“We don’t see a future in them…” barriers to accessing sexual and reproductive health information and services among young people with disabilities in Kyotera border district

Abstract

Background

Young people with disabilities (YPWD) face numerous challenges in accessing sexual and reproductive health information (SRH) and services, including stigma and discrimination related to their disability. Consequently, many YPWD are reluctant to seek health care and have a high unmet need for SRH services. This study set out to explore the barriers to accessing Sexual and Reproductive health information and services among young people with disabilities in a Ugandan border context - known for high rates of early sexual initiation. The findings aimed to contribute insights that support the development of inclusive healthcare policies aligned with the SDG commitments to leave no one behind.

Methodology

We conducted a qualitative study among 12 male and female YPWD (aged between 10 and 24 years) with physical disabilities and 7 key Informants in Kyotera border district. Data were collected through In-Depth Interviews and Key Informant Interviews. Thematic analysis was conducted on transcripts.

Results

This study identified three key thematic barriers to young people with disabilities in accessing sexual and reproductive health information and services: individual, community, and health facility barriers. Individual barriers included Limited awareness about the availability of SRH information and services and low self-esteem. Community barriers were beliefs and practices, while health facility barriers reported by YPWD were communication challenges, shortages of commodities, and negative provider attitudes.

Conclusion

The intricate challenges confronted by young people with disabilities in accessing sexual and reproductive healthcare in Kyotera underscore the urgent requirement for comprehensive interventions, spanning various levels, to dismantle these multifaceted barriers and establish a more inclusive and accessible SRH environment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-25008-w.

Background

Disability is described as a long-term impairment whether physical, mental, intellectual, or sensory that can either be congenital or acquired throughout a person’s life, significantly impeding an individual’s ability to participate in society on equal terms with others [1]. The World Health Organization (WHO) further describes disability in three dimensions: first, impairments that affect an individual’s physical and mental functions; second, limitations in activities, including basic tasks such as walking, hearing, and seeing; and third, restrictions on participation in everyday life, encompassing working, engaging in social and recreational activities, and accessing healthcare and preventive services [2].

Globally, an estimated 1.3 billion people are living with some form of disability [2], and between 180 and 200 million of them are aged 10 to 24 year [2]. Over 80% of these individuals reside in low- and middle-income countries (LMICs), where a majority live below the poverty line [3]. These individuals, particularly young people with disabilities (YPWD), often face significant barriers to accessing essential services, including sexual and reproductive health (SRH) services [4]. The United Nations’ Convention on the Rights of Persons with Disabilities mandates that people with disabilities enjoy equal rights, including the right to access SRH services [5]. However, despite this international mandate, YPWD continue to face immense challenges in accessing SRH services globally [6–8].

In Africa, studies show that the barriers to SRH service access for YPWD are particularly acute, given the region’s limited health infrastructure, cultural stigma, and insufficient policy implementation [8, 9]. Although initiatives such as the Maputo Plan of Action [10], aim to improve access to SRH services for all, including people with disabilities, the realities on the ground remain stark. In many African countries, including Uganda, persons with disabilities often find themselves excluded from mainstream SRH interventions, further entrenching their marginalization [11–13].

In Sub-Saharan Africa, where rates of unmet SRH needs are among the highest in the world, YPWD face compounded difficulties [8, 9]. The region is grappling with high levels of stigma, discrimination, and a lack of tailored SRH services for individuals with disabilities [14, 15]. These factors create an environment where YPWD are not only excluded from SRH services but also face heightened risks of SRH-related issues, including unintended pregnancies, sexually transmitted infections (STIs), and gender-based violence [9, 16].

Access to sexual and reproductive health services among YPWD in Uganda

According to the 2024 National Population and Housing Census, about 21% of persons with disabilities reported multiple functional difficulties [17]. Among Ugandan adolescents with disabilities aged 10–19 years, the most commonly reported functional difficulties were seeing (1.1%), remembering (1.2%), walking (1.2%), hearing (1.2%), and speech (0.6%) [17].

