scenario. These disadvantages begin early in
life and continue into adulthood.

Barriers
WGWD encounter legal and practical barriers to SRHR information and services and the common
barriers include lack of training or awareness raising among service providers and support staff on
how to serve persons with disabilities

Increased Risk
Lack of access to vital information and resources on SRHR increases women and young people with
disabilities' susceptibility to sexual assault, sexually transmitted infections (STIs), unintended
pregnancy and adverse birth outcomes (mother and baby) and denies them the right to the highest
attainable level of sexual and reproductive health.
In addition to being excluded from these critical health services, women and young persons with
disabilities are often subject to coercive healthcare practices and medical procedures, as well as
disrespectful and abusive treatment. Substituted decision-making systems, in particular, have been
associated with heightened rates of abuse of persons with disabilities, allowing parents or
guardians to subject women and young persons with disabilities to medical procedures against
their will.

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The guidance in this section is organized according to different SRHR services that women and young
persons with disabilities may require. To ensure a continuum of care across all areas of SRHR services
for women and young persons with disabilities, each of these service-area subsections should be read
in conjunction with the other subsections.

3.2 SRH Rights of women and girl with disabilities

Issues

WGWD suffer from: -

 stigma and discretion at SDP levels and are treated without regard to privacy and
confidentiality
 Disrespectful and abusive treatment.
 Substituted decision-making systems (parents or guardians to subject WGWD to medical
procedures against their will)

GUIDANCE
SRHR incorporates liberties, such as the freedom to make decisions about whether and when to
reproduce free from coercion or violence, and entitlements, such as access to the full range of
essential SRHR services
WGWD have rights to:
 receive SRHR services as equal citizens in a dignified and respectable manner
 to be informed, have access to safe, effective, affordable, and acceptable methods of family
planning, including methods for regulation of fertility, which are not against the law,
 of access to appropriate healthcare services to enable women to have a safe pregnancy and
childbirth and provide couples with the best chance of having a healthy infant

These rights are underpinned by the following fundamental human rights:

 The rights to life and health, including sexual and reproductive health, protected in the
International Covenant on Civil and Political Rights (ICCPR),
 The rights to privacy, liberty and security of the person, and to decide the number and spacing
of children, protected in the ICCPR,432 CRPD,433 CEDAW,434 and the CRC.435
 The rights to information and education, including information and education on sexual and
reproductive health, protected in the ICESCR,436 CRPD,437 CEDAW,438 and the CRC.439
 The right to equality and non-discrimination, protected in the ICCPR,440 the ICESCR,441
CRPD,442 CEDAW,443 and the CRC.444
• The right to accessibility, protected in the CRPD.454
 Section 83: Constitution of Zimbabwe (2013)-Rights of persons with disabilities, states that
The State must take appropriate measures, within the limits of the resources available to it, to
ensure that persons with disabilities realize their full mental and physical potential, including
measures--
 to enable them to become self-reliant;
 to enable them to live with their families and participate in social, creative or recreational
activities;
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 to protect them from all forms of exploitation and abuse;
 to give them access to medical, psychological and functional treatment;
 to provide special facilities for their education; and
 To provide State-funded education and training where they need it.

The disabled persons act (1992) was enacted to make provision for the welfare and rehabilitation
of disabled persons; to provide for the appointment and functions of a Director for Disabled
Persons’ Affairs and the establishment and functions of a National Disability Board; and to provide
for matters connected with or incidental to the foregoing

A key foundation of the right to health—and therefore the right to sexual and reproductive
health—is the obligation to make health-related information, goods and services available;
accessible; acceptable; and of good quality. The state is obligated to respect, protect, and fulfil
SRHR.

Available, meaning that information, goods, and services exist in sufficient quantity across a
country. This includes having enough trained service providers and appropriate healthcare
facilities equitably distributed.
Accessible, meaning the information, goods, and services can be used by all persons with
disabilities. The requirement of accessibility includes physical accessibility, economic accessibility,
and information accessibility.
Acceptable, meaning that health information, goods and services conform to ethical standards, are
culturally respectful, sensitive to the gender and disability needs of the individual, and respectful of
a person’s privacy and confidentiality.
Quality, meaning that health information, goods and services are scientifically and medically
appropriate and delivered by trained personnel in a respectful and rights-based manner

The UN CRPD underlined that States must ensure that women with disabilities can exercise their
legal capacity particularly in regard to decisions relating to their SRHR, including their right to
found a family and raise their children.

The UN Committee on the Rights of the Child urges States to:

 Provide all adolescents “access to free, confidential, adolescent-responsive, and non-

discriminatory sexual and reproductive health services, information, and education, available
both online and in person, including on family planning, contraception, including emergency
contraception; prevention; care and treatment of sexually transmitted infections; counselling;
pre-conception care; maternal health services; and menstrual hygiene”.

 Ensure that adolescents, particularly adolescent girls with disabilities, do not face barriers to
“commodities, information and counselling on SRHR, such as requirements for third-party
consent or authorization”.

