By Tara Lutz, MPH, CHES, NACCHO Health & Disability Fellow
According to the World Health Organization’s (WHO) 2006 publication, Defining Sexual Health, the working definition of sexuality is “…a central aspect of being human throughout life…” Because all human beings are sexual beings, sexual and reproductive health is a universal human right, and should be afforded to all individuals, regardless of intellectual and/or physical ability. However, historically, society has not acknowledged the sexual and reproductive health needs and desires of people with disabilities. Instead, people with disabilities have experienced physical, structural, and attitudinal barriers to receiving sexual health education and healthcare. This mistreatment has led to incorrect and dangerous assumptions that people with disabilities as a group are not sexually active and are therefore not at risk for negative sexual outcomes such as sexually transmitted infections (STIs) and unplanned pregnancy.
Research indicates that adolescents with disabilities are just as interested and engaged in sexual behaviors as their peers without disabilities. More importantly, teens with and without disabilities are experiencing similar rates of associated consequences of health risk behaviors (e.g., contracting STIs). Yet due to historical bias, youth and adults with disabilities are less likely to receive adequate healthcare, including education and access to preventive screenings, and information on sex-related topics. In fact, research shows that individuals with disabilities face numerous barriers to quality sexual and reproductive health services. These barriers include limited financial resources and physical accessibility restrictions (e.g. accessible exam tables), which are further compounded by healthcare providers, lacking in awareness, and/or experience treating people with disabilities.
The broad range of topics and meanings associated with sexuality and sexual behaviors make inclusive sex education and healthcare services even more critical for people with disabilities. Sex can mean different things to different people. For example, a healthy sex life can involve one, multiple or no partners, or no partners at all. Attitudes and awareness about sex and risks related to sexual behaviors also vary based on a person’s upbringing and personal experiences. As a result, in order to provide appropriate and comprehensive sexual and reproductive care, healthcare professionals should engage their patients in a conversation about their own behaviors. All adolescents and adults with disabilities should be asked questions regarding their sexual health at healthcare appointments, just as people without disabilities should be asked. Healthcare providers should incorporate inclusive terminology and preferred pronouns, while addressing the following topics: sexual behaviors and with whom they occur, previous and current partner(s), previous history of STI testing and treatment, and methods of birth control and STI prevention used.
The Role of Local Health Departments
Approximately 50% of local health departments (LHDs) provide family planning services, STI screening services, and information about teen pregnancy prevention. However, less than 30% of these programs are designed to be inclusive of people with disabilities. LHDs can improve services for people with disabilities by increasing access to programs related to sexual health and reproduction. By providing inclusive programs and services, LHDs will also improve the overall health of the communities they serve.
The following activities provide specific examples of action steps LHDs can take to embed inclusion into their agency’s sexual health and reproductive services:
- Talk to local Boards of Education (BOE). State law governs sexual health and HIV education, but it is up to the local BOE to determine the health curriculum that is taught in schools. Partnering with and serving as a resource for schools on the topic of inclusive sexual health education will benefit all students.
- Make sure resources, programming, and activities on the topic of sexual health, including STI testing and pregnancy prevention activities, are accessible to and inclusive of people with disabilities. For more information, see NACCHO’s fact sheet titled “Including People with Disabilities in Reproductive Health Programs and Services”.
- Communicate in multiple modalities. Deliver public health communication and messaging on the topic of sexual health in multiple formats. Consider audio, visual, written, electronic, web-based and other forms of communication. For more information, see NACCHO’s fact sheet titled “Five Steps for Inclusive Communication: Engaging People with Disabilities”.
- Get to know the local population. Directly engaging people from the community who have disabilities as well as organizations that serve people with disabilities can provide opportunities for dialogue. Stakeholder input can direct local public health efforts to better identify and address community needs.
- Provide regular training opportunities to educate LHD and partner agency staff on the need for inclusive sexual health promotion.
- Make a commitment to community-wide inclusive sexual health. Include inclusive sexual health initiatives in future strategic plans, community health assessments (CHA), and community health improvement plans (CHIP).
LHD staff should also reference the following resources for more information on fostering inclusion and accessibility related to sexual and reproductive healthcare services and education:
- NACCHO Fact Sheet: Including People with Disabilities in Reproductive Health Programs and Services
- CDC Disability and Health: Healthy Living
- Planned Parenthood
- Planned Parenthood: Developmental Disabilities and Sexuality Curriculum
- Guttmacher Institute: Sex and HIV Education
- Kaiser Family Foundation: It’s Your Sex Life
- Columbia University: Go ask Alice!
- National Coalition for Sexual Health: Sexual Health and Your Patients: A Provider’s Guide
The NACCHO Health and Disability Fellowship is supported by the Centers for Disease Control and Prevention (CDC), Cooperative Agreement #5NU38OT000172-04-00 and the Disability and Health program.