Awareness and barriers to accessing sexual and reproductive healthcare services among Deaf women in Krachi West District of Ghana: a qualitative study

Abstract

Background

Although Ghana is one of the countries that has ratified the United Nations Convention on the Rights of Persons with Disabilities and enacted the Persons with Disabilities Act, women with disabilities across the country have continuously reported barriers to accessing sexual and reproductive healthcare services. Such barriers hinder the achievement of the United Nations Sustainable Development Goals 3 and 10, which aim to promote good health and well-being and reduce inequalities within and among countries, respectively. This study explored the awareness of sexual and reproductive healthcare (SRH) services and barriers to accessing them among Deaf women in the Krachi West District.

Methods

This study employed a descriptive qualitative design, using in-depth interviews as the main data collection technique. Our study spanned from November 2021 to January 2022, and it included 13 Deaf women aged 15 to 49 in the Krachi West District of Ghana. The participants were selected using the purposive sampling method. Thematic content analysis was employed for data analysis, with QSR NVivo 12 software used for coding and developing themes.

Results

All participants were aware of SRH services such as family planning, antenatal care, and postnatal services, with family members and partners being their primary sources of information. The study identified several key barriers to accessing these services, including financial constraints, high service costs, communication difficulties with healthcare providers, stigma, inappropriate attitudes from healthcare providers, and a lack of community support.

Conclusion

The study found that all participants were aware of SRH services, although few made use of them. Socio-economic, health system, and community-level barriers, such as an inability to pay, communication gaps, negative attitudes from healthcare workers, and a lack of community support, hinder Deaf women from accessing SRH services. Our findings call for reorienting the health system to accommodate the SRH needs of women with hearing disabilities. Additionally, public education and sensitisation are needed to improve people’s understanding of the SRH needs of persons with disabilities, such as Deaf women, and the importance of supporting their needs with the available resources.

Background

Disability can be defined as a constraint on an individual’s capacity to engage in what is considered “normal” in their everyday society due to physical, cognitive, mental, sensory, emotional, developmental, or a combination of these impairments [1]. Globally, 1.3 billion people (16% of the global population) experience significant disability [2]. Persons with disabilities (PWDs) constitute one of the most disadvantaged groups in many societies and continuously face all forms of discrimination in the most critical areas of life, such as health [3]. Currently, over 430 million people suffer from disabling hearing loss, with approximately 80% of them residing in low- and middle-income countries (LMICs) [4]. It is also estimated that by 2050, over 700 million people will have hearing loss or deafness that is disabling [4]. Deafness is not defined by gender, race, age, or financial status. Certain groups of Deaf individuals, such as Deaf women and women with hearing loss who identify with the Deaf community, are more vulnerable to marginalisation [5]. ‘Deaf women’ refers to women who are part of the Deaf community, which has its own language (Ghanaian Sign Language), culture, and shared experiences, whereas ‘deaf women’ denotes women who have hearing loss but may not necessarily identify with the Deaf community or be involved in Deaf culture. In this paper, we used ‘Deaf women’ to refer to women with hearing loss who identify with the Deaf community (registered as disabled at the Department of Social Welfare in the Krachi West District).

The prevalence of disability in Ghana is unevenly distributed between women and men, with 10.6% and 6.2%, respectively [6]. Consequently, women have the highest prevalence of all types of disability, except for speech disability [6]. More women than men with disabilities are vulnerable to economic marginalisation, facing higher rates of unemployment, lower wages, and fewer opportunities for education, vocational training, and employment [5]. Furthermore, women with disabilities experience a double burden of discrimination due to the intersection of disability and gender [7]. This discrimination impacts various aspects of the lives of PWDs than those without disabilities, including poor health, lower academic achievements, limited economic prospects, high levels of poverty, and low socio-economic status [1, 2]. Poverty coupled with disability worsens healthcare exclusion [8].

PWDs face discrimination regarding their sexual and reproductive health (SRH) partly due to a widely held myth that disabled women are asexual and incapable of having a positive childbearing experience, as evidenced by studies from Ghana and Vietnam [9–11]. This belief is unfounded, as women with disabilities aspire to have children, and a substantial number of them engage in sexual relationships [12, 13]. Despite these reproductive desires, global findings indicate that women with disabilities continue to encounter numerous challenges in accessing SRH services [7].

