Mombasa, Kenya — For persons with disabilities, being in the room does not always mean being included.
At the MenEngage Africa SRHR Progress 2026 Symposium in Mombasa, this gap was placed at the centre of a conversation on sexual and reproductive health and rights. Advocates and practitioners asked a fundamental question: Are persons with disabilities truly seen, heard and served?
Dr Sarah Musau, Executive Director, Gifted Community Center (GCC), Kenya’s Network of Youth with Disabilities and College Students, challenged organisations to look beyond representation and examine whether persons with disabilities are intentionally included in their workplaces, programmes and decision-making spaces. How are we involving persons with disabilities?” she asked.
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For sexual and reproductive health and rights, the consequences of that exclusion can be profound.
The National Council for Persons with Disabilities Executive Director, Dr Michael Munene, challenged participants to rethink how they measure an inclusive health system. He asked: What is the true measure of an inclusive health system?
Is it the number of hospitals built, policies adopted or programmes implemented, or whether a woman using a wheelchair can safely access maternal healthcare, whether a deaf adolescent can receive sexual and reproductive health information in a language they understand, and whether a young person with an intellectual disability can make informed decisions about their own wellbeing?
An inclusive health system, he said, should be judged by how intentionally it reaches people who have historically been excluded, rather than by how well it serves those who can already access it with ease.
The scale of the challenge is global.
At least 1.3 billion people worldwide – about one in six – live with a disability, and in Africa the figure sits at an estimated 80 million people, or 10-15% of the population, a number expected to grow due to conflict, poverty, and non-communicable disease. Despite representing the world’s largest minority group, persons with disabilities remain among the least likely to access equitable health services, including sexual and reproductive health care.
Munene said persons with disabilities remain among those least likely to access equitable health services, despite making up what he described as the world’s largest minority.
“They are children and young people, mothers and fathers, professionals, entrepreneurs, farmers, students and leaders,” he said. “Yet, despite the world’s largest minority, persons with disabilities remain among those least likely to access equitable health services, including sexual and reproductive health services.”
The barriers, he said, are not simply a consequence of disability itself.
“The World Health Organization reminds us that these disparities are not caused by disability itself, but by barriers embedded within our societies and health systems,” he said.
Those barriers can include inaccessible health facilities, information that is not available in accessible formats, discrimination and difficulties communicating with healthcare providers. WHO similarly identifies stigma, discrimination, poverty, exclusion and barriers within health systems as major drivers of health inequities experienced by persons with disabilities.
The consequences can be life-changing and sometimes life-shortening.
“Nothing about us without us,” he said, adding that the principle must move beyond rhetoric and become standard practice in health policy, programme design, implementation and accountability.
Joseph Etyang, a deaf disability rights advocate and a board of directors at the National Council for Persons with Disabilities, brought that reality into the discussion.
He said that disability inclusion means more than simply making a building physically accessible.
“It means equal rights and opportunities,” he said. “Accessible service has been mentioned in the discussion by our director. Because it not only leads ramps, but it means that it is accessible and applicable to all types of disability.”
Etyang pointed to Kenya’s ratification of disability rights protections and the Persons with Disabilities Act, signed in 2025 and now being implemented under the National Council for Persons with Disabilities. He said that 16 counties in Kenya currently have specific disability legislation, with several more developing dedicated disability policies – progress he described as incremental but real.
However, significant gaps remain.
Structural barriers persist in basic infrastructure, accessible toilets remain rare, and physical access to buildings and services is inconsistent. Language access is a particular challenge for the deaf community, compounded for people from rural areas who may lack access to formal sign language education, leaving many reliant on written communication that isn’t always accessible to them either. Etyang said that his organization has developed sign language materials for community use.
Data gaps were flagged as another critical barrier; without disability-disaggregated data, programs and policies cannot be designed accurately to meet actual needs.
Women and girls with disabilities, he said, face the most acute barriers of all when it comes to sexual and reproductive health, compounded by community stigma and attitudes. “Then it becomes a big barrier for them to receive basic health services,” he said.
Etyang said that inclusion must be measured not simply by whether policies exist, but by whether people can actually use the services and exercise the rights those policies promise.
A call to action
Etyang shared data on Kenya’s disability inclusion progress: 35 counties have implemented disability employment provisions, reaching thousands of persons with disabilities, with deaf and disabled communities present well beyond major cities like Mombasa and Kisumu.
