1. Ssanyu Rebecca Advocacy Officer National Union of Women with Disabilities of Uganda

2. About the National Union of Women with Disabilities of Uganda National Union of Women with Disabilities of Uganda is abbreviated as NUWODU. It was founded in 1999 Mission: To promote social, cultural, economic and political advancement of girls and women with disabilities

3. Why focus on Girls and Women with Disabilities? Girls and women with disabilities comprise 10% of all women worldwide They comprise ¾ of PWDs globally (WHO) In Uganda, 16% population (i.e. 5.44m people) are PWDs above the age of 15 years (UBOS, 2010) Of these 75% (i.e. 4.08m people) are WWDs above the age of 15 years GWWDs generally live in remote rural areas with limited, if any, access to socioeconomic services GWWDs subjected to multiple forms of discrimination, first as women then as PWDs

4. The Sex by Choice not by Chance Intervention Conceived by NUWODU and the Disabled People’s Organisation Denmark (DPOD) in 2009 To respond to sexual and reproductive health rights and needs of GWWDs GWWDs were and are still being denied their SRH rights and their corresponding needs not being addressed by service providers GWWDs also find themselves unable to resist chancy sexual violations against them At other times they engage in consensual yet risky / chancy sexual acts Hence GWWDs highly prone to HIV&AIDS, STIs and sexual and reproductive ill-health

5. The Sex by Choice Intervention: Strategies Used Promotion of disability and SRH as human rights and development issues rather than private issues Family and community approach: participation of all parities as advocates for and promoters of SRHR for GWWDs Using culturally sensitive approaches: working with cultural, religious, political, opinion leaders Active involvement of men Strategic partnerships with relevant CSOs, legal aid service providers and DPOs Awareness creation among service providers Research and documentation

6. The Sex by Choice Intervention: Emerging Successes Increased knowledge, self-esteem and skills among girls with disabilities about sexuality issues Involving affected WWDs and sometimes their spouses in planning and implementation processes has generated quicker positive response than had been anticipated Capacity building of WWDs as counsellors and legal advisors has not only benefited PWDs but also people without disability Referral of WWDs needing legal redress on matters of sexual violation Increased disability awareness and sensitivity among service providers, particularly officers of the health sector and the criminal justice system

7. The Sex by Choice Intervention: Challenges Discrepancies between SRH policy and practice  Good policy, poor commitment to implementation  Even when adopted, do not translate to local level service delivery  Inadequate in responding to needs of GWWDs Education of healthcare professionals lacking in disability understanding management Negative attitudes of healthcare providers Lack of disability desegregated national data on PWD health indicators

8. Relevance of SRHR of GWWDs to the HIV/AIDS and STI debate Sexual and reproductive ill-health and HIV share root causes Most HIV infections are sexually transmitted or associated with pregnancy, childbirth and breastfeeding Linking Sexual and Reproductive Health Rights and HIV and AIDS increases the effectiveness of the HIV&AIDS response Most people with disabilities think of their sexual and reproductive lives in a holistic way with HIV and AIDS as only one consideration

9. Bridging the policy-practice gap in SRH services to GWWDs At Policy Level  Inclusion of disability training in the curriculum of healthcare professionals  The issue of abortion needs to be addressed by governments from an objective and human rights perspective  Data: governments should (are obliged to) build a knowledge base of data and information about the situation of persons with disabilities  Recruitment of communication experts for the deaf, blind and deaf-blind in public healthcare facilities sgould be taken seriously  Physical access in healthcare facilities (beds, ramps, toilets/pits) should be addressed

10. Bridging the policy-practice gap in SRH services to GWWDs At Implementation Level  Focus specific Sexual and Reproductive Health education to girls and women with disabilities  Promote contraception / family planning among WWDs – taking care to ensure correct information and consent  Include GWWDs in both formal and informal sexual and reproductive health education  In carrying out health education, specific attention should be put to communication needs of the deaf, blind and deaf blind persons

11. Conclusion Because SRH and HIV&AIDS are mutually reinforcing and precipitated by the same factors, a holistic approach towards addressing these issues is the best way to go. Linkages between the two should promote rights, address root causes of vulnerability, and reduce stigma and discrimination. Governments should act to reduce the discrepancies between policy and practice and adhere to international standards in delivering services to women (and indeed persons) with disability. It is then and only then that true social economic development and progress towards realisation of millennium development goals will be realised.

12. Every one, Every day, Every way … Help to Improve Sexual and Reproductive Health for girls and Women with Disabilities