Uganda has several national commitments and policies aimed at providing inclusive SRH services to people with disabilities in Uganda. These include the National Council on Disability Act 2003the 2006 Disability Act; the 2006 Equal Opportunities Commission Act 2006, and the 2006 National Policy on Disability [18],. However, access to SRH services for YPWDs remains limited. YPWDs face societal stigma, cultural myths, and a lack of awareness regarding the rights of persons with disabilities, restricting their participation in socio-economic development [19].

In addition to legal and social barriers, structural and attitudinal challenges further hinder access to SRH services. Young people with disabilities have equal needs for sexual and reproductive health services and information as their peers without disabilities, including access to family planning and safe childbirth. However, widespread misconceptions such as the belief that persons with disabilities are not sexually active have contributed to a lack of attention to their SRH needs. These assumptions often lead to the exclusion of young persons with disabilities from health services and programming, further reinforcing inequality in access [17].

Reinforcing these observations, a qualitative study conducted among people with physical disabilities in Kampala, Uganda revealed that negative attitudes of service providers, long queues at health facilities, distant health facilities, high costs of services involved, unfriendly physical structures and the perception from able-bodied people that PWPDs should be asexual as barriers to use of SRH services and information [19].

Another study conducted among young women with disabilities and access to HIV/AIDS interventions in Uganda revealed that widespread misconceptions about the sexual behavior of young women with disabilities, along with their exposure to violence and exclusion from health services and promotion activities, make young women with disabilities especially more vulnerable to HIV and hinder the full realization of their sexual and reproductive health rights [20].

According to the Uganda Functional Difficulties Survey [18], there is limited data on the utilization of sexual and reproductive health services by young people with disabilities in Uganda. To address this gap, an understanding of the factors affecting access to SRH information and services for YPWD is urgently needed. This study investigates the barriers to accessing SRH information and services among YPWD in Kyotera District.

Kyotera District, located along Uganda’s southern border with Tanzania, is characterized by high mobility, diverse populations, and elevated HIV prevalence (13%). The district’s key locations Mutukula, a major border crossing, and Kasensero, a prominent landing site are hubs for truck drivers, fisherfolk, cross-border traders, and sex workers. These dynamics contribute to a complex SRH risk environment, especially for vulnerable groups like young people with disabilities, who may face compounded risks such as limited access to services, exposure to transactional sex, and heightened susceptibility to STIs. This unique context informed the selection of Kyotera as the study site.

Methods

Study design and setting

A qualitative research design was used to gain a deeper understanding of the barriers to accessing sexual and reproductive health information and services among young people with disabilities. The study was conducted in Kyotera border District, located in central Uganda. Data collection was conducted between 4th and 18th May, 2023.

Kyotera district comprises a rural population of 197,300 and an urban population of 73,800, summing up to a total population of 246,100 [21]. The predominant ethnic groups in Kyotera are Baganda, Banyarwanda, Bahima and Banyankole. The study was conducted in Mutukula and Kasensero Town councils. Kyotera District’s southern boundaries are part of the international boundary between Uganda and Tanzania where there is Mutukula, a one stop border and Kasensero, a landing site. Mutukula and Kasensero host a diverse population, including truck drivers, fisher men, transporters, cross-border traders, sex workers, border officials, border town residents, and tourists/visitors. This diversity contributes to a complex socio-economic landscape, characterized by heightened risks for poor Sexual and Reproductive Health outcomes. The transient nature of these populations, driven by cross-border trade and mobility, exacerbates these challenges [22–24].

Living in border areas presents distinctive economic and social hurdles, such as severe poverty and family separation, with parents often working in neighboring countries [22, 23]. Consequently, many adolescents in these communities resort to high-risk occupations like vending and cross-border trading [22, 23]. These circumstances expose them to various vulnerabilities, including engagement in transactional sex, having multiple sexual partners, and increased susceptibility to HIV infection. Furthermore, the first HIV case in Uganda was reported in Kyotera (curved out from Rakai district); the district has continued to experience high HIV prevalence rates at 13% compared to the national average of 6.2% [25]. Kyotera district has transitioned and the first victims’ children and grandchildren are now the parents of adolescents [25].

