The median age of respondent was 35 years. Among 384 respondents, one-third (35%) of them were illiterate. More than half of them were Hindu (56%), never married (64%), belonged to a joint family (59%) and unemployed (59%). The average household size was 5.1. One in five (15%) had ever utilized any SRH services
Age, type of family, family size, marital status, educational status of study population and their caretaker were significantly associated with utilization of SRH services. Women aged 35 and above (OR=3.4, CI: 1.795-6.430), belonged to joint family (OR=2.0, CI:1.100-3.760), have less than five family size (OR=2.3, CI:1.304-4.011), literate (OR=0.0, CI:2.3(1.201-4.612), have literate caretaker (OR=2.9, CI:1.009-8.588) and ever married (OR=174.7, CI:23.818-1281.599) were more likely to utilize SRH services compared to their counter partners.
Table 1 Socio-demographic and socio-economic characteristics of respondents and their association with utilization of SRH services (n=384)
Characteristics
|
Utilization of SRH services
|
p-value
|
Crude OR (95%CI)
|
Yes
n (%)
|
No
n (%)
|
Age
35 and above
Below 35
|
45(22.2)
14(7.7)
|
158(77.8)
167(92.3)
|
0.000*
|
3.4(1.795-6.430)
Ref
|
Religion
Hindu
Buddhist/Kirat/ Christian
|
39(18.3)
20(11.7)
|
174(81.7)
151 (88.3)
|
0.076
|
1.7(0.946-3.027)
Ref
|
Ethnicity
Brahman/Chhetri
Dalit/Janajati/Madhesi/Thakuri/Dasnami
|
24(19.5)
35(13.4)
|
99(80.5)
226(86.6)
|
0.124
|
1.2(0.885-2.770)
Ref
|
Type of family
Joint
Nuclear
|
43 (18.9)
16(10.3)
|
185(81.1)
140 (89.7)
|
0.024*
|
2.0(1.100-3.760)
Ref
|
Household size
Less than 5
5 or more
|
33(22.1)
26(11.1)
|
116(77.9)
209(88.9)
|
0.004*
|
2.3(1.304-4.011)
Ref
|
Educational status
Literate
Illiterate
|
47(18.8)
12(9.0)
|
203(81.2)
122(91.0)
|
0.013*
|
2.3(1.201-4.612)
Ref
|
Educational status of caretaker (n=314)
|
|
|
|
Literate
Illiterate
|
34(14.2)
4(5.3)
|
205(85.8)
71(94.7)
|
0.048*#
|
2.9(1.009-8.588)
Ref
|
Marital Status
Ever married
Never married
|
58(41.7)
1(0.4)
|
81(58.3)
244(99.6)
|
0.000*#
|
174.7(23.818-1281.599)
Ref
|
Occupation
Employed
Unemployed
|
35(29.4)
24(9.1)
|
84(70.6)
241(90.9)
|
0.000*
|
4.2(2.353-7.441)
Ref
|
Wealth quintile
Lowest
Other
|
11(14.5)
48(15.6)
|
65(85.5)
260 (84.4)
|
0.810
|
1.1(0.537-2.217)
Ref
|
a As per classification system used by Health Management Information System section of Department of Health Services, Nepal[11]
Crude odds ratio is the odds ratio which identifies the association between variables with the use of SRH services. The variable for which p value is less than 0.05(*) is considered significant
#Fisher’s exact test
Ref reference group
The qualitative study shows that all women with disabilities were refrained from SRH services and information.
“There isn’t specific but all kind of women with disabilities are been refrained from SRH services and information. They do not have access to these services. (Participant number 3, Local political leader during KII)”
“SRH services are needed for all. I think that those women with mild disability who are able to walk, aged 20-45 years, belong to upper class and caste, educated, and married utilize SRH services more compared to others. (Participant number 1, Woman with disability during in-depth interview)”
Though economic status was not found to be significantly associated with utilization of SRH services, the qualitative finding shows poor economic status as one of the barriers to utilization of SRH services among women with disabilities.
“Woman with disability who belongs to rich family are more educated and aware of SRH services that those who belongs to poor family. Poor economic condition and illiteracy are barriers to utilize SRH services. (Participant number 4, Local political leader during KII)”
Utilization of SRH Services
The utilization of SRH services among women with disabilities was low (15%). Only 12 percent had ever received maternal and newborn care, 11 percent had ever utilized contraceptive information and services, 0.3 percent had ever received prevention and appropriate treatment of infertility services, and 0.5 percent had ever utilized safe abortion and post-abortion care. None of them had ever utilized other SRH services such as combatting HIV/AIDS and other sexually transmitted diseases; prevention of gender-based violence, care for victims and information, education and counseling on sexual violence; actions to eliminate harmful traditional practices such as female genital mutilation and early and forced marriage; and comprehensive sexuality education and youth friendly services. No need of (57%) followed by unaware of SRH services (24%) were prime reasons for not utilizing SRH services.
