Bolarinwa, Obasanjo ORCID: https://orcid.org/0000-0002-9208-6408, Odimegwu, Clifford, Mohammed, Aliu and Gayawan, Ezra (2025) Spatial modelling of the shared impact of sexual health knowledge and modern contraceptive use among women with disabilities in Africa. Contraception and Reproductive Medicine, 10 (16).

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Abstract

Background
Women with disabilities remain highly vulnerable to sexual and reproductive health problems, particularly in sub-Saharan Africa (SSA), where their sexual and reproductive rights, such as access to sexual health information and contraception, are often neglected. This study investigated the spatial patterns of the shared impact of sexual health knowledge and modern contraceptive use among women with disabilities in Africa.

Methods
We used the most recent Demographic and Health Survey (DHS) data involving 16,157 women with disabilities from ten African countries for this study. The data were analysed using both spatial and Bayesian inference to account for the shared component model patterns between sexual health knowledge and modern contraceptive use among women with disabilities while accounting for factors unique to each outcome. Bayesian inference via the Integrated Nested Laplace Approximation (INLA) was used for implementation. Priors for shared effects ​were set as log-normal distributions, while Gaussian priors were assigned to fixed effects. Intrinsic Conditional Autoregressive (ICAR) priors modelled spatial dependencies between districts, introducing spatial autocorrelation based on shared boundaries. Penalised Complexity (PC) priors controlled precision parameters to balance model complexity.

Results
The study revealed low sexual health knowledge (ranging from 3% in Nigeria to 27% in Uganda) and modern contraceptive use (ranging from 1% in DR Congo and Chad to 27% in Uganda) among women with disabilities across the countries surveyed. The spatial patterns showed diverse intra-country and inter-country disparities of sexual health knowledge and modern contraceptive use among the women, with lower shared impact observed in Mauritania, Nigeria, Uganda, Chad, and DR Congo relative to Kenya, Malawi, Mali, South Africa, and Rwanda. Factors that influence sexual health knowledge and modern contraceptive use among women with disabilities include education, marital status, place of residence, community literacy level, community socio-economic status, and age.

Conclusions and recommendations
Sexual health knowledge and modern contraceptive use among women with disabilities in Africa remain low, albeit with varied intra-country and inter-country spatial disparities. Therefore, spatial areas with low sexual health knowledge and modern contraceptive use should be given more attention when implementing measures to promote the use of modern contraceptives among women with disabilities. Promoting sexual health knowledge and modern contraceptive use among women with disabilities in Africa could significantly contribute towards the realisation of the 2030 Sustainable Development Goal agenda of “leaving no one behind”.

Background
Globally, women with disabilities are highly exposed to sexual and reproductive health problems due to systemic barriers and discrimination with respect to their sexual and reproductive rights [1, 2]. Despite the various legal frameworks, protocols, and agreements at national and international levels, women with disabilities continue to experience various forms of sexual and reproductive health violations, including forced sterilisations, forced abortions, lack of access to contraceptive choices, forced marriages, limited access to sexual health information, sexual violence, and sexual abuse [1, 3, 4].

These issues contribute to the increased risk of sexual and reproductive health problems among women with disabilities. For instance, lack of access to modern contraceptive choices and limited sexual health information has been associated with an increased risk of unintended pregnancies, unsafe abortions, and sexually transmitted infections (STIs), including HIV, among women with disabilities [5,6,7]. Yet, there is a lack of attention to the sexual and reproductive health problems of women with disabilities, particularly in sub-Saharan Africa (SSA), although women with disabilities have the same sexual and reproductive health needs as those without disabilities [8].

Sexual health knowledge is important in equipping individuals with the right information, skills, and attitudes to make informed sexual and reproductive decisions and protect their health [9]. Most women with disabilities lack knowledge of sexuality and sexual health, which often limits their capacity to make informed sexual and reproductive health decisions [5, 10]. Lack of access to both formal and informal education on sexuality and sexual health [11] and limited availability of sexual and reproductive health information in disability-appropriate formats such as brailles, audios, and sign interpreters [1] often contribute to poor sexual health knowledge among women with disabilities. Other factors include hesitancy to approach carers on sexual health matters due to societal prejudice and lack of trained or experienced care providers [3, 12]. Meanwhile, limited sexual education and information predispose many women with disabilities to risky sexual behaviours, including having multiple sexual partners and lack of modern contraceptive use [5, 13], thereby increasing their risk of sexual and reproductive health problems.

Despite the importance of contraception in reducing unintended pregnancies, maternal morbidity and mortality, and preventing STIs, including HIV [14], women with disabilities face significant barriers to accessing modern contraceptives, especially in SSA [15, 16]. Access to modern contraceptives among women with disabilities is often limited by a lack of knowledge and education on contraception, poor socio-economic status, lack of disability-friendly healthcare facilities and policies, societal stigma, and discriminatory practices of some healthcare providers [15, 17]. Besides, evidence suggests that women with disabilities have a higher burden of sexual and reproductive health problems due to the lower prevalence of contraceptive use and higher unmet need for modern contraceptives in low- and middle-income countries (LMICs), especially in SSA [18, 19].

The intersection of sexual health knowledge and modern contraceptive use remains an important research area in sexual and reproductive health [20]. Previous studies have shown that good sexual health knowledge increases the use of modern contraceptives due to an improved understanding of the available methods of contraception and how to access them [21, 22]. However, the intersection of sexual health knowledge and modern contraceptive use remains less investigated among women with disabilities in SSA, although they experience greater barriers in accessing sexual health education and information as well as modern contraceptives [15, 18, 23].

Besides, factors such as geographic location play a significant role in access to sexual health information and modern contraceptive use [24, 25]. For instance, previous studies revealed that rural-urban residency could influence sexual health knowledge and contraceptive use of women with disabilities [10, 26]. Nonetheless, the shared impact of spatial patterns of sexual health knowledge and modern contraceptive use among women with disabilities in Africa remain less known. Therefore, this study sought to investigate the spatial patterns of the shared impact of sexual health knowledge and modern contraceptive use among women with disabilities in SSA in order to highlight the geographic areas with increased vulnerability of women with disabilities to sexual and reproductive health problems, at the same time, utilising spatial pattern modelling will inform targeted interventions, that could improve healthcare accessibility, and promotes disability-inclusive policies.

Item Type:	Article
Status:	Published
DOI:	10.1186/s40834-025-00349-4
School/Department:	London Campus
URI:	https://ray.yorksj.ac.uk/id/eprint/11687

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