Study population

The study population comprised of male and female young people with physical disabilities (aged between 10 and 24 years), and key informants who deal/work with YPWD. The study adhered to the World Health Organization’s definition of young people, encompassing individuals aged 10–24 years old [26]. The key informants included Community leaders, health workers and Non-Governmental Organizations. Young people (either a boy or girl) living either with their biological parent(s) or a guardian/caretaker were eligible for interview.

Prior to data collection, the research team consulted the National Union of Disabled Persons of Uganda (NUDIPU) for guidance on how best to identify young people with disabilities in border communities. Based on their advice, a household listing was conducted in December 2022 in collaboration with Local Council (LC1) leaders and community guides in Mutukula and Kasensero. These local leaders, who were familiar with their communities, helped identify households with young people living with physical disabilities. During the listing exercise, disability status was confirmed by the caregivers and/or the young people themselves, based on self-reported or observable functional difficulties such as difficulty walking, hearing, seeing, or speaking, rather than on a formal medical diagnosis. Through this process, 30 young people with disabilities were initially identified; however, by the time of data collection in May 2023, the number reduced to 12 due to mobility (some relocating to other places) and others returning to school in Tanzania. Hence, 12 YPWD were ultimately selected and interviewed.

Data collection

In-Depth Interviews (IDIs) and Key Informant Interviews (KIIs) were the methods used for qualitative data collection. Twelve In-Depth Interviews (IDIs) were conducted among YPWD. IDIs were used to delve deeply into the individual experiences and perspectives of young people with disabilities in Kyotera border district, shedding light on the barriers they face in accessing sexual and reproductive health information and services and the sexual behaviors of YPWD. The IDI guide was translated to Luganda the most dominant Language in Kyotera district. Given the sensitivity of this topic and cultural traditions in the study context, participants were interviewed by an interviewer of the same sex.

The IDI guide explored several key areas, including the participant’s personal information, their knowledge and attitudes toward sexual and reproductive health services, access to SRH services for YPWD, and barriers to SRH information and services. This IDI guide answered the three specific objectives of this study.

Seven Key informant interviews were conducted (4 in Mutukula and 3 Kasensero). Key informants for this study comprised community/LC1 leaders, health workers, and a representative from non-governmental organizations (NGOs). The KIIs were conducted in English using a semi-structured interview guide. The duration of the interviews ranged between 40 and 60 min.

The KII guide focused on topics such as the participant’s personal background, barriers to SRH information and services, sexual activity among YPWD, sexual violence, and programming and governance. This guide also answered the three specific objectives of this study: The involvement of key informants, such as health workers, local leaders, and individuals working with disability organizations, was essential in addressing these objectives.

Quality control and assurance

We recruited competent interviewers who had experience in working with children and could speak the local language-Luganda. A two-day training of interviewers was conducted to ensure detailed understanding of objectives, process, and output requirements. Debriefs were always held between PN AND LWO. The tools were translated from English to Luganda by a language professional and back translated to English to ensure conceptual equivalence and cultural sensitivity. Pretesting of the tools was done at Kasenyi Landing Site, Entebbe among population groups similar to the study population before collection of data. Furthermore, interviews were audio recorded, we used careful probing, and interviewed up to data saturation to ensure dependability.

Data management and analysis

After completing fieldwork, interview audio recordings were transcribed and subsequently translated into English, with handwritten notes used to supplement any information gaps in the transcripts. All data including audio files, transcripts, field notes, and consent forms were securely stored in password-protected folders on encrypted devices accessible only to authorized members of the research team. Physical notes were kept in a locked cabinet at the Department of Population Studies, Makerere University. Access to all data was restricted to the core research team members (LWO, PN, and BK) to ensure confidentiality and data protection.