Table 2 Utilization of SRH services among women with disabilities (n=384)
Variables
|
Frequency
|
Percent
|
Utilization of SRH services
Yes
No
|
59
325
|
15.4
84.6
|
Utilization of SRH services by component*
Maternal and newborn care services
Contraceptive information and services
Prevention and appropriate treatment of infertility
Safe abortion and post-abortion care services
|
45
38
1
2
|
11.7
9.8
0.3
0.5
|
Reason for not utilizing the service from nearest health facility (n=325)
No need
Facility too far away
Health facility is not disability-friendly
Don't know about the service
Other
|
186
21
27
78
13
|
57.2
6.5
8.3
24.0
3.4
|
* Multiple responses
Others: Providers are often unavailable, prefer to receive care at home, no one available to accompany, no quality services, language barrier, scared of side effects, no tradition
Disability and Utilization of SRH Services
Among 384 respondents, about one-third (31%) of them had physical disability and 7 percent had disability related to vision, 16 percent had disability related to hearing, 7 percent had disability related to voice and speech, 12 percent had mental/psychosocial disability, 9 percent had intellectual disability, 0.5 percent had autism and 18 percent had multiple disability. Among 318 disability ID card holders, 14, 40, 25 and 21 percent of them had profound, severe, moderate and mild disability respectively.
Table 3 Disability related characteristics of respondents (n=384)
Variables
|
Frequency
|
Percent
|
Types of disabilitya
Physical disability
Disability related to vision-blindness
Disability related to vision-low vision
Disability related to vision -complete blind
Disability related to hearing -deaf
Disability related to hearing -hard of hearing
Disability related to voice and speech
Mental or psychosocial disability
Intellectual disability
Disability related to Autism
Multiple disability
|
119
7
11
8
33
29
26
44
35
2
70
|
31.0
1.8
2.9
2.1
8.6
7.6
6.8
11.5
9.1
0.5
18.2
|
Severity of disability (n=318)a
Profound
Severe
Moderate
Mild
|
45
127
80
66
|
14.2
39.9
25.2
20.8
|
aBased on type and severity of disability defined by Government of Nepal[12]
Both type and severity of disability were significantly associated with utilization of SRH services. Those women having physical disabilities (OR=3.0; CI:1.692-5.254) and mild disability (OR=2.8; CI: 1.500-5.262) were three times more likely to utilize SRH services compared to their counter partners.
Table 4 Disability related characteristics of respondents and their association with utilization of SRH services (n=384)
Characteristics
|
Utilization of SRH services
|
p-value
|
Crude OR (95%CI)
|
Yes
n (%)
|
No
n (%)
|
Type of disability
Physical disability
Other than physical disability
|
31(26.1)
28(10.6)
|
88(73.9)
237(89.4)
|
0.000*
|
3.0(1.692-5.254)
Ref
|
Severity of disability (n=318)
Mild
Moderate/Severe/Profound
|
19(28.8)
40(2.6)
|
47(71.2)
278(87.4)
|
0.001*
|
2.8(1.500-5.262)
Ref
|
Crude odds ratio is the odds ratio which identifies the association between variables with the use of SRH services. The variable for which p value is less than 0.05(*) is considered significant.
Ref reference group
The qualitative study also supported the quantitative finding revealing need of assistance and lack of support from family members as barrier to utilization of SRH services
“Those women who have mild physical disability are able to utilize SRH services. But those who have mental disability and severe form of other disability are unable to utilize such services. They need someone to escort but their family members are often busy in household chores and livelihood related activities (Participant number 3, Local political leader during KII)”
Empowerment and Utilization of SRH Services
Among 384 respondents, more than half of them (61%) did not participate at all in three key household decisions (health care, major household purchases and visit to family or relatives). Only half of them (52%) had membership in community group. Less than a quarter (22%) earned cash or in-kind and only 12 percent owned any house or land either alone or jointly with someone else.
More than half of them (63%) were low empowered, a quarter (26%) were moderately empowered and only 11 percent were highly empowered.
