Women with Functional Disabilities Use More Healthcare Yet Report Greater Access Barriers: Evidence from the 2022 Kenya Demographic and Health Survey

Abstract Background. Women with disabilities need more health care than other women, so high use of services is expected. Whether that use reflects inclusion or a burdensome path to care is unclear, especially in sub-Saharan Africa. We examined whether higher healthcare utilization coexists with greater access barriers among women with functional disabilities in Kenya, and what role health insurance plays. Methods. Cross-sectional analysis of the 2022 Kenya Demographic and Health Survey among women aged 15–49. Functional disability was defined as a lot of difficulty or inability in at least one of six Washington Group domains (seeing, hearing, communicating, remembering, walking, and self-care). Outcomes were four access barriers (permission, money, distance, and company), inpatient care (past 12 months) and outpatient care (past 4 weeks). Insurance was a second exposure. Complex-sample logistic regression adjusted for age, education, wealth and residence. Results. Women with functional disabilities had higher odds than other women of reporting any barrier to care (aOR 1.57, 95% CI 1.15–2.14). They also had higher odds of healthcare utilization; inpatient care (aOR 1.98, 1.28–3.07) and outpatient care (aOR 2.64, 1.96–3.54). Among outpatient users, barriers were also more common with disability (71.4% versus 55.6%; aOR 1.39, 0.88–2.20). Insurance was associated with fewer barriers and more service use, but coverage was low and did not differ significantly by disability. Insurance did not significantly modify the disability gap in barriers (interaction p = 0.41). Conclusions. Women with functional disabilities used more care yet reported greater access barriers. Use alone is a poor signal of inclusion. Universal health coverage monitoring should also assess whether people with disabilities can obtain care affordably and without substantial barriers.