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  Review legislation with a view to guaranteeing the best interests of pregnant adolescents and
ensure that their views are always heard and respected”.

 Offer age-appropriate, comprehensive and inclusive SRH education, based on scientific

evidence and human rights standards and developed with adolescents…[as] part of the
mandatory school curriculum and [should] reach out-of-school adolescents”. Special attention
should be given to topics such as gender equality and preventing early pregnancy and sexually
transmitted infections.

 information should be available in alternative formats to ensure accessibility to all

adolescents, especially adolescents with disabilities

Strategies/Actions

Table 2: Strategies/Actions to ensure the enjoyment of SRHR by WGWD

The following practical steps need to be taken to ensure the enjoyment of SRHR by WGWD

Awareness-raising,  Community sensitization meetings

 Making the statutes readily available to DPOs and WGWDs and
health service providers
 Involve PWs in policy/strategy formulation consultations
Information & Avail information or rights and obligations of duty bearers in
communication accessible formats including
technologies (ICT)  Appropriate print
 Braille
 Sign language
 Digital and audio formats
 Appropriate software
Capacity  Training of DPOs/WGWDs in service demand advocacy
development  Accountability monitoring on duty bearers
 Patient charter for PWDs

Outcome

The main outcome of SRHR rights programming will be the

1. increase in awareness to disability rights by DPOs/WGWD and health care service providers

2. Improved capacity to demand and make duty bearers accountable

Indicators

 PWDs reached with rights training

 PWDs awareness to their rights and duty bearer rights

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3.3 Family Planning (FP) services for WGWD
Issues: WGWD are not asexual. They have sexual needs like everyone else. They face increased
challenges in accessing essential SRHR information and services and thereby escalating their
vulnerability to STIs and unintended pregnancies. To compound their challenges is the lack of
training or awareness raising among service providers and support staff on how to serve PWDs.

WGWDs require family planning services that are both effective and useful. These services must be
provided in a respectful and non-discriminatory manner and must be accessible by all persons that
require them.

Family Planning Guidance

The WHO (2017) indicates that access to contraceptive information, goods, and services is one of the
fundamental pillars of SRHR services. Contraceptive access helps WGWDs choose whether and when
to have children, prevent unintended pregnancies (and the attendant risks of maternal/newborn
mortality or morbidity), and protect against STIs, including HIV. Women and young persons with
disabilities have a right to equal access to voluntary family planning and modern contraceptive
methods, as well as counselling on how to safely and effectively use them. This includes access and
training on how to use emergency contraceptives. The full range of modern contraceptive methods
to which persons with disabilities should have access includes: barrier methods (male and female
condoms, diaphragms), short-acting hormonal methods (the pill, injectables, the vaginal ring), long
acting reversible methods (implants, intrauterine devices), permanent methods (male and female
voluntary sterilization), and emergency contraception. Women and young persons with disabilities
must also have access to accurate, evidence-based information about family planning methods,
including the basal temperature method, two day method, and standard day method. WGWDs must
be allowed and supported to make their own decisions around whether to use contraceptives and
which method is best for them. No individual with a disability should undergo sterilization or be
given contraception without their voluntary and fully informed consent. Safeguarding WGWDs from
forced contraception, including forced sterilization, is essential to preserving their right to be free
from torture or cruel, inhuman or degrading treatment or punishment.

Strategies/Actions
The following practical steps need to be taken to ensure the uptake of SRHR by WGWDs

Table 3: Strategies/Actions to ensure the uptake of SRHR by WGWDs

Awareness-raising,  Community FP sensitization meetings
 Involve PWDs in FP policy/strategy formulation consultations
Information & Avail FP information in accessible formats including
communication  Appropriate print
technologies (ICT)  Braille
 Sign language
 Digital and audio formats
 Appropriate software
13
 Capacity  Training of healthcare workers to provide FP services to WGWDs
development (e.g. condoms use/insertions)
 Ethical service provision training
 Non-discrimination and stigma reduction
 Developing disability inclusive protocols and guidelines for
emergency contraception
Service delivery  Community FP services(CBD)
 Non-discriminatory service provision
 Services must be provided in disability friendly facilities and
rooms
 FP registers and records must also disaggregate by disability and
type

Outcomes

 Increase in number of WGWD seeking FP services

 Planned families/ reduction in unwanted pregnancies

Indicators

1. Proportion of WGWDs who accessed family planning services by type of disability and age

2. Contraceptive prevalence rate among WGWDs

3. At least five modern contraceptive methods are available, and information about their use is
available in accessible formats.i
4. Emergency contraception and condoms are available to women and young persons with
disabilities (disaggregated by number of new users, by method and age).
5. Percentage of clients who are women with disabilities in need of and receiving
contraceptive services (disaggregated by disability, age, and method being used).
6. All service providers and support staff receive training on working with women with
disabilities.
7. All service providers and support staff receive training on working with young persons with
disabilities.
8. Compliance with quality standards for the delivery of contraceptive services to adolescents
and youth that include young persons with disabilities.