Participation in household decision making, membership in community group, earn cash/in-kind and empowerment were significantly associated with utilization of SRH services. Those respondents who participated in household decision were six times more likely to utilize SRH services compared to those who did not participate (OR=6.1; CI: 3.272-11.545). Those respondents having membership in community group were two times more likely to utilize SRH services compared to non-members (OR=2.4; CI: 1.320-4.224). Moderately or highly empowered women with disabilities were four times more likely to utilize SRH services compared to those who were low empowered (OR=4.5; CI: 2.471-8.101).
Table 5 Empowerment level of respondents and their association with utilization of SRH services (n=384)
Characteristics
|
Utilization of SRH services
|
p-value
|
Crude OR (95%CI)
|
Yes
n (%)
|
No
n (%)
|
Involvement in household decision making
|
|
|
|
Participate in all decisions
No participation
|
44(29.5)
15(6.4)
|
105(70.5)
220(93.6)
|
0.000*
|
6.1(3.272-11.545)
Ref
|
Membership in community group Yes
No
|
39(21.0)
20(10.1)
|
147(79.0)
178(89.9)
|
0.004*
|
2.4(1.320-4.224)
Ref
|
Earn cash or in-kind
Yes
No
|
36(41.9)
23(7.7)
|
50(58.1)
275(92.3)
|
0.000*
|
8.6(4.707-15.745)
Ref
|
Ownership of house/land
Yes
No
|
10(21.7)
49(14.5)
|
36(78.3)
289(85.5)
|
0.205
|
1.6(0.764-3.515)
Ref
|
Women empowermenta
Moderately and highly empowered
Low empowered
|
40(27.8)
19(7.9)
|
104(72.2)
221(92.1)
|
0.000*
|
4.5(2.471-8.101)
Ref
|
Crude odds ratio is the odds ratio which identifies the association between variables with the use of SRH services. The variable for which p value is less than 0.05(*) is considered significant
Ref reference group
aWomen’s empowerment was a composite index of women empowerment comprising involvement in household decision-making, membership in community group, cash earning, ownership of house/land and educational status of women[13]
The qualitative study reveals that women with disabilities are more prone to violence.
“Women with disabilities themselves are not in situation to share their needs or problems. If someone misbehaved, other women could discuss about it openly and say ‘No’. But, in regards to women with disabilities, they are not empowered. They are unable to raise their voice and defend themselves. (Participant number 4, Local political leader during KII)”
The qualitative findings also highlighted the issues of sexual violence and forced control on reproduction among women with disabilities.
“Many women with disabilities are not getting any support from home and they themselves are not aware of SRH. And……(sigh) those women with disabilities, who are bedridden, are prone to sexual violence. There are some instances of rape and forced marriage among women with disabilities in our locality. (Participant number 2, Woman with disability during in-depth interview)”
“We found that some family members are providing Depo-Provera injection to their daughters with disabilities. The family members have to go outside for work. They feel that girls with disabilities are prone to sexual violence in their absence. So, they provide Depo-Provera injection to prevent her from being pregnant. (Participant number 7, FCHV during FGD)”
Media Exposure and Utilization of SRH Services
The media exposure seemed quite low. Among 384 respondents, about one-third of them had never listened to radio/FM or watched TV. The percentage of non-user was even higher for newspaper and internet, which was 68 percent and 66 percent respectively. Those respondents who often listened to radio/FM were two times more likely to utilize SRH services compared to those who never listen to radio/FM (OR=2.3; CI: 1.303-4.088).
Table 6 Media Exposure and their association with utilization of SRH services (n=384)
Characteristics
|
Utilization of SRH services
|
p-value
|
Crude OR (95%CI)
|
Yes
n (%)
|
No
n (%)
|
Listen to radio/FM
Often
Never
|
37(21.3)
22(10.5)
|
137(78.7)
188(89.5)
|
0.004*
|
2.3(1.303-4.088)
Ref
|
Watch TV
Often
Never
|
32(16.0)
27(14.7)
|
168(84.0)
157(85.3)
|
0.719
|
1.1(0.635-1.932)
Ref
|
Read newspaper
Often
Never
|
8(15.1)
51(15.4)
|
45(84.9)
280(84.6)
|
0.953
|
1.0(0.435-2.192)
Ref
|
Surf internet to get information on health
|
|
|
|
Often
Never
|
11(23.4)
48(14.2)
|
36(76.6)
289(85.8)
|
0.107
|
1.8(0.877-3.860)
Ref
|
Crude odds ratio is the odds ratio which identifies the association between variables with the use of SRH services. The variable for which p value is less than 0.05(*) is considered significant.