Thematic analysis [4] was conducted using an inductive approach, where two team members (LWO & PN) thoroughly reviewed the transcripts to familiarize themselves with the data. Initial codes, relevant to the study objectives, were annotated on the transcripts, forming the basis of the initial coding frame. The research team collectively discussed and agreed upon the codebook. The identified themes and sub-themes were then entered into ATLAS.ti23 to facilitate data analysis. Both researchers (LWO & PN) independently coded the transcripts, meeting regularly to ensure consistency. Any discrepancies were resolved through discussion and input from other team members. New codes were incorporated as they emerged, and analysis continued until no further new codes were identified.

Results

Socio-economic and demographic characteristics of YPWD and key informants in Kyotera border district

The distribution of participants’ characteristics is shown in Table 1. The results show that most of our participants were male (67%), aged between 10 and 14 years (42%). Majority (83%) had attained some primary education and (83%) were single. Seven in ten were still in school. Most (58%) had mobility impairments. Most (71%) Key Informants were male, almost all above 30 years of age. Regarding education, 57% had certificate or diploma. The Key informants included health workers (57%), community/LC1 leaders (29%).

Table 1.

Background characteristics of YPWDs and KIIs

Characteristics	YPWDs N (%)	KIIs N (%)
Location
Mutukula	8 (67)	4 (57)
Kasensero	4 (33)	3 (43)
Gender
Male	8 (67)	5 (71)
Female	4 (33)	2 (28)
Age
10-14	5 (42)
15-19	4 (33)
20-24	3 (25)
25-29		1 (14)
30-39		1 (14)
40-49		3 (43)
50-59		2 (29)
Physical disability type
Mobility impairment	7 (58)
Hearing impairment	3 (25)
Visual impairment	2 (17)
Marital Status
Single	10 (83)	1 (14)
Married	2 (17)	6 (86)
Religion
Catholic	7 (58)	4 (57)
Muslim	1 (8)	2 (29)
Pentecostal	3 (25)	1 (14)
Anglican	1 (8)	0 (0)
Education level
Nursery	1 (8)
Primary	10 (83)	2 (29)
Secondary	1 (8)	1 (14)
Certificate/diploma	0 (0)	4 (57)
Occupation
Service	3 (25)
Fishing	2 (17)
Student	7 (58)
Community/LC1 leaders		2 (29)
NGO/CBO		1 (14)
Health worker		4 (57)

Barriers to accessing sexual and reproductive health information and services among young people with disabilities

The emerging themes revealed three distinct levels of barriers: individual, community and health system-level barriers.

a. Individual level barriers

The individual level barriers that hindered young people with disabilities (YPWD) to access SRH information and services included: Limited awareness about the availability of SRH information and services and low self-esteem.

Limited awareness about the availability of SRH information and services

Owing to busy schedules such as fishing-related work, leaves YPWD uninformed about any SRH programs or information in the community. Their limited understanding of SRH topics acts as a barrier, hindering their ability to actively seek essential healthcare services and make informed decisions regarding their reproductive well-being.

“Sometimes I am not aware of what is happening because we rarely get that information this side of the lake”- (IDI, Male, 16 years, Kasensero).

Often information about SRH services is obtained from health services. However, YPWD especially those from hard-to-reach areas and those with mobility impairment reported challenges related to long distances to the health facilities. This challenge was particularly pronounced in Mutukula town council, where the government health centers are situated farthest from residential areas, often necessitating transportation using a “boda bodas” (commercial motorcycle). This was a serious challenge for YPWD with mobility impairments, as they needed resources to pay for the transportation.

“I may want a service but then I delay to get it because I don’t have money for transport and yet I cannot walk because it is a long distance”- (IDI, Male, 18 years, Mutukula).

“… I talked about distance when coming from home to the health facility, it is very difficult because they have to use boda bodas [motor cycle] to bring them which sometimes causes other complications to them and they can’t move for a long distance”- (KI, Health worker, Mutukula HCIII).

Study findings revealed lower education levels among YPWD. Some informants reported that YPWD have lower education levels compared to their able-bodied counterparts. Low education levels were attributed to the unwillingness to invest in the education of YPWD.

