Sexual and reproductive health services are often inaccessible to women with disabilities for many reasons, including attitudes from health providers and a lack of physical access. In this story, a woman with disability talks about her experience giving birth and how it drives her activism today.
“No, no, no! We don’t want to take care of her!” These were the words that Coumba Ndiaye, from Dakar, Senegal, heard repeatedly when she sought care to deliver her baby. She approached four health centres, but all refused her, saying her disability (related to polio as a child) would make the delivery “too complicated.”
She was finally referred to a hospital. But when she arrived there, a midwife abruptly told her, without examining her, that she would be taken to the operating room for a caesarean section. The midwife, Coumba said, had made her decision by looking at her disability. “She saw my disability and automatically for her… disability means surgery. I was afraid,” she said.
But behind the midwife, a voice assured her: “Wait for me! I’m going to help you give birth in a regular way.” It was a respectful health worker, who later helped Coumba get onto the delivery bed with a bench and then assisted her to have a vaginal birth, like most other mothers in the hospital.
Roughly around an hour after the birth, a nurse came to move her to the resting room, but did not help her off the bed. Coumba fell and started haemorrhaging. She fainted. Two days later, she woke up in a resuscitation room. “The baby was doing very well. But me? I had a haemorrhage. I didn’t know where I was,” she said.
Coumba, who was then just 22 years old, was later told by the head midwife not to have another child. “At that moment, I cried,” she recalled, with a sigh.
Fighting for women with disability today
Today, 22 years later, Coumba is an activist and city councillor in Pikine, a Dakar suburb, striving for disability inclusion. As president of the municipality’s commission for education, training and local languages, she ensures that children with disabilities study and have appropriate learning materials. As part of the municipality’s inter-commission, she ensures disability is taken into account in its other commissions, including health and the living environment, and also advises on the care of women with disability.
Access to education was an issue for her when young. As a teenager, she had to walk holding her leg for more than one hour to reach her high school. “There was no bus. I didn’t have crutches or a prosthesis. I was limping, I was holding my leg to not feel the pain,” she recalled.
“I lived through many experiences and that’s why I’m confident today. I can fight for disabled women. I also know that I can talk with the authorities,” she said, adding she engages with women’s groups, the association of Senegalese midwives, female lawyers and community groups.
Coumba is an activist and municipal councillor today fighting for disability inclusion. Photo credit: Sightsavers/Sidy Camara
Her birth experience still drives her activism today. She raises the situation of disabled women giving birth when she can, and sometimes helps individual women with disabilities on a personal capacity. “[If] someone calls me for the delivery of a pregnant disabled woman, I go to her home to offer my help for free,” she said.
In her previous work with a disability organization, she encountered many other women who had experiences similar to hers. “A woman in a wheelchair can’t climb [onto] a delivery bed for the prenatal medical visit. All these issues make women [with disability] scared to marry someone and get pregnant,” she said.
“See the person, not the disability”
Although inclusivity is progressing in Senegal, there was still a need for change “from the bottom to the top of society” she said. She called for a goal to provide access to health centres to all people with disabilities, without them having to face problems. “Disabled people are afraid to go to the hospital. If they get sick, they stay at home, they take medicine bought in the street. We must make the hospital accessible.”
She believes health workers need better training on how to provide equitable and respectful health services for people with disabilities. “Hopefully, the way they look at people with disabilities will change. It’s necessary to see the person, not the disability,” she said, adding communication with people with disabilities was very important.
“Step by step, society will include people with disabilities. My dream is to make all delivery rooms accessible to disabled women… [and] have medical staff both skilled and kind. When the delivery room will be available for disabled women, I would say that I have reached my goal.”
A version of this story first appeared in the WHO Global report on health equity for persons with disabilities.