Five broad categories of barriers limit and hinder access to SRH services among PWDs [14]. These include socio-economic barriers, health system or institutional barriers, national level barriers, community level barriers, and individual level barriers. Socio-economic barriers include poverty, financial constraints, health care affordability, and geographical location [15]. Insensitivity and negative attitudes towards PWDs by healthcare workers, health system capacity constraints, communication gaps, and inadequate health-related information in sign language have been identified as barriers within the health system [12, 14, 16–19]. Additionally, a lack of community and family support, sigma and negative attitude by community members regarding the sexuality of PWDs are identified as community-level barriers to SRH usage by PWDs [12, 14, 16, 20].

Ghana is among the countries that have ratified the United Nations Convention on the Rights of Persons with Disability (UNCRPD) and has also enacted the Persons with Disability Act 715 [21]. Nonetheless, barriers to accessing SRH care services have been continuously reported by women with disabilities across the country [16]. The United Nations Sustainable Development Goal (SDG) 10 (reduce inequalities within and among countries) and SDG 3 (good health and well-being), with a particular focus on target 3.7, which aims to ensure universal access to sexual and reproductive health-care services, will also not be achieved if women with disabilities are denied access to essential SRH services [22].

Although several studies have explored the barriers that women with disabilities face in accessing SRH services, limited attention has been specifically given to Deaf women. Deaf women face unique challenges that differ from those experienced by other disability groups, particularly communication barriers with healthcare providers, limited access to SRH information in accessible formats, and social exclusion stemming from linguistic and cultural differences [23, 24]. In Ghana, Deaf women often remain invisible within mainstream disability and health discourses. They are frequently excluded from SRH programmes that do not consider their need for sign language interpretation and culturally appropriate care [25]. There is a need to unearth specific barriers hindering access to sexual and reproductive healthcare among Deaf women in Ghana to develop tailored programmes and interventions that will help achieve SDG 3.7. This study assesses Deaf women’s awareness of SRH services and explores the socioeconomic, health system, and community-level barriers they face in accessing SRH in Krachi West. Findings from the study could assist health policymakers and programme planners in the Krachi West District and nationally in adopting inclusive strategies to enable Deaf women to access SRH services.

Methods

Study design

This study employed a descriptive qualitative design to assess the awareness and challenges faced by Deaf women in accessing SRH services. A qualitative approach was selected for this study to thoroughly explore the experiences and barriers encountered by Deaf women in accessing SRH services. This method particularly suited for understanding the complex, often underrepresented experiences of marginalised groups, such as individuals with disabilities [8, 26]. Furthermore, this approach offers a flexible and responsive means to understand the unique challenges faced by Deaf women in accessing SRH services [12].

Study area

The study was conducted in the Krachi West District over a three-month period from November 2021 to January 2022. Krachi West is one of the eight administrative districts in the Oti Region of Ghana [27]. The district shares boundaries with Krachi Nchumuru District to the north, Krachi East District to the east, and Volta Lake to the south and west. Beyond the Volta Lake, it shares a boundary with Sene West District to the west [27]. The Krachi West District was chosen for this study because SRH services, including skilled delivery and antenatal care attendance, have been suboptimal in the district over the past few years. Skilled delivery rates have remained below 80%, and antenatal care attendance has fluctuated between 47% and 48% in the past three years [28]. Despite this, there is no available data on the service utilisation of Deaf women in the district.

Sample size, participant selection and recruitment

The study comprised 13 Deaf women of reproductive age (15–49 years) residing in the Krachi West District at the time of data collection. A purposive sampling method was used to select 13 participants: Deaf women aged 15 to 49. The sample size for this study was determined based on principles of data saturation, a key concept in qualitative research. Guest et al. [29] posits that data saturation is typically achieved with approximately 12 to 15 participants in in-depth interviews. This sample size allows for a comprehensive understanding of the experiences and challenges faced by Deaf women in accessing SRH services, without overextending the research resources. Participants were identified through the Department of Social Welfare at the Krachi West District Assembly. The disability register available at the department was used to identify Deaf women in each community in the district. These women were then traced to their various communities and enrolled in the study.

Data collection instrument and process

A semi-structured interview guide was developed and used based on the study objectives. The tool comprised an open-ended interview guide with a structured short questionnaire to capture socio-demographic characteristics of the participants (age, marital status, number of children, education level, religion, ethnic background, occupation, and place of residence). Additionally, there were open-ended questions regarding participants’ awareness of existing SRH services in the district and barriers (socio-economic, health system and community level) to accessing these services. The interview guide was pre-tested with three Deaf women outside the district, specifically in Krachi Nchumuru District. This pre-testing helped to reframe unclear questions in the interview guide and enhance clarity in the interviewing process.