Ref reference group
Knowledge and Perception of Women with Disabilities and Utilization of SRH Services
Majority (72%) of respondents had heard about SRH. Radio/FM (40%) followed by teacher (37%) were found to be the main source of SRH related information. The overall knowledge on SRH was found to be poor. More than two-third of them i.e. 69 percent had very poor knowledge and 18 percent of them had poor knowledge on SRH.
Among 384 respondents, only half (50%) of the respondents, perceived the need for SRH services. Only one-third (35%) of them perceived themselves as susceptible for SRH related disease/condition and 8% of them perceived SRH related diseases/condition as very severe. Only 30% of them reported benefit of utilization of SRH services. Only 14 percent reported themselves as competent/very competent for behavior change related to utilization of SRH services.
Table 7 Knowledge of respondents on SRH (n=384)
Variables
|
Frequency
|
Percent
|
Heard about SRH
Yes
No
|
109
275
|
28.4
71.6
|
Source of SRH related information (n=109)*
Friend
Family Member
Health worker
Female Community Health Volunteer (FCHV)
Teacher
Mother’s/Women’s group
Training
Radio, FM
TV
Internet
Newspaper
Poster, Pamphlet
Study books
|
24
20
26
26
40
6
7
44
23
8
11
2
4
|
22.0
18.3
23.9
23.9
36.7
5.5
6.4
40.4
21.1
7.3
10.1
1.8
3.7
|
Knowledge on SRHa
Good
Satisfactory
Poor
Very poor
|
4
45
68
267
|
1.0
11.7
17.7
69.5
|
Have comprehensive knowledge about HIVb
Yes
No
|
2
382
|
0.5
99.5
|
Note:
aKnowledge of SRH was a composite measure adapted from Measure Evaluation for Sexual and Reproductive Health Knowledge [14]
bComprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting HIV, knowing that a healthy-looking person can have HIV, and rejecting the two most common local misconceptions about transmission or prevention of HIV[15]
Knowledge on SRH, perceived need, susceptibility, severity and self-efficacy were found to be significantly associated with utilization of SRH services. Women with disabilities having knowledge on SRH were four times more likely to utilize SRH services (OR=4.3; CI: 2.428-7.692) compared to those who have very poor knowledge. Those respondents who perceived need of SRH services, perceived oneself susceptibility to SRH related disease/condition and perceive that SRH related disease/ condition is severe were ten (OR=9.9; CI: 4.382-22.550), seven (OR=7.5; CI: 4.001-14.220) and four (OR=3.9; CI: 1.928-7.974) timely likely to utilize SRH services respectively compared to those who did not perceive.
Table 8 Knowledge and perception of respondents on SRH and their association with utilization of SRH services (n=384)
Characteristics
|
Utilization of SRH services
|
p-value
|
Crude OR (95%CI)
|
Yes
n (%)
|
No
n (%)
|
Knowledge on SRH
Other
Very poor
|
35(29.9)
24(9.0)
|
82(70.1)
243(91.0)
|
0.000*
|
4.3(2.428-7.692)
Ref
|
Perceived need of SRH services
Yes
No
|
52(27.2)
7(3.6)
|
139(72.8)
186(96.4)
|
0.000*
|
9.9(4.382-22.550)
Ref
|
Perceived susceptibility to SRH related disease/condition
|
|
|
Yes
No
|
44(32.6)
15(6.0)
|
91(67.4)
234(94.0)
|
0.000*
|
7.5(4.001-14.220)
Ref
|
Perceived severity to SRH related disease/condition
|
|
|
Very severe
Other
|
5(36.6)
44(12.8)
|
26(63.4)
299(87.2)
|
0.000*
|
3.9(1.928-7.974)
Ref
|
Perceived benefit of utilization of SRH services
|
|
|
Yes
No
|
24(20.9)
35(13.0)
|
91(79.1)
234(87.0)
|
0.052
|
1.8(0.994-3.128)
Ref
|
Self-efficacy
Competent/very competent
Other
|
23(41.1)
36(11.0)
|
33(58.9)
292(89.0)
|
0.000*
|
5.7(2.996-10.668)
Ref
|
Crude odds ratio is the odds ratio which identifies the association between variables with the use of SRH services. The variable for which p value is less than 0.05(*) is considered significant.
Ref reference group
Access to and Utilization of SRH services
Majority (73%) of respondents reported that the nearest health facility was not disability friendly specially referring to road (48%).