“…their level of education is very low, you find that few of them can study up to secondary level, and no one teaches them about SRH issues, so this limits their understanding of SRH”- (KI, Health worker, Kasensero).

Low self esteem

The results indicated that many young people with disabilities were hesitant to initiate SRH discussions. Feelings of embarrassment also emerged as a significant barrier, preventing YPWD from accessing the necessary services. For instance, one participant expressed difficulty in finding a trust worthy person to talk to about sexual and reproductive health issues.

“…you can’t just go to your friend and ask them to tell you about SRH issues and I don’t have anyone who I can talk to about SRH issues any time I want”- (IDI, Male, 20 years, Mutukula).

Another participant highlighted feelings of discomfort when interacting with peers without disabilities.

‘It is obvious that when you are with them [persons without disabilities], you can’t be feeling good because for them, they don’t have any disability”- (IDI, Male, 14 years, Mutukula).

b. Community level barriers

Beliefs and practices were identified as significant barriers faced by young people with disabilities in the community.

Beliefs and practices

The most commonly voiced barrier to accessing SRH services among YPWD was the prevailing beliefs and practices in the community. One key informant explained that many community members hold misconceptions about YPWD, such as assuming they are not sexually active, which discourages some YPWD from openly discussing SRH issues and results in the denial of essential SRH services.

“…those people (YPWD) are treated as people of low class and because of this, some people can’t imagine if there’s anyone interested in them, they usually ask themselves, who can date a PWD?”- (KI, NGO, Kasensero).

Some young people with disabilities are reluctant to seek sexual and reproductive health information from their parents or friends due to fears of being judged or discriminated against. They expressed concerns that discussing SRH topics might lead to negative reactions from parents.

“I fear, they [parents] may say am spoilt when I ask about SRH issues, and they may start discriminating me because they don’t expect me to talk about SRH”- (IDI, Male, 14 years, Mutukula).

I fear, she (mother) may beat me, she said we are still young and they told us never to disrespect our parents. (IDI, 10 years, Female, Mutukula).

I fear my parents and I don’t usually see the health workers. (IDI, Male, 20 years, Mutukula).

Some informants noted a similarity in cultural beliefs between Mutukula, Kasensero, and neighboring Tanzania, as they share borders. One prevalent belief is that engaging in sexual intercourse with a person with a disability can lead to healing of chronic diseases such as HIV/AIDS or increased wealth. Consequently, this misconception has resulted in some PWDs contracting sexually transmitted infections (STIs) like HIV/AIDS. As such, parents restrict movements of children with disabilities. This not only limits their interaction with peers but also hinders access to health services. This hinders them from socializing with non-disabled children and seeking health services.

“…if you use those people (YPWD) sexually, it’s believed that you’ll get better and even become richer. This belief has led some individuals to even sacrifice those with disabilities for their own prosperity”- (KII, Health worker, Kasensero).

Additionally, another key informant highlighted that boys with disabilities often face more stigma than girls with disabilities when it comes to perceptions of future relationships or family roles. In some communities, girls with disabilities are viewed as more likely to be supported by a partner, whereas boys with disabilities are perceived as unable to provide for a family. This gendered perception contributes to negative assumptions about the sexual roles and capabilities of boys with disabilities.

“… girls undermine boys living with disability imagining they are up to no good, they can’t provide for a home but for girls with disability, a man can work for her than a boy”- (KI, Health worker, Mutukula).

Furthermore, some key informants reported that YPWD who live with care takers or no-relatives rarely discuss SRH issues because they are not free with them. They are excluded from SRH education and advice since they are considered asexual and ineligible for marriage.

“…some do not live with their biological parents. Their caretaker cannot perform the same role as a biological parent. They are not bothered to engage in SRH discussions with such a child because they don’t see a future in them”- (KI, Health worker, Kasensero).

c. Health facility level barriers

The health facility level barriers reported by YPWD were communication challenges, shortages of commodities, and negative provider attitudes.