Three research assistants trained as data collectors who understood both the official Ghanaian Sign Language (GSL) and the local sign language of the area were recruited to collect data. They received training on various aspects of the data collection process and the interview guide. Data was collected via in-depth interviews, most of which took place in the participants’ homes, while in a few instances, a private room at a local community centre was used. Each interview lasted between 45 minutes and 1 hour. The first author actively supervised the data collectors during the data collection to ensure data quality. Also, regular meetings were held to review the data collection process and reflect on how individual biases could affect the data. This process of continuous reflexivity during data collection ensured that questions were asked appropriately and that personal biases were minimised. After conducting 10 in-depth interviews, no new themes or information emerged, indicating that data saturation has been reached. However, three additional interviews were conducted to conclude the data collection. According to Guest et al. [29], about 92% data saturation occurs after interviewing approximately 12 participants when employing in-depth interviews.

Data processing and analysis

A thematic content analysis, employing Braun and Clarke’s approach [30] was used to analyse the data. Trained research assistants who understood the sign language transcribed all recorded videos of the interviews into text format in the English Language. The first author and all trained research assistants read through the texts numerous times to ensure transcription accuracy and consistency. Transcripts were revised to eliminate grammatical errors while maintaining the original context. To obtain a general understanding of the results, edited transcripts were read multiple times. For data coding, all transcripts were imported into QSR NVivo 12 software. The coding process commenced with a critical analyses of each transcript, coding them into emerging themes. The coding process involved three individuals, including “two research assistants and one independent auditor”. This approach was used to ensure reliability and to reduce potential bias during the analysis. The coding followed a deductive approach. Initially, individual coders developed codes independently. These were then collectively reviewed in iterative sessions to consolidate and finalise the themes. Final themes were agreed upon through consensus. The themes were presented with appropriate quotes from the transcripts to support them. Also, responses to structured questions on socio-demographic characteristics were entered into Excel and imported into Stata version 15 for analysis. The results on the socio-demographic characteristics were presented in a tabular form using frequencies and percentages.

Ethics considerations

Ethical approval was granted by the Ghana Health Service Ethics Review Committee (Protocol ID Number: GHS-ERC 043/07/21). Before each interview, informed consent was obtained. Participants were informed about the rationale for the study and the study procedures. The benefits and risks of participation were also explained to each participant. The participants were then asked to sign or thumbprint the informed consent form to indicate their willingness to participate in the study. Each participant received a copy of the signed or thumb-printed consent form for future reference. Parental or guardian consent and child assent were also obtained from the participants who were below 18 years. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Findings

This section provides details of the findings from this work, including the socio-demography of participants, awareness of participants on SRH and barriers to accessing SRH. The barriers are grouped under individual, health system, and community-level barriers to accessing sexual and reproductive health care services among Deaf women.

Socio-demography of the participants

Table 1 shows socio-demographic characteristics of the study participants. In total, 13 Deaf women were individually interviewed. Many (46.1%) were aged 25–34 years. Close to 40% each of the participants were married and single. More than half (53.8%) of the participants had no formal education. For the number of children, 30.8% were without children whilst same had 1 to 3 children. Farming was the major occupation (30.8%) among the participants. Majority (69.2%) of the participants were Christians. Most (38.6%) of the participants were Guans. Majority (84.6%) of the participants were from rural communities.

Table 1.

Socio-demographic characteristics of participants

Variable	Number	Percentage (%)
Age
15–24	3	23.1
25–34	6	46.1
35–49	4	30.8
Marital status
Married	5	38.5
Single	5	38.5
Divorce	2	15.4
Widowed	1	7.6
Educational level
No formal education	7	53.8
Basic	4	30.8
Junior High School	2	15.4
Number of children
No child	4	30.8
1 to 3	4	30.8
4 to 6	5	38.4
Occupation
Farming	4	30.8
Trading	2	15.4
Hairdresser	1	7.6
Fish monger	2	15.4
Tailoring	1	7.6
Unemployed	1	7.6
Student	1	7.6
Apprentice	1	7.6
Religion
Christian	9	69.2
Muslim	2	15.4
Traditionalist	2	15.4
Ethnic background
Akan	3	23.1
Ewe	3	23.1
Dagomba	1	7.6
Konkonba	1	7.6
Guan	5	38.6
Place of residence
Rural	11	84.6
Urban	2	15.4

Awareness of sexual and reproductive healthcare services

This theme relates to the participants’ knowledge and understanding of available SRH services, including family planning, antenatal care, and postnatal services. While all participants were aware of these services, their awareness did not always translate into utilisation due to various barriers. The primary sources of information about SRH services were family members and partners, emphasising the role of informal networks in spreading SRH information.