14
3.4 Maternal and Newborn Health

Issues: WGWD frequently encounter substandard care, including discrimination and abusive
treatment, when accessing maternal and new-born health services. Negative attitudes about
women with disabilities having and raising children can deter them from utilizing these vital
services. They also often lack access to information about maternal and new-born healthcare and
services

Maternal and New-born Health (MNH) Guidance

According to the WHO Vision (2015) WGWDs have a right to access the full range of maternal and
new-born health services during the perinatal period, including information, goods, and services to
prevent unintended pregnancy; antenatal care; skilled birth attendance; emergency obstetric care;
post-partum care; and new-born care. These essential services are critical to ensuring safe
pregnancy and delivery for women with disabilities and can also help prevent the majority of
maternal and new-born deaths or disability. The WGWD must also have access to the components
of a healthy pregnancy (e.g. potable water, education, sufficient nutrition, diagnosis and treatment
of STIs (including HIV & AIDS, syphilis, HPV, and non-communicable diseases) to promote safe
pregnancy and reduce the risk of pregnancy-related death and disability

The following practical steps need to be taken to ensure the uptake of Maternal and new-born
Health by WGWDs

Table 4: Strategies/Actions to ensure the uptake of Maternal and New-born Health by

WGWDs
Awareness-raising,
Community MNH sensitization meetings (to raise awareness about the
rights of WGWDs to become parents and to change attitudes about their ability
to raise children.

-to increase awareness about men’s role in facilitating access to maternal and
new-born health services, as well as care and support during the perinatal period )
 Involve PWDs in MNH policy/strategy formulation consultations
Information & Avail MNH information in accessible formats including
communication  Appropriate print
technologies (ICT)  Braille
 Sign language
 Digital and audio formats
 Appropriate software
Capacity  Training of healthcare workers to provide MNH services to
development WGWDs
 Ethical service provision training
 Non-discrimination and stigma reduction

15
 Service delivery  Ensure that essential MNH services are available to WGWDs
during pregnancy, childbirth, and the time immediately after
birth, as quality care during this period is critical for reducing
maternal, foetal, and neonatal death and injuries, and maintaining
well-being
 Services must be provided in disability friendly facilities and
rooms(disability friendly delivery beds/bathroom and ramps)
 Non-discriminatory service provision
 ANC/Delivery/PNC registers and records must also disaggregate
by disability and type
 Financial support for pregnant WGWDs during
ANC/Delivery/PNC (Advocate for comprehensive health
insurance and other social protection programmes)
 Ensure waiting mothers’ shelters are available and accessible to
WGWDs.
 designing culturally, disability, and gender-sensitive antenatal
classes
 Ensure that women with disabilities can be accompanied by a
companion of their choice at birth

Outcomes

 Increase in number of WGWDs seeking MHN services

 Reduced maternal mortality and morbidity
Indicators

1. Maternal mortality ratio, disaggregated by disability.

2. Proportion of women with disabilities who receive skilled care (or attendance) at birth.
3. Proportion of pregnant women with disabilities who receive antenatal care (ANC) per the
2016 WHO ANC Model.
4. Proportion of women with disabilities who receive at least one postpartum care visit.
5. Proportion of pregnant women having a planned caesarean section who have the procedure
carried out at or after 39 weeks 0 days, disaggregated by disability.
6. Number of midwives who speak sign language.

3.5 STI and HIV/Aids services for WGWD

Information, testing, and treatment services for STIs, including HIV/AIDS for Women and Young
Persons with Disabilities

Issues: WGWD are often stereotyped as not being at risk for STIs and barriers to accessing STI
services can result in women and young persons with disabilities being excluded from such
16
services. Individuals living with HIV, who may or may not self-identify as a PWDs, are also at risk of
violations of their SRHR.

 Women and young persons with disabilities are often excluded from information campaigns
about STIs due to a variety of factors, including stereotypes, isolation, and the inaccessible
nature of some public education campaigns.
 Stereotypes around the sexuality of women and young persons with disabilities, including
stereotypes that they are asexual, not sexually active, or not sexually desirable, can lead service
providers and support staff to assume that they are not at risk of contracting STIs. As a result,
service providers often fail to provide women and young persons with disabilities with
information about STI prevention methods (such as HPV vaccines or use of condoms) or to
inform them about or offer them tests for STIs as part of routine healthcare visits.
 Some family members or caregivers of women and young persons with disabilities do not want
them to learn about sexual and reproductive health, including STIs, for fear it will increase their
sexual activity.
 Lack of disability-sensitive regulations and protocols for pre-and post-exposure for
victims/survivors of rape can exclude women and young persons with disabilities from
prophylactic treatment or STI testing, increasing their vulnerability to contracting STIs and
resulting in STIs going undetected and untreated.
 When a woman or a young person with a disability is found to have an STI, service providers
often fail to counsel that woman or young person on how the diagnosis affects other areas of
their SRHR, such as how to have sex safely or how to plan for pregnancy.
 Communication barriers can deny women and young persons with disabilities access to
essential counselling and psychological support when making decisions to undergo STI testing,
treatment, and prevention.
 Poverty, physical barriers to STI testing facilities, and isolation can prevent women and young
persons with disabilities from accessing STI testing, treatment, and other related services.

