Factors Affecting Access to Sexual and Reproductive Health Services Among Women With Disabilities in Dar Es Salaam, Tanzania

Abstract

Background: Access to sexual and reproductive health (SRH) services remains a critical public health issue, especially for women with disabilities (WwDs), who face systemic healthcare barriers. Despite several efforts, WwDs in Dar es Salaam, Tanzania, continue to be excluded from essential SRH services due to individual, community, and structural factors. This study explores key determinants influencing SRH access among WwDs and offers evidence-based recommendations to enhance service utilization. Objectives: The study aimed to determine the factors affecting access to sexual and reproductive health services among women with disabilities in Dar es Salaam, Tanzania. Methods: We conducted a cross-sectional mixed-methods study to assess SRH access among women with disabilities (WwDs) in Dar es Salaam. Using stratified random sampling, 362 WwDs representing diverse disability types and backgrounds were surveyed across health facilities. Quantitative data were analyzed with SPSS 25 using descriptive and logistic regression analyses to explore associations with SRH service utilization. Qualitative insights from healthcare providers and policymakers were thematically analyzed using NVivo 12. Results: Only 43.4% of WwDs accessed antenatal care, with even lower utilization for postnatal care (29.3%) and STI screening (31.8%). Individual barriers included severe disability (AOR=0.63, p=0.018) and lack of education (AOR=0.71, p=0.035), while SRH knowledge (AOR=1.32, p=0.025) and autonomy (AOR=1.47, p=0.008) were protective. Community stigma reduced access (AOR=0.57, p=0.003), whereas peer support improved it (AOR=1.35, p=0.048). Structural barriers included inaccessible facilities (79% lacked ramps) and untrained providers (68% reported no disability training). Qualitative findings reinforced the quantitative results by highlighting architectural and transportation barriers as key obstacles to SRH access for WwDs. Conclusion and Recommendations: The study concludes that multi-level interventions are essential to enhance SRH access among WwDs in Dar es Salaam. Policy reforms should prioritize disability-inclusive healthcare infrastructure, communication accessibility, and provider training. Community sensitization programs must be strengthened to combat stigma.