An unmarried Deaf woman expressed her awareness of SHR services like this:

I know about antenatal, weighing and family planning services. All these services are provided at the clinic. But sometimes, some mothers [Traditional Birth Attendants] in the community attend to pregnant women till they deliver (Participant # 11)

Another woman said:

I have heard about family planning. My boyfriend told me about family planning. I went to the clinic but the method I was looking for was not available, so I came back home. (Participant #7)

Participants mainly received information about SRH services from family members and partners. Many mentioned their parents and/or partners as their source.

…My boyfriend was the one who told me about family planning. My mother also mentioned it to me. (Participant # 4)

When I first had my menstrual flow, my mother told me about family planning and took me to the hospital to have it done. She said ‘if a man touches me [a man having unprotected sex with her], I will get pregnant’. (Participant # 3).

Socio-economic barriers to accessing sexual and reproductive healthcare services

This theme encompasses the financial and economic challenges that hinder Deaf women from accessing SRH services.

Regarding family planning, an inability to afford services was a major obstacle, with many participants stating that the cost of contraceptives and other SRH-related services was high for them to afford. Aside from the five (5) participants who have never used contraceptives, the rest complained about the cost. Also, participants reported difficulty in affording essential SRH services, such as delivery items.

One participant noted:

Most of us are not working and do not have money, so I think the cost of the methods are expensive. If someone doesn’t have GHS 15 [USD 1] she cannot do it [Jadelle implant]. Even the injection [depo Provera] that is GHS 2 (USD 0.15), if you don’t have money, you cannot afford. (Participant # 3)

A mother recounted:

After I delivered my first son at the hospital, I decided not to deliver at the hospital again because I cannot afford the payments they demand for some of the delivery items such as delivery pads [maternity pads]. (Participant # 3)

The financial constraints reported by Deaf women in accessing SRH services are rooted in several socio-economic factors, including poverty arising from low-paid work, and the lack of social welfare support. Deaf women face significant barriers in accessing education and vocational training, which limits their employment opportunities.

The study revealed that Deaf women in Krachi West District do not receive adequate social welfare support to alleviate their financial difficulties. Although Ghana has social protection schemes, such as the Livelihood Empowerment Against Poverty (LEAP) initiative, these programmes often fail to reach marginalized groups, including PWDs. Participants did not mention receiving any form of social welfare or financial assistance specifically targeted at PWDs. This lack of support further compounds their financial challenges and limits their ability to access SRH services. These factors are interconnected and exacerbate the economic marginalization of Deaf women in the Krachi West District.

In the absence of formal social welfare support, many Deaf women rely on informal networks, such as family members, partners, or community members, for financial assistance. However, this dependence is often unreliable and insufficient to meet their SRH needs.

As illustrated by one participant:

…That one there is a problem. The GHS 15 [USD 1] I paid for the contraceptive [Jadelle implant] I am now using is expensive. If not that my boyfriend agreed to pay, I wouldn’t have been able to afford it. The reason why I got pregnant previously even though I was on an injection [Depo Provera-a contraceptive injection] was that, the time was due and I didn’t get the money to go and take the injection [Depo Provera] again. So, if something can be done about the money aspect, it would help. (Participant #5)

Due to the inability to afford SRH services, some participants faced unwanted pregnancies and unsafe abortions. It also led some participants to miss their next SRH appointments or stop using SRH services. Here are some comments from participants:

This pregnancy I am carrying now, I never wanted it. But because I did not get the money to do the family planning that’s why I became pregnant…. (Participants #3)

A woman who had an unsafe abortion narrated that:

When I got pregnant and my boyfriend said he was not ready for it, we went to the hospital to abort it and we were told to pay GHS 400 [USD 27]. My boyfriend said he cannot afford, so we came home and a friend gave me some medicine [herbal preparations] to drink which nearly killed me. (Participant # 2)

Health system barriers to accessing sexual and reproductive healthcare services

This theme highlights the systemic challenges within healthcare facilities that prevent Deaf women from accessing SRH services. Key issues include health workers' inability to understand sign language, insufficient health education materials in accessible formats, and stigmatization by healthcare providers.