Communication challenges

One female young person with disabilities shared that communication difficulties pose a significant barrier to accessing sexual and reproductive health services especially for those with speech and hearing impairments. She noted that the absence of sign language experts at health facilities complicates interactions.

“I always fail to communicate with the health worker because she does not know sign language and no one else does”- (IDI, Female, 20 years, Mutukula).

One informant also affirmed that most health centers did not have sign language experts to support YPWD with hearing impairments.

“We don’t have a PWD-focal person at the health facility. We (YPWD) cannot get specialized health care”- (KI, NGO, Kasensero).

Shortage of commodities

The findings revealed that young people with disabilities (YPWD) face a significant challenge due to the frequent shortages of essential commodities such as contraceptives in government hospitals. YPWD reported that when they sought SRH care from government health centers, they were often redirected to clinics where the required medications were also unavailable. This situation worsens their struggle to access appropriate SRH services, creating additional barriers to effective care.

“Sometimes you may not find their medicine and you just come back home. If the medication is not there, they just write on a note sometimes to go and you buy them”- (IDI, female, 16 years, Mutukula).

“I rarely go there since they (health facilities) have few health workers and no medication, so am not sure if it’s (SRH Services) there maybe if they offer them to pregnant women” -(IDI, male, 22 years, Mutukula).

“Since we got used that government hospitals don’t have medicine, we just go to the clinics and buy”- (IDI, male, 13 years, Mutukula).

One informant revealed that commodity shortages in government health facilities are a significant challenge for young people with disabilities, making it difficult to access medication even when they fall ill due to frequent stockouts.

“… commodities are hard to get since government hospitals don’t have medicine so when they go there, they just send them to the clinics so you find they don’t get medication as it would be or as needed so that’s a big problem”- (KI, LC1, Mutukula).

Negative provider attitude

Young People with Disabilities reported that they encounter discrimination while waiting in queues to receive services. Some YPWD reported lack of sensitivity and discrimination on the part of health workers.

“There is a time I went to the hospital and I had to be in a long line, but due to my disability I couldn’t line up with others so I just left without medication”- (IDI, Male, 18 years, Mutukula).

“…sometimes they (health workers) may first want to work on the able-bodied ones and first put you aside yet you came earlier than them; because they see you are disabled. You be having nothing to do because you need services.”- (IDI, Female, 20 years, Mutukula).

Discussion

The study explored barriers to accessing Sexual and Reproductive Health information and services among young people with disabilities in Mutukula and Kasensero, Uganda. The findings revealed individual, community, and health facility barriers that hinder YPWD from accessing SRH services. These barriers are consistent with those identified in the literature, although some unique challenges emerged that are specific to the geographical and cultural context of the study areas.

One of the significant individual barriers identified was limited awareness about the availability of SRH information and services. YPWD reported not being informed about SRH programs due to their busy schedules, especially those involved in activities like fishing. This finding aligns with Kakchapati et al. [27], who found that a lack of awareness among people with disabilities significantly limits their access to essential SRH services. In both studies, the lack of information prevents YPWD from making informed decisions about their reproductive health, with those in hard-to-reach areas being disproportionately affected.

Similarly, a cross-sectional study conducted in China to assess knowledge levels and access barriers related to sexual and reproductive health information among youth with disabilities found that respondents had poor knowledge of SRH and limited access to related information, particularly those from rural areas [28]. These findings underscore how geographical location, coupled with disability status, compounds informational inequality. In both studies, lack of SRH awareness emerged as a critical barrier that prevents youth with disabilities from making informed decisions about their reproductive health. This points to a need for targeted interventions especially for youth in remote or underserved communities aimed at improving SRH knowledge and ensuring equitable access to information and services.

Another individual barrier identified was low self-esteem among YPWD, which hindered their ability to engage in SRH discussions or seek services. This is consistent with findings from Mathabela and Madiba [4], who reported that persons with disabilities often experience social stigma and feelings of embarrassment when discussing sexual and reproductive health matters. These feelings are exacerbated by the negative attitudes they encounter in their communities, further reducing their confidence in accessing SRH services. The current study’s findings also showed that YPWD had difficulty finding trustworthy individuals with whom they could discuss SRH issues, which resonates with Pocock et al. [29], who highlighted the importance of trust and support systems in facilitating access to SRH services among young people.