He credited the National Council for Persons with Disabilities with leading accessibility audits, reasonable accommodation, and assistive device provision but flagged real gaps, including 16 counties still without specific disability legislation, only 3.1% of county employees currently covered under inclusion measures, and just four public institutions reporting to the Council.
Still, he said more needs to be done, particularly in health facilities.
“We need more,” Etyang said, calling for stronger implementation and better disability-disaggregated data to guide programmes.
Can you be served when you’re not counted?
Barbara Ndolo, a project officer at Cheshire Disability Services Kenya (CDSK), brought that question into the realities of sexual and reproductive health services.
“Disability is not a problem of an individual. It’s an issue of balance,” she said. “Disability is part of human diversity.”
She argued that disability rarely exists in isolation; it interacts with other forms of marginalisation, age, sex, religion, refugee status, and these intersections shape whether and how a person can access SRHR services.
“Persons with disabilities are not homogenous,” she said. “They are very heterogeneous.”
She pushed back against treating persons with disabilities as a single, uniform group. Experiences differ significantly depending on the nature of a person’s disability; someone who is deaf navigates services very differently from someone using a wheelchair, meaning services must be adapted accordingly rather than designed around a generic notion of “disability.”
She grounded this in research her programme had commissioned across 25 health facilities in three Kenyan counties, part of a wider study spanning five countries in East and Southern Africa, including Zambia, Rwanda, and Ethiopia, with strikingly consistent findings across all of them. The research, conducted with partner Afya Research, assessed SRH services against four measures: availability, accessibility, acceptability, and quality.
Service quality was found to be suboptimal across the board, affecting all patients regardless of disability, but disability-specific gaps compounded the problem. Only 52% of facilities had ramps, 40% had safe and appropriately designed entrances, and just 12% had accessible toilets.
Most strikingly, sign language interpretation was absent across the facilities studied, a gap Ndolo said results directly in miscommunication between patients and healthcare workers. Healthcare workers themselves reported limited awareness of disability-inclusive care, while young people with disabilities cited a lack of income as a further, compounding barrier to accessing SRH services at all.
The findings, she said, showed that while the overall quality of sexual and reproductive health services was suboptimal for everyone, persons with disabilities faced additional barriers that could further limit their access.
Ndolo said that inclusion cannot mean designing a single programme and assuming it will work for everyone.
“Adaptation, when it comes to adaptation to the services, we need to tailor-make them to the different types of disability and the accessibility needs of persons with disabilities,” she said.
For Jemimah Apisi, the barriers are not theoretical. She has experienced them herself.
Apisi is a deaf young woman with lived experience of navigating sexual and reproductive health services. She works as a peer educator for LVCT Health. She mentioned two stories that highlighted the human cost of the systemic gaps.
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In one, she said she got sick and went to the hospital for tests, not knowing if she had an STI. There was no way for the facility to communicate with her or decide the correct medication or referral pathway. The facility had no way to communicate with her or determine the right medication or referral pathway. Rather than being redirected to appropriate care, she was left waiting with no resolution, and ultimately left without receiving treatment at all, an experience she described as one of the most difficult she’s faced.
The second account was more distressing. A deaf woman she knew, in significant pain and later found to be pregnant, was taken to a hospital where nursing staff reportedly responded with mockery rather than care, questioning how she could have gotten pregnant or married, while she was in visible distress.
“The nurses were laughing that this young girl became pregnant. How? Who married you?” she said.
Apisi framed this as a violation of basic rights, pointing to international human rights frameworks that recognise SRH access – including the right to marry and to sexual and reproductive healthcare – as fundamental, not conditional on disability status.
She called for healthcare workers to be sensitised and trained to communicate with persons with different disabilities, while health facilities must provide accessible information and infrastructure.
But she also stressed the importance of information as a pathway to independence.
“Information is key for us to be independent,” she said. Many persons with disabilities are forced to seek information about sexual and reproductive health from the internet because they have not received it through formal channels.
Her message was that accessibility must go beyond ramps.
“We don’t have only deaf people, but also people who are autistic or with multiple disabilities,” she said. “So, we need to be focused on the issues… not only focus on one, but focus on all.”
Ultimately, she said, meaningful inclusion will require a change in attitudes.
“If the attitude changes, then they’re able to accept each individual and dignify them,” Apisi said.
