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This literature review surveys the state of current scholarship on physical disability in Ghana. The intention is to identify major themes and opinions relating to the challenges faced by Ghanaians with physical disabilities. After an extensive literature review, the authors selected 21 articles for inclusion based on the criteria that they had to focus on physical disability in a Ghanaian setting. Reviewing the articles revealed that most scholars have focused on the pervasive oppression of Ghanaians with physical disabilities. Six major topic areas emerged, including the experience of the disability rights movement from the 1990s to the present, the public perception of people with physical disabilities, the issue of families and abuse, the rights to education, challenges around employment and finances, and health care for disabled Ghanaians. This literature review presents these topics, discusses their implications, and makes suggestions for further research and action to improve human rights for Ghanaians with physical disabilities. Keywords Ghana, human rights, social sciences, disability, physical disability, family Introduction Review of the Literature The United Nations Convention on the Rights of Persons History of Disability Rights in Ghana With Disabilities (2006) sparked a surge in research into The literature demonstrates that the disability movement of disability rights across the world. In Africa, Ghana has been the 1990s was a time of major social change for persons with no exception as Ghanaian scholars have produced signifi- disabilities (PWDs) in Ghana. In 1992, the Ghanaian govern- cant work on disability issues, especially since 2006. The ment amended the Constitution, after the country democra- literature has covered a wide range of disabilities, including tized, to provide access to basic rights such as education and physical disability, mental illness, and diseases such as accessible public spaces while transforming the political HIV/AIDS. In the interest of narrowing this discussion, for atmosphere into one in which PWDs and their advocates and this review, we have chosen to focus on physical disability. care givers could more safely fight for their rights (Gavu This important work relates to a large segment of the et al., 2015; Mprah et al., 2014). Shortly thereafter, the gov- Ghanaian population, as existing research demonstrates ernment introduced a community-based rehabilitation (CBR) that the physical disability rate for Ghana is currently pilot program based upon welfare principles and funded between 3% and 4%, or between 650,000 and 860,000 peo- internationally from 1999 to 2002 by both the United Nations ple (Dassah et al., 2018; Kassah, 2008). There is a growing and the Official Development Assistance (Kuyini et al., body of work relating to this population in Ghana. Of the 2011; Metts & Metts, 2000). The program was a laudable resulting articles, the authors selected 21 which focus most effort to reintegrate individuals with disabilities into the strongly on the experience of persons with physical dis- abilities. In this review, six major topic areas emerged: the experience of the disability rights movement from the Wilfrid Laurier University, Kitchener, Ontario, Canada 1990s to the present, the public perception of people with Wilfrid Laurier University, Waterloo, Ontario, Canada physical disabilities, the issue of families and abuse, the Corresponding Author: rights to education, challenges around employment and Magnus Mfoafo-M’Carthy, Associate Professor, Lyle S. Hallman Faculty finances, and health care for disabled Ghanaians. of Social Work, Wilfrid Laurier University, 120 Duke Street West, Throughout this review, general trends within these six Kitchener, Ontario, Canada N2C 2T8. Email: email@example.com topic areas are explored in detail. Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 SAGE Open community, but it failed to achieve its goals due to a lack of (2015) found that 62% of students with disabilities inter- commitment by community members and government offi- viewed did not know that the Act existed. Notably, Sossou cials. As a result, international funding eventually dried up. and Yogtiba (2016) also suggest that a lack of government Despite the failures of the rehabilitation and reintegration commitment both socially and economically may send a programs rolled out during the 1990s, they served the impor- message to the public that the progression of disability rights tant purposes of improving public discourse surrounding the is not a priority. Nevertheless, to date there appears to be no social inclusion of PWDs and motivating disabled activists, clear suggestion within the existing literature regarding pos- the government, and civil society to take action for bigger sible