Access to health care, reproductive health and disability: a large scale survey in Sierra Leone

Soc Sci Med. 2011 Nov;73(10):1477-89. doi: 10.1016/j.socscimed.2011.08.040. Epub 2011 Sep 29.


This is the first study to compare health status and access to health care services between disabled and non-disabled men and women in urban and peri-urban areas of Sierra Leone. It pays particular attention to access to reproductive health care services and maternal health care for disabled women. A cross-sectional study was conducted in 2009 in 5 districts of Sierra Leone, randomly selecting 17 clusters for a total sample of 425 households. All adults who were identified as being disabled, as well as a control group of randomly selected non-disabled adults, were interviewed about health and reproductive health. As expected, we showed that people with severe disabilities had less access to public health care services than non-disabled people after adjustment for other socioeconomic characteristics (bivariate modelling). However, there were no significant differences in reporting use of contraception between disabled and non-disabled people; contrary to expectations, women with disabilities were as likely to report access to maternal health care services as did non-disabled women. Rather than disability, it is socioeconomic inequality that governs access to such services. We also found that disabled women were as likely as non-disabled women to report having children and to desiring another child: they are not only sexually active, but also need access to reproductive health services. We conclude that disparity in access to government-supported health care facilities constitutes a major and persisting health inequity between persons with and without disabilities in Sierra Leone. Ensuring equal access will require further strengthening of the country's health care system. Furthermore, because the morbidity and mortality rates of pregnant women are persistently high in Sierra Leone, assessing the quality of services received is an important priority for future research.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Cross-Sectional Studies
  • Disability Evaluation
  • Disabled Persons*
  • Female
  • Health Care Surveys
  • Health Services Accessibility*
  • Health Services Needs and Demand
  • Health Status
  • Health Status Disparities*
  • Humans
  • Male
  • Maternal Health Services / statistics & numerical data*
  • Reproductive Health Services / statistics & numerical data*
  • Reproductive Health*
  • Sex Factors
  • Sierra Leone
  • Statistics as Topic
  • Surveys and Questionnaires
  • Women's Health
  • Young Adult