STI and HIV/Aids services for WGWDs Guidance

The Programme of Action of the International Conference on Population and Development (ICPD
Programme of Action: 1994] directs that information, testing, and treatment services for sexually
transmitted infection (STI), including HIV, are fundamental to protecting SRHR for women and
young persons’ both with and without disabilities. Women and young persons with disabilities
have the same right to these services as individuals without disabilities. Essential STI services
include: access to accurate information regarding STIs and how to prevent them; access to
voluntary methods for prevention, treatment, and care; vaccination against human papillomavirus
(HPV) and hepatitis B; access to prophylactic treatment for individuals who may have been exposed
to sexually transmitted infections, including survivors of sexual violence; voluntary and confidential
testing for sexually transmitted infections with timely dissemination of test results; counselling and
psycho-social support; and access to affordable antiretroviral medicines for people living with HIV.
17
Common STIs that women and young persons should be informed about and tested for include HIV,
trichomonas’s, gonorrhoea and chlamydia infection, syphilis, cancroid, genital herpes and warts,
and hepatitis B.ii Access to both male and female condoms and information on how to properly use
condoms are central components of STI information and prevention services.

The following practical steps need to be taken to ensure the uptake of information, testing, and
treatment services for STIs, including HIV/AIDS for WGWD

Table 5: Strategies/Actions to ensure the uptake of information, testing, and treatment

services for STIs, including HIV/AIDS for WGWD
Awareness-  Link marginalized and most affected populations to additional
raising, service providers, peer support networks or community-based
organizations, or legal services when necessary
Information & Develop accessible, targeted, and non-stigmatizing information and
communication testing campaigns around HIV/AIDS/STI in accessible formats including
technologies  Appropriate print
(ICT)  Braille
 Sign language
 Digital and audio formats
 Appropriate software
Capacity  Training of healthcare workers to provide MNH services to WGWDs
development  Ethical service provision training
 Non-discrimination and stigma reduction
Service delivery  Provide timely and quality health care disability, sexual orientation,
religion, language, socioeconomic status, or HIV or other health
status,
 Prohibit mandatory testing or treatment, or coercive practices.
 Respect patient privacy and confidentiality
 Ensure that women and young persons with disabilities have access
to accessible counselling and testing for HIV.

Outcomes

 Increase in number of WGWDs seeking STI and HIV/Aids services

 Reduced maternal mortality and morbidity
Indicators

 Reduced STIs including HIV prevalence

3.6 Prevention and management of cancer of the reproductive system

18
Issues: WGWDs are under screened for cervical cancer compared with the general population,
likely because, in part, of both emotional and physical challenges associated with Pap testing.
Women with certain disabilities often require an examination under anaesthesia to undergo a
speculum examination. However, anaesthesia is not without risks and the perioperative experience
can be burdensome to patients and caregivers.

Guidance

The WHO (2014) Comprehensive Cervical Cancer Control: A Guide to essential practice

Cervical cancer is one of the greatest threats worldwide to women’s lives. The primary cause of
cervical cancer is persistent or chronic infection with one or more of the high-risk types of human
papillomavirus (HPV). Preventing HPV through vaccination is fundamental to curbing cervical
cancer. Service providers must ensure that women and adolescent girls with disabilities have
access to the vaccine. All adolescent girls should receive the vaccine before initiating sexual activity.
Service providers must also be sure to offer the vaccine to women with disabilities who may have
missed out on receiving the vaccine as an adolescent. Since the vaccine does not protect against all
types of HPV, and many women with disabilities may not have received the vaccine before the onset
of sexual activity, service providers should screen all adolescent girls and women with disabilities
for cervical cancer

1. Ensure that programmes are tailored to serve populations of women and young persons with
disabilities who may be even more vulnerable to cervical cancer screening
2. Train women and young persons with disabilities to become peer or community health
educators and foster the development of support groups.
3. Train service providers and support staff and implement safeguards to guarantee privacy and
confidentiality of cervical cancer screening. Ensure results are given in private, unless the
4. Develop education programmes for family members and caregivers to understand the
importance of cervical cancer screening
The following practical steps need to be taken to ensure the uptake of cervical screening for WGWD

Table 6: Strategies/Actions to ensure the uptake of cervical screening for

WGWD
Awareness-raising,  Link marginalized and most affected populations to additional
service providers, peer support networks or CBOs
Information & Develop accessible, targeted, and non-stigmatizing information and
communication testing campaigns around cervical cancer screening in accessible
technologies (ICT) formats including
 Appropriate print
 Braille
 Sign language
 Digital and audio formats
19
  Appropriate software
Capacity  Training of healthcare workers to provide MNH services to
development WGWDs
 Ethical service provision training
 Non-discrimination and stigma reduction
Service delivery  Provide accessible, confidential pre-testing counselling to support
WGWDs to make their own voluntary decision around cervical
cancer screening.
 Community based cervical cancer screening services
 Prohibit mandatory testing or treatment, or coercive practices.
 Respect patient privacy and confidentiality
 Ensure that women and young persons with disabilities have
access to accessible counselling and testing for HIV.