Table 9 Disability-friendly related characteristics of health facility (n=384)
Variables
|
Frequency
|
Percent
|
Nearest health facility is disability-friendly
Yes
No
|
103
281
|
26.8
73.2
|
Reason behind not disability-friendly health facility (n=281)*
Road to reach health facility is not disability friendly
No ramp in health facility
The room inside health facility is not disability friendly
Bad behavior of health workers
Discrimination
No disability friendly IEC/BCC materials
Long distance
|
262
156
98
5
1
15
3
|
48.5
28.9
18.1
0.9
0.2
2.8
0.6
|
*Multiple responses
Less of half (47%) of them could access SRH services in less than 30 minutes. The average time taken to visit nearest health facility for SRH services was 45 minutes. The average time distance between home and nearest health facility with SRH services was 9 km. Accessibility of health facility was not significantly associated with utilization of SRH services among WwD.
Table 10: Accessibility of health facility and their association with utilization of SRH services (n=384)
Characteristics
|
Utilization of SRH services
|
p-value
|
Crude OR (95%CI)
|
Yes
n (%)
|
No
n (%)
|
Time taken to reach the nearest health facility
|
|
|
|
> 30 mins
≤30 mins
|
32(18.0)
27(13.2)
|
147(82.0)
178(86.8)
|
0.204
|
1.4(0.822-2.504)
Ref
|
Distance between home and the nearest health facility
|
|
|
|
>1 km
≤1 km
|
20(14.9)
39(15.6)
|
114(85.1)
211(84.4)
|
0.861
|
0.9(0.529-1.704)
Ref
|
Enrolment to health insurance
Yes
No
|
13(17.1)
46(14.9)
|
63(82.9)
262(85.1)
|
0.639
|
1.2(0.599-2.307)
Ref
|
Nearest health facility is disability friendly
|
|
|
|
Yes
No
|
17(16.5)
42(14.9)
|
86(83.5)
239(85.1)
|
0.708
|
1.1(0.608-2.081)
Ref
|
Crude odds ratio is the odds ratio which identifies the association between variables with the use of SRH services. The variable for which p value is less than 0.05(*) is considered significant.
Ref reference group
However, qualitative study shows that remoteness and lack of disability friendly health facility are barrier to utilization of SRH services.
“Persons with severe and profound disabilities are deprived from utilizing SRH services in remote areas as health facilities are not accessible for them and the health providers are unable to reach their home. (Participant number 3, Local political leader during KII)”
Factors Independently Associated with Utilization of SRH Services
Fifteen characteristics which exhibited significant association with utilization of SRH services at 95 percent CI in bivariate analysis were further subjected to multivariate analysis. There was no problem of collinearity among independent variables as the highest Variance Inflation Factor was 2.009.
Marital status, perceived need of SRH services and perceived susceptibility to SRH related disease/condition were found to be significantly associated with utilization of SRH services. Those women with disabilities who were ever married are 122 times more likely to utilize SRH services compared to those who were never married (AOR=121.7, CI: 12.206-1214.338). Those women with disabilities who perceived need of SRH services were five times more likely to utilize SRH services compared to those who did not perceive need of SRH services (AOR=5.5; CI: 1.419-21.357). Those women with disabilities who perceived themselves susceptible for SRH related disease/ condition were six times more likely to utilize SRH services compared to those did not perceive themselves as susceptible (AOR=6.0, CI:1.978-18.370).
Table 11: Factors independently associated with utilization of SRH services (n=384)
Characteristics
|
Crude
|
Adjusted
|
p-value
|
OR (95%CI)
|
p-value
|
OR (95%CI)
|
Age
35 and above
Below 35
|
0.000*
|
3.4(1.795-6.430)
Ref
|
0.879
|
0.9(0.224-3.594)
Ref
|
Type of family
Joint
Nuclear
|
0.024*
|
2.0(1.100-3.760)
Ref
|
0.821
|
0.847(0.201-3.574)
Ref
|
Educational status of caretaker (n=314)
|
|
|
Literate
Illiterate
|
0.048*#
|
2.9(1.009-8.588)
Ref
|
0.468
|
1.7(0.400-7.359)
Ref
|
Marital Status
|
|
|
|
|
Ever married
Never married
|
0.000*#
|
174.7(23.818-1281.599)
Ref
|
0.000*
|
121.7(12.206-1214.338)
Ref
|
Household size
|
|
|
|
|
Less than five
Five or more
|
0.004*
|
2.3(1.304-4.011)
Ref
|
0.459
|
1.7(0.434-6.352)
Ref
|
Occupation
|
|
|
|
|
Employed
Unemployed
|
0.000*
|
4.2(2.353-7.441)
Ref
|
0.130
|
2.5(0.762-8.236)
Ref
|
Type of disability
|
|
|
|
|
Physical disability
Other than physical
|
0.000*
|
3.0(1.692-5.254)
Ref
|
0.818
|
0.9(0.232-3.169)
Ref
|
Severity of disability (n=318)
|
|
|
|
Mild
Moderate/Severe/Prof.