At the community level, cultural beliefs and practices were found to play a significant role in limiting access to SRH services for YPWD. For example, some community members believed that YPWD are asexual or incapable of engaging in sexual activity, which mirrors the findings of Seidu et al. [30], who reported that widespread misconceptions about the sexuality of persons with disabilities lead to their exclusion from SRH programs. The belief that sexual relations with a person with a disability can cure chronic illnesses such as HIV/AIDS, as identified in the current study, adds a layer of complexity.

In addition to these barriers, it is important to highlight the heightened vulnerability of young persons with disabilities to sexual violence and exploitation. Such protection concerns severely impact their sexual and reproductive health rights and access [7]. Studies in Uganda and other settings have documented that persons with disabilities face increased risks of sexual assault and abuse, which can create fear and trauma that deter them from seeking needed SRH services [31, 32]. Addressing these risks through targeted protection measures, community engagement, and rights-based education initiatives is crucial to safeguarding their rights, shifting harmful social norms, and improving SRH outcomes.

Additionally, parental attitudes and fear of judgment were identified as significant barriers, particularly among younger participants. Some YPWD expressed concerns that discussing SRH issues with their parents might lead to accusations of being “spoilt” or facing discrimination, a barrier that has been documented by Kumi-Kyereme [8]. In their study, parental resistance to discussing SRH topics with children, particularly those with disabilities, was identified as a major obstacle to SRH education and access.

At the health system level, communication challenges were a significant barrier, particularly for YPWD with hearing impairments. The absence of sign language interpreters at health facilities made it difficult for them to communicate with healthcare providers, a challenge that has been similarly identified by Matin et al. [33]. Their study reported that the lack of trained personnel and specialized services for persons with disabilities contributes to poor health outcomes. In the current study, participants emphasized the lack of a disability focal person in health facilities, which compounded these communication barriers.

Furthermore, negative attitude from health providers was another health system barrier reported by participants. These findings agree with the work of Mathabela and Madiba [4] and Kakchapati et al. [27], who documented the maltreatment of YPWD by healthcare workers, including verbal abuse, discrimination, and communication challenges. Such negative experiences create a hostile environment that discourages YPWD from seeking the SRH services they need. Additionally, shortages of essential SRH commodities such as contraceptives were another health facility barrier reported by participants. This finding echoes the results of Kuumuori et al. [9], who found that stockouts of SRH commodities in government health facilities are a common issue in low-resource settings, exacerbating the difficulties faced by marginalized populations such as YPWD.

While the barriers identified in this study are consistent with much of the existing literature, a unique aspect of the findings was the influence of local beliefs, particularly the misconception that engaging in sexual relations with YPWD can cure diseases. Such myths not only perpetuate sexual exploitation and violence but also expose gaps in legal protection and accountability. In Uganda, sexual violence is criminalized under the Penal Code Act, and although additional reforms such as the Sexual Offences Bill (2021) have been proposed, enforcement remains weak and cases are often met with impunity. This underscores the need for culturally sensitive interventions that are complemented by strengthened legal and policy measures to protect the rights and bodily autonomy of YPWD. Although similar beliefs have been reported in other African settings, the prevalence of this belief in the study area highlights the need for culturally sensitive interventions. The findings also revealed a gap in SRH education due to low education levels among YPWD where only one YPWD had attained secondary education, a theme also discussed by Kuumuori et al. [9], who noted that lower education levels limit the ability of individuals with disabilities to access and understand SRH information.

To address these multifaceted barriers, evidence from other low-resource settings suggests that multisectoral interventions are effective. These include training healthcare workers in disability-inclusive and sensitive care, integrating sign language interpreters within health services, and establishing peer support networks to enhance trust and information-sharing among young persons with disabilities [7]. Additionally, inclusive education programs and leveraging accessible digital platforms can improve dissemination of SRH information. Adapting such strategies to the specific socio-cultural context of Kyotera could help overcome the informational and attitudinal barriers identified in this study.