Outcomes

Increased number of WGWDs who receive cervical cancer screening

Indicators

 Percentage of adolescent girls with disabilities immunized against HPV.

 Percentage of women and young persons with disabilities who received cervical cancer
screening tests and get the results within the past year.

 Breast, uterine, pelvic, and cervical cancer identification protocols explicitly include women
and adolescent girls with disabilities

3.7 Sexual and Gender Based Violence (SGBV) services for WGWDs
Issues: WGWDs experience the same forms of GBV as individuals without disabilities. However,
they also experience unique forms of GBV as a result of their disability, such as sexual abuse by a
caregiver; withholding of medication or an assistive device; purposefully substandard care; denial
of necessities like food, toileting, or grooming; control of sensory devices; financial control;
restriction of communication devices control of sensory devices; financial control; restriction of
communication devices

Lack of accessible prevention initiatives may prevent WGWDs from being screened, recognized or
reported for GBV. GBV prevention programmes for persons with disabilities are underfunded,
limiting the effectiveness of and access to critical programs for women and young persons with
disabilities at risk of GBV.

Guidance

20
The Committee on the Elimination of Discrimination against Women, General Recommendation No.
19: Violence against Women (Eleventh Session, 1992)

Established that GBV is a form of gender-based discrimination that violates fundamental rights,
including:

 The right to be free from GBV, protected in the Convention on the Rights of Persons with
Disabilities (CRPD
 The right to equality and non-discrimination, protected in the CRPD, and CEDAW.
 The right to life, protected in the CRPD
 The right to be free from torture and other cruel, inhuman or degrading treatment or
punishment, protected in the CRPD
 The right to be free from practices that harm women and young persons with disabilities,
protected in CRPD,
 The right to equality before the law and access to justice, protected in the CRPD.
 The right to protection and safety for persons with disabilities in situations of risk, including
humanitarian emergencies, protected in the CRPD.
States have specific obligations under international human rights law to prevent, protect against,
investigate, punish, and redress GBV—obligations that are collectively referred to as a State’s due
diligence obligations
Strategies/Actions
The following practical steps need to be taken to ensure the uptake of GBV service for WGWD

Table 7: Strategies/Actions to ensure the uptake of GBV service for WGWD

Awareness-raising, Community based campaigns on the dangers of GBV
Participation: Communities, including WGWD are engaged as active
partners to end GBV and promote survivors’ access to services.
Information & Develop accessible, targeted, and non-stigmatizing information SGBV
communication in accessible formats including
technologies (ICT)  Appropriate print
 Braille
 Sign language
 Digital and audio formats
 Appropriate software
Capacity  Training of healthcare workers to provide SGBV services to
development WGWD
 Training of justice Police and judicial services workers to
provide SGBV services to WGWD

 Ethical service provision training

21
  Non-discrimination and stigma reduction
Service delivery  Provide accessible, confidential SGBV counselling and clinical
services to support WGWDs
 Ensure that WGWDs who are victims of SGBV access to emergency
prophylaxis
Outcomes

Decrease in SGBV cases among WGWD

Indicators

 Service providers trained to offer SGBV services

 GBV public awareness campaigns include GBV against persons with disabilities.
 GBV information material is available in a variety of accessible formats to disseminate
information about rights and prevention services

3. 8 Inclusive SRHR in disasters and crises (e.g. COVID-19)

Issues: During emergencies, the number of adolescents with disabilities may increase due to
physical or psycho-logical injury or mental health conditions that manifest as a result of crisis. The
lack of access to SRH information, the disruption or inaccessibility of SRH services, and the
increased risk of SEA as well as high-risk sexual behaviours among adolescents during emergencies,
puts adolescents at risk of unwanted pregnancy, unsafe abortion,

Guidance
Humanitarian Emergencies—WGWD Access to Health Information and Services
The Minimum Initial Service Package (MISP) for Reproductive Health is a set of priority
interventions that is designed to “reduce mortality, morbidity and disability among populations
affected by crises, particularly women and girls. The MISP contains guidelines for providing
coordinated RH services during the earliest phases of an emergency (natural disaster or man-
made) and guides the planning for comprehensive RH services when the situation has stabilized.

The MISP has five objectives:

• To ensure SRH coordination;

• To prevent and manage the consequences of sexual violence;

• To prevent excess newborn and maternal morbidity and mortality;

• To reduce HIV transmission;

• To plan for the provision of comprehensive SRH services.