Participants reported difficulties in communicating with healthcare workers, which often led to poor-quality care, therefore, underscoring the need for special provisions for them. An example of such a provision is a person who can understand their needs.

Participants said:

The health system has not made any provision for us as Deaf women. That is why they add us to those who can understand them when they speak. We expect that there should be someone trained specifically to understand us. (Participant # 2)

A major barrier to effective communication is the lack of sign language skills among healthcare providers. None of the participants reported meeting healthcare workers who could communicate in sign language. This communication gap often leads to misunderstandings, poor-quality care, and dissatisfaction among Deaf women.

…One of the main challenges we have is the inability to access care; when we go to the hospital no one understands us. When I got pregnant, I tried to attend hospital but when I went the first time, I could not communicate effectively with the nurse at the clinic so I was not satisfied with the care I was given…The main challenge is who to talk to in the health facility and how they can also understand us. (Participant #9)

In the hospital it is difficult to communicate with the health staff… (Participant # 5)

This shows that healthcare providers in Ghana are not adequately trained to address the needs of PWDs, including Deaf women. During their training, healthcare professionals receive little to no education on disability issues, sign language, or effective communication with patients who have hearing impairments. This lack of training leaves healthcare providers ill-equipped to handle the unique needs of Deaf women.

Additionally, another major concern raised by participants as a health service barrier was the unavailability of education materials in accessible formats, such as sign language videos or visual aids and information in the format they could understand. Most health education materials are designed for the general population and do not consider the needs of Deaf individuals. This further isolate Deaf women and limits their ability to make informed decisions about their SRH.

One of the participants mentioned that:

Apart from the information materials that are in pictures, the rest will be difficult to read by those who didn’t go to school. At least, there should be someone who can sign the sign language to educate us. When they are giving health education, they combine all of us including those who can hear and speak. (Participant #4)

Also, stigmatization and inappropriate attitudes by healthcare providers were highlighted. Some healthcare providers hold negative attitudes toward Deaf women, which further hinders effective communication. These attitudes may stem from a lack of understanding or awareness about disability issues. Participants reported being stigmatized and treated inappropriately by healthcare workers, which discouraged them from seeking care.

Participants said:

…And they stigmatize us. They make us feel like we are not fit to become pregnant or use contraceptives. When you visit the hospital, the nurses will be looking at you in a way that will make you feel bad. (Participant # 5)

…they laughed at me when I tried to tell them I was pregnant (Participant #9)

Community-level barriers to accessing sexual and reproductive healthcare services

This theme explores the social and cultural challenges faced by Deaf women in their communities, including stigma, lack of support, and exploitation. Most participants highlighted a lack of community assistance and stigma as community-level barriers. Some community members, particularly men, also exploited Deaf women rather than protecting them.

Sociocultural norms often portray PWDs as asexual or unfit for marriage, resulting in exclusion and ridicule.

A participant said:

The community doesn’t care about our sexual and reproductive lives. They see us as people who don’t deserve marriage. Anytime I mention my intentions to get married, I am laughed off. (Participant #2).

This quotation illustrates the pervasive societal belief that Deaf women are unable to fulfil traditional sexual roles such as marriage and childbearing. Such attitudes arise from deeply rooted stereotypes that view disability as a limitation to personal and social achievement. The laughter and ridicule described by the participant highlight the emotional toll of this discrimination, which can lead to social isolation and low self-esteem among Deaf women.

A Deaf woman who has six (6) children with six (6) different men also mentioned that:

All the men will pretend they like me; once they get me pregnant, they leave me even before I deliver the baby. They complain that they are not able to communicate with me. It hurts me a lot. (Participant # 13)

This shows the exploitation and vulnerability faced by Deaf women in intimate relationships. The men’s behavior reflects a lack of respect and commitment, rooted in the perception that Deaf women are less deserving of stable relationships.

According to several participants, most Deaf women are not able to discuss their SRH issues with their close relatives or friends because of the fear of being judged or misunderstood.

