Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
PLoS One. 2022 Aug 29;17(8):e0273869. doi: 10.1371/journal.pone.0273869. eCollection 2022.
People with disabilities deal with widespread exclusion from healthcare services, including sexual and reproductive health (SRH) rights. Studies analyzing the relationship between disability and key SRH utilization outcomes have often reported mixed findings. In Pakistan, very little to no literature is available on this topic, therefore we aim to determine inequalities in the utilization of essential maternal and reproductive health services between women with and without disabilities in Pakistan.
This was a secondary analysis of Pakistan Demographic Health Survey 2017-18 performed on a weighted sample of 6,711 women aged 15-49 years with a live birth in the 5 years preceding the survey. Six types of disabilities were assessed i.e. vision, hearing, communication, cognition, walking and self-care. Utilization of essential maternal and reproductive health services was assessed through a set of four outcome variables: (i) modern contraceptive use; (ii) skilled antenatal care (ANC); (iii) skilled birth attendance (SBA); and (iv) skilled postnatal care (PNC). Multivariate Cox regression analysis was performed to determine the association between dependent and independent variables. Data were analyzed using Stata MP Version 16.0.
A total of 6,711 women were included out of which 14.1% (n = 947) live with at least one form of disability. Mean age was 29.4 (S.E = 0.13) years. The most prevalent form of disability was vision (7.0%), followed by walking (4.8%), cognition (4.8%) and hearing (1.8%). Women with disabilities were comparatively less educated, belonged to older age group, and had higher parity than their non-disabled counterparts. With the exception of modern contraceptive use, which was more prevalent in the group with disabilities, women with disabilities were less likely to utilize skilled ANC, SBA and PNC in bivariate analysis. However, these associations turned insignificant in the adjusted model. Overall, no statistically significant differences were observed in the utilization of essential reproductive health services between women with and without disabilities after adjusting for important covariates.
Our analyses did not find any statistically significant differences in the utilization of essential maternal and reproductive health services between women with and without disabilities. In-depth research utilizing qualitative or mixed methods is required to understand how well the healthcare system in Pakistan is responsive to the different needs of disabled women.
残疾人在获得医疗服务方面普遍受到排斥，包括性健康和生殖健康（SRH）权利。分析残疾与关键 SRH 利用结果之间关系的研究经常得出相互矛盾的结果。在巴基斯坦，几乎没有关于这个主题的文献，因此我们旨在确定巴基斯坦残疾妇女和非残疾妇女在利用基本母婴健康服务方面的不平等。
这是对巴基斯坦 2017-18 年人口健康调查的二次分析，使用了在调查前 5 年内有活产的 6711 名 15-49 岁的加权女性样本。评估了六种类型的残疾，即视力、听力、沟通、认知、行走和自我照顾。通过一组四个结果变量评估基本母婴健康服务的利用情况：（i）现代避孕药具的使用；（ii）熟练的产前护理（ANC）；（iii）熟练的分娩护理（SBA）；和（iv）熟练的产后护理（PNC）。使用多变量 Cox 回归分析确定因变量和自变量之间的关系。使用 Stata MP 版本 16.0 进行数据分析。
共纳入 6711 名女性，其中 14.1%（n=947）至少有一种形式的残疾。平均年龄为 29.4（S.E=0.13）岁。最常见的残疾形式是视力（7.0%），其次是行走（4.8%）、认知（4.8%）和听力（1.8%）。与非残疾女性相比，残疾女性教育程度较低，年龄较大，生育子女较多。除了残疾女性中更普遍的现代避孕药具使用外，残疾女性在接受基本 ANC、SBA 和 PNC 方面的可能性较小。然而，这些关联在调整后的模型中变得不显著。总体而言，在调整重要协变量后，残疾妇女和非残疾妇女在利用基本生殖健康服务方面没有观察到统计学上的显著差异。需要利用定性或混合方法进行深入研究，以了解巴基斯坦的医疗保健系统在多大程度上能满足残疾妇女的不同需求。