ASRH programmes should engage other sectors to ensure that health staff, adolescents, community
members, and other humanitarian actors are aware of the rights of adolescents, particularly as they
22
relate to RH. All efforts should be made to ensure that adolescents, including marginalized groups
and those with disabilities, have access to RH information and services and that they are not
subjected to human-rights violations. Suspected or known violations of adolescents’ human rights
during an acute emergency or while providing comprehensive RH services, should be reported

Strategies/Actions
The following practical steps need to be taken to ensure the uptake of cervical screening for WGWD

Table 8: Strategies/Actions to ensure the uptake of cervical screening for WGWD

Awareness-raising,  Create awareness platforms humanitarian emergencies
 Disaster/epidemic response campaigns
Information & Develop accessible, targeted, and non-stigmatizing information about
communication disaster/epidemic/Emergency Preparedness response plans in
technologies (ICT) accessible formats including
 Appropriate print
 Braille
 Sign language
 Digital and audio formats
 Appropriate software
Capacity  Training of healthcare workers to provide SRHR services to
development WGWD during humanitarian emergencies
 Non-discrimination and stigma reduction strategies in
humanitarian emergencies
Service delivery  Establish systems for community-based distribution (CBD) of
condoms and family planning (FP) methods for adolescents (
 Assess adolescents at community level for psycho-social,
protection and SRH issues
 Put into place peer-education system for sharing information on
ASRH
 Adolescent-friendly clinical services;
 Clinical management of survivors of sexual violence;
 Treatment and referral of clients with obstetric emergencies

Outcomes

 Increased number of WGWDs who receive disaster/epidemic preparedness awareness

 Disaster/epidemic coverage among WGWD increased

Indicators

 DPOs with emergency SRHR provisions guidelines

 Public health facilities with guidelines for emergency SRHR provisions
 Emergencies communication guidelines in place

23
 Section D:

4.0 Making inclusive SRHR sustainable

4.1 Introduction
SRHR are the cornerstones of universal health coverage (UHC). Investing in SRHR is cost-effective
and affordable. Gender barriers to accessing UHC must be addressed in order to achieve the right to
health and the achievement of the SDGs, ensure universal access to SRHR and eliminate preventable
maternal mortality and gender-based violence. UHC programmes around the world include SRHR
and have demonstrated that this approach can improve affordability and save lives.

4.2 Strategies

4.2.1 Strengthening Community-led Approaches

Community-led approaches makes the difference in reaching the WGWDs especially in hard to reach
areas. The establishment of drop in centres as well as peer led initiatives will make SRHR
programming sustainable. The wider civil society and DPOs play a pivotal role in complementing the
government in the delivery of SRHR programmes to PWDs and only the establishment of long lasting
relations will benefit the women and girls.

Community-Based Rehabilitation
The CRPD specifies the right of persons with disabilities to live within their communities (Art. 19).
Community Based Rehabilitation (CBR) focuses on enhancing the quality of life for people with
disabilities and their families; meeting basic needs; and ensuring inclusion and participation. It is a
multi-sectoral strategy that empowers persons with disabilities to access and benefit from education,
employment, health and social services.
It is a strategy within general community development targeted on rehabilitation, equalization of
opportunities and social inclusion of all children and adults with disabilities. CBR is implemented
through the combined efforts of PWDs themselves, their families and communities, and the
appropriate health, education, vocational and social services. CBR has developed from a medical
approach to one based on the human rights of persons with disabilities. Thus the focus of CBR has
evolved from medical rehabilitation towards more comprehensive multi-sector approaches such as
access to health care, education, vocational training, income generation programmes and community
participation and inclusion. Again it is essential to have (i) the direct participation of PWDs in
planning and implementation of CBR programmes, (ii) increased collaboration between sectors
providing services, and (iii) government support in development of national policies. CBR is an
essential component of community development

24
Figure 1: CBR Matrix (Source: Toolkit on Disability for Africa-Inclusive health services for persons with disability)

4.2.3 Investment in comprehensive SRHR services

Investing in comprehensive sexual and reproductive health services in UHC is necessary to address
the needs of women, girls, adolescents and people in the most marginalized situations who need
these the most. The government cannot go it alone and will require the assistance of development
partners to fund this critical dividend of the population

4.2.4 Peer-led initiatives

Peer-led initiatives can be considered essential components to SRHR and general health
programming for WGWDs. Stakeholders must facilitate the exchange of ideas between special
schools, DPOs and WGWDs must develop the culture of empowered disability champions and focal
persons

4.2.5 Home, family and culture

The home must play a complimentary role in ensuring that WGWDs are encouraged and helped to
utilise SRHR services within their communities. The caregivers at home must also be empowered to
create demand for SRHR services for WGWDs. Harmful cultural and religious practices must be
discouraged through engagement with community networks. The community leaders and men at
home will play a leading role in promoting the uptake SRHR

25
 SECTION E:

5. 0 Cross cutting Issues- Monitoring & Evaluation

5.1 Defining, classifying and measuring disability

Data on the rate at which PWDs use health services is often not readily available in Zimbabwe. The
uptake of SRHR by persons with disabilities is rarely measured. General surveys do not fully or
consistently disaggregate data on disability in such a way that a distinct analysis of the social,
economic and demographic factors relating to disability in health services can be made. The CRPD
(article 31) requires States to collect appropriate information, including statistical and research
data, to enable them to formulate and implement policies to give effect to inclusive health services
and other rights guaranteed in the treaty.