solutions to implementation barriers for the Persons and better changes. Eventually, the 1992 constitutional With Disability Act. amendment was deemed unsatisfactory by PWDs, the pub- lic, and the government alike, as it did not cover all basic Current State of Disability Rights human rights (Gavu et al., 2015). This eventually led to the passing of the 2006 Persons With Disabilities Act. According Disability advocacy and improvements in public perceptions. to Gavu et al. (2015), the aim of the Act “was to fulfill a con- Some of the recent literature suggests that the passage of the stitutional obligation of enacting laws to protect and promote Disability Act has led to improvements in public attitudes the rights of people with disabilities” (p. 7). The Act also toward PWDs (Reynolds, 2010; Sossou & Yogtiba, 2016). proposed that by 2016, PWDs would have the same access to When asking questions about disability, Reynolds (2010) various services as a non-disabled person would (Reynolds, found that most people in her sample could articulate that 2010). Specifically, the Act outlined rights of PWDs to physical disability had spiritual rather than medical causes. proper housing, equal employment and educational opportu- Due to this understanding, most interviewed acknowledged nities, access to public spaces and transportation, adequate that PWDs should have basic rights; however, they do not nec- medical care, and protections against abuse (Dassah et al., essarily believe that these should be the same rights as people 2018; Dogbe et al., 2016; Ganle et al., 2016; Gavu et al., without disabilities. While this is a small improvement, Reyn- 2015; Kassah, 2008; Kassah et al., 2012; Reynolds, 2010). olds (2010) argues its significance lies in the recognition of Overall, the passing of the Act was a meaningful step in the inherent rights for PWDs. Overall, Sossou and Yogtiba (2016) removal of barriers to social inclusion of PWDs within suggest that “public education and knowledge, easier access to Ghana. information, and greater national visibility of productive peo- The Persons With Disabilities Act has been critiqued in ple with disabilities” have led to an improvement in the social the years since its implementation. One of the longest-stand- situation of PWDs in Ghana (p. 27). ing issues is that of building architecture. Despite the Act’s These improvements have been driven by the actions of call for equal access to public spaces, inaccessible public PWDs themselves. The literature shows that many Ghanaian buildings are consistently pointed out in the literature as a PWDs actively resist oppression and marginalization, which continued form of discrimination against PWDs (Dassah continues to be a major issue in Ghanaian society, in impor- et al., 2018; Ganle et al., 2016; Gavu et al., 2015; Gregorius, tant and unique ways. For instance, Bourgeois’ (2011) study 2016). A unique take on the reasons behind this inaccessibil- on self-activism through sports demonstrates an interesting ity is offered by Gavu et al. (2015), who note that public and effective strategy used by athletes with disability to fight perception of PWDs suggests they “are incapable of making for recognition of their humanity. In her interviews, a meaningful contribution” to society (p. 6). As a result, Bourgeois (2011) found that disabled Ghanaians use sports PWDs are physically excluded from meaningful spaces. In to demonstrate their abilities in the public arena, thereby addition to barriers in the built environment, the general lack earning respect for their talents and reducing stigma. Positive of enforcement of the provisions of the Persons With attitudes toward the athletes carry over into daily life, as out- Disability Act is also a common theme. The Act is applauded siders notice that the PWDs are capable of completing “regu- for its conceptualization of basic human rights for all; how- lar” activities and tasks. As a result, people are more willing ever, these rights are often not implemented properly, espe- to speak and interact with PWDs. Individuals with disabili- cially concerning PWDs facing multiple oppressions in a ties self-advocate for their rights, resisting oppressive atti- way that is similar to those who are incarcerated (Dogbe tudes and promoting social inclusion (Bourgeois, 2011). As a et al., 2016; Gavu et al., 2015; Kassahe et al., 2012; Sossou result, sports become a vehicle for political activism sur- & Yogtiba, 2016). rounding disability rights in Ghana. Still, identifying the exact barriers to the proper imple- mentation of the Persons With Disability Act remains unclear. Social exclusion and stigma. Despite acknowledging some Speculation within the literature suggests that lack of public improvements, the literature generally paints a picture of education regarding both the Act and disability