Study limitation

While our study offers valuable insights into the barriers faced by young people with disabilities in accessing sexual and reproductive health information and services in Kyotera border district, there are several limitations to consider. Firstly, the small sample size of participants affects the generalizability of findings to other settings, but we believe that most of our findings apply to other contexts, particularly those in other border areas.

Another issue was that some households that were selected during the household listing prior to the data collection, had members including some YPWD who had relocated, others had returned to school in neighboring Tanzania, which affected our planned sample size and could have influenced our study’s outcomes.

Conclusion

This study highlights the significant barriers that young people with disabilities face in accessing sexual and reproductive health information and services. The findings reveal an interplay of individual, community, and health facility level barriers that collectively hinder YPWD from receiving essential care. Individual barriers such as limited awareness about the availability of SRH information and services and low self-esteem hinder YPWD ability to seek and utilize SRH services effectively. Community barriers such as beliefs and practices create additional challenges, preventing open discussions and support from families and peers.

Furthermore, health facility barriers, including communication challenges, shortages of commodities, and negative provider attitudes, worsen the difficulties YPWD encounter within healthcare settings. Addressing these barriers is crucial for improving SRH access among YPWD, empowering them to make informed decisions regarding their sexual and reproductive health.

Abbreviations

AIDS

Acquired immunodeficiency syndrome

AU

African union

CECAP

Consolidating early career academic program

CRPD

Convention on the rights of persons with disability

FGDs

Focus group discussions

HIV

Human immunodeficiency virus

ICPD

International conference on population and development

IDIs

In-depth interviews

KIIs

Key informant interviews

LMICs

Low- and middle-income countries

MOHCDGEC

Ministry of health, community development, gender, elderly, and children

NAC

National council for disability

PAC

Parent-adolescent communication

PWDs

Persons with disabilities

SEM

Socio-ecological model

SRH

Sexual and Reproductive Health

SSA

Sub-saharan Africa

STIs

Sexually transmitted infections

TASO

The aids support organization

UBOS

Uganda bureau of statistics

UDHS

Uganda demographic and health surveys

UN

United nations

UNCST

Uganda national council for science and technology

UNFPA

United nations population fund

UNICEF

United nations international children’s emergency fund

WHO

World health organization

WWD

Women with disability

YPWD

Young people with disabilities

Authors’ contributions

LWO, PN, and BK conceptualized the study, developed study tools, and conducted data collection. LWO conducted methodology development, Literature review, analysis and drafted the manuscript. PN and BK provided Supervision to LWO and edited the manuscript.

Funding

The study was funded by Makerere University and the Carnegie Corporation through the Makerere University Carnegie – Supporting Early Career Academic (SECA) Program.

Data availability

The data that support the findings of this study are available from the corresponding author upon request.

Declarations

Ethics approval and consent to participate

Ethical approval was obtained from the TASO Research and Ethics Committee (TASO-REC), (Registration Number TASO-2022-161) and the study was registered by the Uganda National Council of Science and Technology (UNCST). Additional authorization to conduct this study was obtained from Kyotera district Local government (Specifically the CAOs office) and community leaders before approaching the individual participants. The study was conducted in accordance with the Declaration of Helsinki and followed all applicable national ethical standards for research involving human participants.

Given the sensitivity of the topic and the vulnerable nature of the participants, a thorough and age-appropriate consent process was implemented. All participants were informed about the purpose of the study, the voluntary nature of their participation, and their right to withdraw at any time without any consequences. For adolescents below 18 years of age, written informed consent was obtained from a parent or legal guardian, and written assent was obtained from the adolescent. Adolescents aged 18 years and above provided their own written informed consent.

To ensure privacy and confidentiality, interviews were conducted in secure and agreed-upon locations. Participants were assured that no identifying information would be disclosed and that their responses would not be shared with parents or guardians. Participants were also informed they could skip any question or end the interview at any point without any repercussions.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.