The purposes for measuring disability are to be able to generate evidence for programme planning
and decision making. It is necessary to measure disability to inform:-

• Provision of services
• Monitoring the functioning of the population
• Assessing the equality of opportunities for persons with disabilities and persons without
disabilities

Providing Services. One reason for collecting data on disability is to design and implement
services for persons with disabilities — either via special programmes for them, or by making
general programmes more inclusive. Estimating the need for services requires collecting
information that serves for eligibility determination. But, beyond that, the need exists for gathering
information on the specific types of services required and the specific barriers limiting the delivery
of those services, such as: what types and what quantities of assistive devices, trained personnel
and distribution systems are needed.
Monitoring the Functioning of the Population. Monitoring can also take place at various levels of
functioning — body function, activity or participation — depending on the goal of the monitoring. A
government might want to assess the scope of potential concerns relating to disability. Monitoring
body functioning pertains more to programmes designed for the prevention of impairments
associated with disability. This requires less detailed information than providing for services.
Equalization of Opportunities. The third main reason for collecting data on disability is to track
whether society is becoming more inclusive; that is to determine whether the opportunity gap
between persons with disabilities and those without disabilities is closing. One may want to see if
and to what extent participation of persons with disabilities is limited because of an inaccessible
and disabling environment.

26
5.2 Mainstreaming disability data collection
A key issue in the collection of disability data is the extent to which the data needs can be met by
integrating disability information into existing surveys and censuses and the extent to which
special modules or even special disability surveys are required. Mainstreaming the collection of
disability data has several important advantages.

First, it allows the disaggregation of existing indicators that are well understood. Second, it
effectively reduces the cost of collecting disability data by only adding a disability module into
existing tools. And third, it provides a signal that the considerations of persons with disabilities are
a core policy issue, rather than being tangential and suitable only for special surveys. Nevertheless,
there are times when a special disability survey may be required. The government may wish to
obtain information that goes beyond what is appropriate for existing instruments. Maybe the
desired information is too detailed, and thus would require excessive space when using the data
tool. Sometimes a different sample is needed to disaggregate results by type of disability or some
other sub-population characteristic.

Finally, some indicators may be expected to change slowly, and are thus not required to be
collected as regularly as some core economic or social indicators. For example, the key barriers to
employment may not change much on a yearly basis, so information on those barriers should only
be collected every few years. For these reasons, there are times when a special disability survey is
required — or a special module on disability that can be included with ongoing survey instruments
— but only at certain periodic intervals

The key indicator for monitoring SRHR services for WGWDs is the proportion of WGWDs who
access SRHR services compared to women and girls without disabilities.

Definition

The proportion of females aged 15–49 with disabilities who report having accessed any type of
sexual or reproductive health services of the government and civil society, including informational
services and/or the provision of health services during the past year.

Various indicators can be developed to monitor different aspects of SRHR service provisions. The
indicators mentioned in the guidance will be a starting point.

5.3 Disability sensitive M&E systems

Building blocks of a disability-sensitive M&E system: Assess the disability-sensitivity of M&E
systems

The starting point for improving the disability-sensitivity of an M&E system is to conduct a rapid
assessment of each of its component parts from a disability perspective. This can be done by way of
a rapid assessment by asking managers of M&E systems the following questions for each of the 12
components of the UNAIDS organizing framework of a functional M&E system;

Component 1: Organizational structures within M&E

27
  Is there a focal point or someone who can advise the M&E unit on disability equality?

 Is there an M&E policy that explicitly articulates the goal of identifying disability-based
health inequalities?

Component 2: Human capacity for M&E

 Does the M&E staff have the capacity to generate, compile, analyse, interpret and
disseminate data that captures disability-based inequalities in SRH or HIV?

 Are there training and capacity-building opportunities available on a regular basis to

strengthen the capacity of M&E staff to collect and compile and analyse data from disability-
sensitive indicators?

Component 3: M&E partnerships

 Are there partnerships in place with stakeholder organizations that are working on, have
expertise in and/or can advocate for disability equality, including researchers,
nongovernmental women’s rights organizations, other civil society organizations (for
example, women living with HIV, youth groups), or disability focal points in different
ministries and international agencies?

 Are such stakeholder groups consulted by or included in advisory bodies of M&E units?

Component 4: M&E plan

 Is the national M&E plan for the particular health topic (for example, SRH or HIV) aligned
with national disability equality priorities and with global commitments such as the
Sustainable Development Goals (SDGs) or the Convention on Elimination of Discrimination
against Women (CEDAW)?

 Does the M&E plan include targets for both women and men/girls and boys and subgroups
among them?

Component 5: Costed M&E plan

 Are there resources allocated in the M&E plan for gathering and analysing data: a) on the
different situations of women and men, including health inequalities and disability
inequality as social determinant of health; b) for monitoring how programmes are meeting
the specific needs of women and men and promoting disability equality?

