When Amaka, a woman with a locomotor disability, went in search of prenatal care for the first time, she faced a distressing experience at a health centre in Abuja, Nigeria's capital. Like many women with disabilities in Nigeria, she faced a healthcare system unprepared to meet her needs. "The healthcare providers did not care that my legs were disabled, I was treated like my legs were normal. It was very distressing. I did not know I could be handled better until I used a different facility for my second delivery," Amaka recalled.
Globally, the World Health Organisation (WHO) reports that approximately 16% of the world's population lives with a form of disability. In Nigeria, findings from the National Bureau of Statistics indicate that 1 in 10 households has at least one person living with a disability, suggesting that 6% of Nigeria's population live with. Unfortunately, these individuals often face discrimination, significantly higher healthcare costs and poorer health outcomes due to systemic barriers.
While Nigeria has enacted various policies aimed at improving healthcare access and quality for persons with disabilities (PWDs), such as the National Health Policy and the National Policy on Sexual and Reproductive Health of Persons with Disabilities, they are not being fully or effectively implemented. As a result, these policies fail to significantly improve healthcare access and quality for PWDs.
Globally, maternal and child health programmes often fail to integrate targeted strategies for women and children with disabilities. This exclusion results in gaps in maternal and child healthcare, where essential services like antenatal care and vaccinations are often inaccessible to those who need them most.
Despite international frameworks like Article 25 of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), which explicitly prohibits discrimination in healthcare, pregnant women with disabilities continue to face systemic barriers. From societal stigma to discrimination in healthcare settings, many delay seeking care, fearing mistreatment or a lack of provider awareness.
These challenges are even more pronounced in regional and national contexts, including Nigeria, where structural gaps and cultural beliefs make access even harder for PWDs.
Limitation to healthcare for women and children with disabilities
The Nigerian healthcare system often excludes PWDs due to communication barriers, inadequate staff training, and societal biases. At the 2023 Policy Dialogue hosted by Nigeria Health Watch and National Health Insurance Authority (NHIA), Hellen Beyioku-Alase, Executive Director of the Deaf Women Aloud Initiative, highlighted these challenges.
"I am a mother of four and I have never gone to the hospital and met a nurse or doctor that understands sign language or even an interpreter. This makes it impossible for them to understand me." she shared.
Women and children with disabilities also face discrimination when seeking maternal care, with some even being shamed for their pregnancies. As Hellen recounted, "Our women go to the hospitals and the healthcare providers shame them for being pregnant." This exclusion drives many away from healthcare, further worsening disparities.
Cost is another major barrier. Healthcare services for PWDs tend to be more expensive due to specialised equipment and additional consultations. Many low-income families struggle to afford assistive devices, personal support services, and transportation to facilities.
Fatima, mother of a son with hearing impairment, noted, "Getting the hearing aid and paying for speech therapy is expensive. I could afford it, but what about families with less financial strength?"
Beyond healthcare costs, PWDs face financial risk protection challenges due to limited job opportunities, often prioritising food and housing over medical care.
Standard medical equipment, such as examination tables, also fail to accommodate pregnant women with disabilities. The lack of disability-related data in Nigeria, makes it difficult to develop targeted interventions for maternal mortality among PWDs.
Creating an inclusive healthcare system
Addressing these issues requires a multi-pronged approach with the physical accessibility of healthcare facilities being prioritised. Nigeria can adopt the Universal Design Principles into healthcare infrastructure, ensuring compliance with accessibility standards.
To improve financial protection, urgent policy action is needed to close implementation gaps in the 2022 NHIA Act, ensuring the Basic Healthcare Provision Fund (BHCPF) and the Vulnerable Group Fund effectively support PWDs.
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Healthcare providers need comprehensive training on how to care for persons with disabilities. Uganda's disability-inclusive training programme has demonstrated how tailored education can improve healthcare workers' attitudes and communication skills. Similarly, the WHO's Disability-Inclusive Health Services Training Package provides structured learning materials that could be adapted for Nigeria's healthcare sector.
Hellen emphasised that, "When passing healthcare information, think of how to communicate it to the community of persons with disabilities. The staff should be trained on how to work and communicate with persons with disabilities"
Disability advocacy programmes, such as those developed by Kupenda for the Children, highlight the importance of community-based awareness campaigns to ensure women with disabilities are aware of the healthcare services available to them.
Inclusive healthcare for women and infants with disabilities is not just a human rights issue, it is a public health priority. Addressing these gaps will help Nigeria move closer to achieving equitable healthcare for all its citizens.