rights in gen- persistent stigma, oppression, and a lack of human rights for eral may lead to apathy about the subject (Gavu et al., 2015; Ghanaians with physical disabilities. Also, most of the stud- Naami et al., 2012). For example, in their study on the imple- ies report that human rights for people with disabilities are mentation of the Act in a Ghanaian university, Gavu et al. still not effectively enforced today, with poor government Mfoafo-M’Carthy et al. 3 support, little commitment from non-government agencies, The authors realize that the negative perception of PWDs and few legal protections for PWDs in vulnerable situations often leads to widespread poverty, exclusion from quality such as prison (Dassah et al., 2018; Dogbe et al., 2016; Ganle health care, abuse, fewer employment opportunities, lower et al., 2016; Gavu et al., 2015). Within this group, the lit- levels of education, and general social exclusion, each of erature reports that more women than men are physically which is discussed in the sections below. disabled, and that women and children with disabilities are more severely disadvantaged than men (Badu et al., 2016; Abuse and Social Exclusion: PWDs and Kassah et al., 2014; Naami, 2015; Naami et al., 2012). Caregivers Barriers to human rights are reinforced by oppressive public perceptions toward disability in Ghana, which con- Abuse and social exclusion of PWDs. If people with physical tinue to permeate the dominant discourse. Ghanaian spiritu- disability are dehumanized as unworthy of respect, this ality is currently informed by a mix of Christianity and means they are not entitled to humane treatment. In Ghana, traditional religion (Kassah, 1998). Spiritual beliefs suggest the literature shows that women and children are especially that physical disability is a punishment from God for the per- vulnerable to abuse (Kassah et al., 2012, 2014). Importantly, son’s, or their family’s, sins, and so it is deemed worthy of Kassah et al. (2012), the main authors on this topic, note that shame (Gregorius, 2016; Kassah, 1998; Naami et al., 2012). abuse of these populations is widely known but not suffi- Due to the shame attached, an individual with a disability is ciently studied. Consequentially, there is little literature on also usually considered a burden on their family with nothing the topic. However, due to its serious nature and the potential to offer (Kassah, 1998; Naami et al., 2012). There is a dis- impacts on abuse victims, this literature is discussed in this connect in that PWDs expect independence, while non-dis- section. abled people perceive almost total dependence due to the Among children, Kassah et al. (2012) found that “social, dehumanizing worthlessness attached to physical disability. capital, physical, and emotional” abuse was most common As Kassah (1998) points out, the stigma involved is not (p. 695). Social abuse is present in both neglect and isolation exclusive to the individual experiencing disability but can by parents, who often attempt to distance themselves from apply to anyone associated with the stigmatized person. This the stigmatized child for fear of ridicule from the wider com- includes family members and caregivers. munity (Kassah et al., 2012). In addition, both capital and Furthermore, the belief that physical disability is a curse physical abuse are spiritually driven. Physical abuse is seen is prevalent enough in Ghanaian society that a trend emerged as a means of driving the evil out of the child, while capital in existing literature regarding the unmarriable qualities of a abuse is sometimes used by parents and spiritual leaders to person with disability. In more than one paper, Kassah (1998, end the child’s life, eliminating evil and sending them back 2008) notes that people will actively avoid marrying some- to the gods (Kassah et al., 2012). Although murder is a crimi- one with a disability or with a family history of disability in nal offense in Ghana, capital abuse perpetrated on physically their family due to the perception of a curse. If a partner dis- disabled individuals is often socially encouraged by pressure covers there is history of disability post-marriage, or a part- to conform to social norms (Kassah et al., 2012). Finally, ner becomes physically disabled during marriage, it is neglect and physical abuse contribute to emotional abuse, as considered reasonable grounds for divorce (Kassah, 1998, the child is deprived of the emotional nurturing required for 2008; Mprah et al., 2014). However, sufficient grounds for healthy development (Kassah et al., 2012). For the most part, divorce do not rest solely on the assumption of a curse. If a abusive actions toward individuals with physical disabilities woman becomes disabled during marriage, she is seen as are heavily entrenched in spiritual, cultural, and social