The association between disability and problems in accessing healthcare: Evidence for women aged 15 to 49 in 16 low- and middle-income countries

OBJECTIVES: Sustainable Development Goal 3.8 aims to achieve access to essential services for all, including persons with disabilities. Yet, there is a lack of evidence on barriers persons with disabilities may experience in low- and middle-income countries (LMICs). The objective of this paper is to investigate access to healthcare among women aged 15 to 49 by disability status in 16 LMICs. STUDY DESIGN: Secondary cross-sectional study. METHODS: This cross-sectional study used Demographic and Health Survey (DHS) data for 164,530 ever-married women aged 15 to 49 across 16 countries. The DHS captures disability through the degree of difficulty women experience across six functional domains (seeing, hearing, mobility, cognition, self-care and communication). Employing a multilevel random-intercept model to account for the hierarchical structure of the study sample, we estimate whether women's disability status is associated with reporting problems in accessing healthcare (getting permission, getting money, distance, not wanting to go alone). RESULTS: The pooled sample for 16 countries reveals that women with disabilities' odds of reporting problems in accessing healthcare are 1.15 (95% CI = 1.05, 1.25) times higher than the odds of women without disabilities. Getting money is the problem for which women with disabilities have the highest odds of reporting problems (AOR = 1.20, 95% CI = 1.13,1.27). At the country level, similar results are found for eight countries, for which women with disabilities have higher odds of reporting at least one type of problem in accessing healthcare. CONCLUSION: Women with disabilities aged 25 to 49 in LMICs report disproportionately more problems in accessing healthcare compared to their nondisabled counterparts. Hence, the results from this study highlight the need to include women with disabilities in health systems.