Participants had these remarks:

When I started dating my boyfriend, I could not tell my mum or any of my friends because my mum will insult me and my friends will laugh at me. My mum always tells me to concentrate on my disability (Participant # 4).

I remember when my first boyfriend visited me at home, my mother sacked him and shouted at him. Since then, I decided not to disclose anything that has to do with my relationship with her again (Participant #8).

Family attitudes can perpetuate the marginalization of Deaf women. This leads to isolation and discrimination.

Discussion

The study sought to explore Deaf women’s awareness of SRH services and the barriers they face in accessing these services in Ghana’s Krachi West District. The findings clearly indicate that the common misconception that women with disabilities are uninterested in issues regarding sexuality and reproduction is incorrect. Deaf women wish to be treated with dignity, akin to their hearing counterparts. However, they frequently face ill-treatment and stigma from both the community and the health facilities concerning SRH matters. Most of the participants who were not married but were in some form of relationship at the time of this study were unable to disclose their relationship status to their family or friends due to the fear of stigma.

All the participants were aware of the existing SRH services within the district, but their awareness did not translate into service usage. This may be due to numerous barriers that hinder the use of SRH service use by the Deaf women, such as socio-economic, institutional, and community-level constraints. Similar findings have been reported in a previous study conducted in Ghana [31], where most of the PWDs had a high awareness of SRH. Our findings are similar to those reported in a study conducted in Ethiopia among PWDs, which indicated that although more than half of the participants had heard of SRH services, only a few had ever utilised them [32]. 

Regarding socio-economic barriers, the inability of Deaf women to pay for SRH and related services is a significant obstacle that has denied most of the participants access. Most Deaf women refrain from utilising SRH services primarily due to financial constraints - a finding that aligns with the results of other studies conducted in Ghana [12, 33]. Generally, PWDs are the most economically marginalised, often among the poorest in society, and typically lack the financial means to cover their health and other essential needs [5, 8]. Consequently, many participants in our study relied on their relatives, friends, and partners to fund their SRH services. This finding aligns with an earlier study [34], where visually impaired individuals in Ghana largely depend on their family, friends, church members, and other benevolent members of society to pay for services accessed in health facilities. Many countries have various health insurance policies and programmes aimed at eliminating or reducing the impact of healthcare costs. In this regard, Ghana had launched the National Health Insurance Scheme (NHIS) and the “free maternal health care policy” in 2003 and 2008 respectively [35]. Yet some hidden charges imposed by facilities for various reasons, such as fees to cover inadequate resources, have undermined the purpose of these policies [36]. Considering the financial challenges faced by PWDs, the costs related to SRH delivery should be reviewed, and the packages provided to PWDs under the NHIS in Ghana need to be reconsidered. Providing adequate resources for use by the facilities is essential to avoid hidden charges, thereby eliminating the cost barrier to SRH access among PWDs.

One main challenge within the healthcare system is the limitation of access to mainstream SRH information [34]. This information is not presented in a format that participants can easily understand, especially sign language. This finding aligns with previous studies conducted in Ghana [12, 37]. Health education and information provided at many health facilities in Ghana gives little consideration to the communication gap between Deaf individuals and those without hearing impairments [20]. Also, the communication gap between healthcare staff and Deaf women serves as a major hindrance to utilising SRH services. Even when Deaf women do access SRH services, the quality of care they receive is poor since healthcare staff do not comprehend their SRH needs. Findings from previous studies conducted in Ghana mirror those reported in this study [16, 33, 37]. The communication gap is largely due to the limited knowledge of health professionals in using sign language [38]. A significant issue is that the training provided to health professionals in Ghana does not equip them with the necessary skills and competences to engage with some of these minority groups [38]. Besides the communication barrier identified as an obstacle within the healthcare system, the negative attitudes of health professionals towards Deaf women also emerged as a significant barrier. The study recorded instances of poor treatment directed at Deaf women by health professionals, which included stigma and unfavourable facial expressions suggesting that Deaf women were unwelcome at the health facility. This finding corroborates with those reported in previous studies that assessed service utilisation among PWDs [39, 40]. Such negative attitudes expressed by health professionals may stem from frustrations arising from difficulties in understanding Deaf women during communication [11], compounded by the lengthy hours healthcare workers often spend attending to Deaf patients. The perception that Deaf women, or women with disabilities, are asexual also contributes to these negative attitudes among health professionals [40], which hinders SRH utilisation among PWDs [12, 43]. This has led to the perpetuation of stigma and stereotypes surrounding Deaf women seeking SRH services. It is crucial that sensitisation and training be provided periodically to healthcare workers regarding these minority groups, ensuring that healthcare providers understand the needs of Deaf women without viewing them as a burden.