|
0.001*
|
2.8(1.500-5.262)
Ref
|
0.722
|
1.3(0.318-5.223)
Ref
|
Women empowerment
|
|
|
|
Moderate and high
Low empowered
|
0.000*
|
4.5(2.471-8.101)
Ref
|
0.968
|
1.0(0.259-3.659)
Ref
|
Listen to radio/FM
|
|
|
|
|
Often
Never
|
0.004*
|
2.3(1.303-4.088)
Ref
|
0.738
|
1.2(0.351-4.389)
Ref
|
Knowledge on SRH
|
|
|
|
|
Other
Very Poor
|
0.000*
|
4.3(2.428-7.692)
Ref
|
0.936
|
0.9(0.254-3.528)
Ref
|
Perceived need of SRH services
|
|
|
|
Yes
No
|
0.000*
|
9.9(4.382-22.550)
Ref
|
0.014*
|
5.5(1.419-21.357)
Ref
|
Perceived susceptibility to SRH related disease/condition
|
|
|
Yes
No
|
0.000*
|
7.5(4.001-14.220)
Ref
|
0.002*
|
6.0(1.978-18.370)
Ref
|
Perceived severity to SRH related disease/condition
|
|
|
Very severe
Not very severe
|
0.000*
|
3.9(1.928-7.974)
Ref
|
0.251
|
2.6(0.504-13.760)
Ref
|
Self-efficacy
|
|
|
|
|
Competent/very comp.
Other
|
0.000*
|
5.7(2.996-10.668)
Ref
|
0.891
|
1.1(0.255-4.813)
Ref
|
Adjusted odds ratio is the odds ratio which identifies the association between variables with the use of SRH services taking all variables in account.
The variable for which p value is less than 0.05(*) is considered significant
#Fisher’s exact test
Ref reference group
Barriers to utilization of SRH services among women with disabilities adapted from health belief model
Health Belief Model is a social psychological health behavior change model developed to explain and predict health-related behaviors, particularly in regard to the uptake of health services[10]. As Health Belief Model is most widely used theories in health behavior research, it was adopted to present the findings from qualitative data of the study.
There are various factors responsible for the final outcome (here, utilization of SRH services). The first factor is individual perception, which is related to perceived susceptibility and perceived severity. Perceived susceptibility refers to subjective assessment of risk of developing a health problem. The combination of perceived severity and perceived susceptibility is referred to as perceived threat[10].The study shows that those women with disabilities who did not perceive oneself susceptible to SRH related disease/condition and did not consider SRH related disease/condition as serious were less likely to utilize SRH services. Lower perceived threat led to a lower utilization of SRH services.
The modifying variables affect health-related behaviors indirectly by affecting perceived seriousness, susceptibility, benefits, and barriers[10]. Perceived severity and perceived susceptibility to SRH related disease/condition depended on knowledge on SRH. The study shows that those women with disabilities who were illiterate, belonged to low socioeconomic status and low social class, lack information from FCHVs and lack sharing among neighbor/friends were less likely to utilize SRH services.
A cue, or trigger, is necessary for prompting engagement in health-promoting behaviors[10]. The study shows that less media exposure (radio/FM, TV, internet other social media) limited engagement in health-related behaviors and resulted low utilization of SRH services among women with disabilities.
The contributing factors for utilization of SRH services are perceived benefits whereas the hindering factors for utilization of SRH services are perceived barriers. Likelihood of action is the results of perceived benefits minus perceived barriers[10]. The study shows that those women with disabilities, who perceived benefits of utilization of SRH services, were more likely to utilize the services. The perceived barriers for utilization of SRH services among women with disabilities were lack of empowerment, severity of disability, type of disability (intellectual disability), lack of disability-friendly environment (lack of family support, distant health facility, lack of accessible infrastructure including road and health facility, stigmatization, bad behavior and attitude of health care providers), and perception that SRH is needed only for married person. The utilization of SRH services by women with disabilities also depended on how the person overcome the barrier considering the benefits.