Component 6: M&E advocacy, communications and culture

 Does the communication and advocacy in relation to the M&E data include explicit
reference to developing messages and undertaking advocacy for disability equality based
on data?

Component 7: Routine programmes monitoring

28
  Are there efforts to sensitize service providers and programmes staff to the importance of
sex-disaggregated data for monitoring disability-based health inequalities?

 Are there mechanisms or processes in place to ensure that data remain disaggregated as
they are compiled and reported from the local level to the national level?

Component 8: Surveys and surveillance

 Are data disaggregated by other variables (such as age, socioeconomic status, and ethnicity)
generated, as appropriate, in epidemiological surveillance and population-based surveys?

 Are sources of data that provide direct information about disability equality as a
determinant of health included in the surveillance system?

Component 9: M&E databases

 Are subnational and national databases designed to accommodate disaggregated data?

 Is there ability to triangulate data across different databases (for example, health, national
social statistics about disability inequality) and different types of data sources, both
quantitative and qualitative?

Component 10: Supervision and auditing

 Are data quality audits undertaken to check for disaggregated data at various levels and to
ensure data quality and timeliness?

 Do supervision and accountability measures support the inclusion of disability in the M&E
systems?

Component 11: Evaluation and research

 Does the national research agenda include topics related to disability inequality in the
context of SRH or HIV?

 Are questions about the impact of disability inequality included in evaluation plans for SRH
and HIV programmes?

Component 12: Data dissemination and use

 Is there an explicit plan to conduct disability analysis and to develop products that
disseminate findings about disability inequality?

 Do information products of the M&E system convey a picture of how men and women are
differently affected and/or how the national response to the particular health issue is
addressing disability inequality?

 Are the key findings or messages about disability-based inequalities presented in a direct,
compelling and easy to understand manner?

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 Are data regularly, widely and in a timely manner disseminated to stakeholders (for
example, through data review and dissemination workshops), especially to those
implementing programmes, making policy decisions, conducting research, and advocating
for disability equality, including women’s NGOs?

 Are data on disability-based inequalities being used in policy decision-making, resource

mobilization, advocacy, communication campaigns and/or research publications?

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 Section F

Resources: Important documents &Tools

This section presents the major resources used for the developments of these guidelines

1. Disabled Persons Act-DPA (1992)

2. The Constitution of Zimbabwe (2013)

3. Toolkit on Disability for Africa-Inclusive health services for persons with disability

4. The African charter on human and peoples’ rights on the rights of persons with Disabilities
in Africa

5. Adolescent SRHR Strategy Zimbabwe

6. United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD).

7. UNFPA (2018)Women and Young Persons with Disabilities (Guidelines for Providing Rights-
Based and Gender-Responsive Services to Address Gender-Based Violence and Sexual and
Reproductive Health and Rights)
8. Women Enabled International
9. UNFPA, UN Women, WHO, UNDP & UNODC, Essential Services Package for Women and Girls
Subject to Violence (2016)
10. WHO & UNFPA, Promoting Sexual and Reproductive Health for Persons with Disabilities
(2009)

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References
1. Government of Zimbabwe: Constitution of Zimbabwe Amendment (No. 20) Act, 2013
2. Government of Zimbabwe: Disabled Persons Act (1992): CHAPTER 17:01/ Government
Printers
3. ICPD (2013): Implementation of the Programme of Action of the International Conference
on Population and Development in Latin America and the Caribbean, USA
4. International Covenant on Civil and Political Rights (ICCPR): The Resource: Part II.
International Human Rights System, 3/11 (un.org)
5. UN General Assembly, Convention on the Rights of Persons with Disabilities : resolution /
adopted by the General Assembly, 24 January 2007, A/RES/61/106
6. WHO and the World Bank (2011) World report on disability. Geneva. Available at:
http://www.who.int/disabilities/world_report/2011/en/index.htm
7. WHO (2014) Comprehensive Cervical Cancer Control: A Guide to essential practice
8. Women With Disabilities Australia (WWDA) (2016) Submission to the National Inquiry into
Equal Recognition Before the Law and Legal Capacity for People With Disability - January
2014
9. Women With Disabilities Australia (WWDA)(2010) Submission to the Preparation Phase of
the UN Analytical Study on Violence against Women and Girls with Disabilities
(A/HRC/RES/17/11)
10. The Committee on the Elimination of Discrimination against Women, General
Recommendation No. Violence against Women (Eleventh Session, 1992
11. UNAIDS ()2009) 12 Components Monitoring and Evaluation System Strengthening Tool.
Geneva:
12. Toolkit on Disability for Africa-Inclusive health services for persons with disability: Toolkit
on Disability for Africa | DISD (un.org)
13. UNFPA (2020)Minimum Initial Service Package (MISP) for SRH in Crisis Situations-
Minimum Initial Service Package (MISP) for SRH in Crisis Situations | UNFPA - United
Nations Population Fund
14. The Guttmacher–Lancet Commission Report (2018)-
https://www.guttmacher.org/guttmacher-lancet-commission

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