Community-level barriers exist that prevent Deaf women from accessing SRH services. It was found that a lack of family networks and community support, along with negative community attitudes and stigma, were major contributing factors to the access and utilisation of SRH services among the Deaf women. Insufficient community and family support networks were also identified in previous studies [11, 12, 39–41]. The community holds an asexual myth about Deaf women, perceiving them as individuals who should not engage in relationships or sex-related activities [40]. Moreover, in many cultures, discussions about SRH are considered taboo [18]. This results in little or no support from the community. Some of these misconceptions stem from inadequate orientation on disability issues and limited knowledge regarding the sex lives of Deaf women. Deaf women face stigma due to societal prejudices about disability and assumptions that they may not have SRH needs or rights [11]. Public education and sensitisation are required to dispel these misconceptions and raise awareness of the need to perceive Deaf women as normal people. Additionally, this study found that community members exploit Deaf women’s vulnerability and abuse them sexually. Similar findings have also been revealed in the literature [19, 42].

Policy implications

To address socio-economic barriers, particularly financial constraints, the cost of accessing SRH services for PWDs should be free and devoid of any hidden charges. This will ensure that PWDs, who are often economically challenged, can access SRH services. To tackle the health system barriers, it is recommended that health training institutions and health facilities incorporate practical studies and training on care delivery to people with special needs and disabilities. This will sensitise and give a clearer understanding of the needs of PWDs, which will positively influence healthcare workers’ attitudes towards PWDs. This training should include studying sign language more practically to gain communication skills with the Deaf. Also, in the short to medium term, the health system such as the Ghana Health Service should consider employing sign language interpreters to assist Deaf women who seek care in facilities. Combining provider training with interpreter services ensures continuity of care while accommodating linguistic and cultural diversity within the Deaf community. This dual approach balances immediate needs with long-term inclusivity goals and aligns with the broader strategy of strengthening healthcare accessibility for persons with disabilities.

To tackle community-level barriers, carefully planned engagement with communities and stakeholders that raises awareness and sensitises the public about the rights and needs of people with disabilities must be undertaken to help the public understand the rights and needs of PWDs, including Deaf women. Lastly, similar research should be conducted on a larger scale to involve a larger sample size and explore the perspective of other stakeholders so that a holistic understanding of the barriers that confront Deaf women in accessing sexual and reproductive health services can be developed.

Strengths and limitations

The study’s main strength is that it is the first to be conducted among Deaf women concerning their SRH experiences in the Krachi West District. It also contributes to the growing knowledge of Deaf women and women with disabilities. The qualitative method employed has helped uncover the experiences of Deaf women on SRH services. Some limitations need to be acknowledged. The results of this study were based on only 13 participants. Hence, the findings cannot be generalised to all Deaf women. The accounts of participants may be influenced by the interpreters. The study also did not consider the perspectives of healthcare providers; therefore, there may be some bias regarding the reported health service barriers. Lastly, recall bias is highly probable since data collection primarily comprised participants’ lived experiences concerning their reproductive history.

Conclusion

We found that all participants were aware of SRH services. It highlighted the socio-economic, health system, and community-level barriers, such as inability to pay, communication gaps, negative attitudes of healthcare workers, and lack of community support, that hinder Deaf women from accessing SRH services. The findings call for the health system to reorient itself to accommodate PWDs, like the Deaf women. Additionally, there is a need for public education and sensitisation to raise awareness of the SRH needs of PWDs for family and community support.

Authors’ contributions

JKA conceived and designed the study, led the fieldwork and data analysis and drafted the initial manuscript. GE and RGA drafted, edited, and revised the manuscript. JKG supervised the research and revised the manuscript. All authors read the final version of the manuscript and approved it for submission and publication.

Funding

The study received no external funding.

Data availability

The dataset used in this study (transcripts, codes, and themes) is available from the corresponding author on request.

Declarations

Consent for publication

All participants consented to their responses to questions asked during the data collection for this research to be published anonymously. All authors have also consented to the publication of this manuscript.

Competing interests

The authors declare no competing interests.