norms. asexual, and consequentially incapable of bearing children or Similarly, abuse toward women with physical disabilities performing motherly roles (Naami et al., 2012). Once per- is driven by values, in this case toward gender norms. In ceived as unable to fulfill traditional female roles, she is con- modern-day Ghana, most women have traditional nurturing sidered unmarriable. Also, the perception of people with roles, such as bearing children and taking care of the house physical disability is that they are deserving of sympathy (Kassah et al., 2014), and some women work from dusk to rather than respect (Naami et al., 2012). This dehumanizes dawn to provide for the home. Women with disabilities are the person and puts them in the position of the undesirable seen as incapable of taking on these roles, as well as incapa- other, making them unmarriable to the greater society. ble of having a healthy sexual life, and so marrying them is To sum up, despite improvements since 2003, the litera- considered socially unacceptable. According to Kassah et al. ture shows that negative public attitudes toward persons with (2014), if a man falls in love with a woman with disability, physical disabilities continue to make them one of the most the stress of the taboo relationship often leads to abuse oppressed groups in Ghana. PWDs violate “normal ways of spurred on by power and control. Partners have been reported relating and behaving,” and as such are left out of public to carry out physical and sexual abuse, such as rape or spheres such as education, medical care, and employment unwanted touching, if a woman is seen as contravening tra- due to stigma and unwillingness to understand (Kassah, ditional norms, as well as verbal abuse by calling their part- 1998, 2008; Kassah et al., 2012, p. 692; Mprah et al., 2014). ners disparaging names (Kassah et al., 2014). These actions 4 SAGE Open are performed as a way for the non-disabled partner to feel Despite the fact that caregiver stress has a multitude of validated in society again. Furthermore, women with physi- negative consequences for both the caregiver and the care cal disability are also more exposed to social abuses than recipient, the authors found only one peer-reviewed article men, such as lower education levels, name-calling by strang- that addressed ways to support caregivers. Zuurmond et al. ers on the street, and police refusal to help abuse cases (2018) report on their experiences running a support group (Kassah et al., 2014). and training program to help caregivers learn how to best assist individuals with physical disabilities. During the pro- Abuse and social exclusion of PWDs and caregivers. Due to the gram, the authors found that most family members do not stigmatization of PWDs, family members and caregivers understand the individual’s diagnosis and lack objective often feel socially excluded. This can lead to frustration and explanations in non-stigmatizing language. As a corrective, exhaustion, which may have dire consequences for both the authors found that supporting the caregivers through themselves and the individuals in their care (Opoku et al., access to non-discriminatory descriptions helped reduce 2017). The stress of marginalization can manifest in several stress, as the caregiver was better able to understand the ways for both the family member and the individual experi- social location from which the person with disability experi- encing disability. In dominant Ghanaian culture, an individ- enced daily life. This understanding led to reduced anxiety ual’s social support system is very important. However, in and increased patience (Zuurmond et al., 2018). Moreover, the lives of person with disabilities, social supports do not the support group helped caregivers feel that they were part seem to be applicable due to stigmatization and dehumaniza- of a community again, which helped reduce feelings of social tion (Opoku et al., 2017). When there is no public or com- isolation. Zuurmond et al.’s (2018) study is significant, as it munity support system, support of the individual with demonstrates the important role that caregiver support plays disability falls to the family. Yet oftentimes the family aban- in the quality of life of both caregivers and care recipients. dons them too, as most Ghanaian families are ashamed of the individual and fear stigmatization (Opoku et al., 2017; Zuur- Education mond et al., 2018). Many families still struggle to understand the innate human worth of the individual experiencing Education is crucially important to all Ghanaians, but the lit- disability. erature points to significant barriers to schooling for PWDs. When families do decide to take on the role of caregivers, First, several authors report that many families see the edu- it is often no easier, as multiple social barriers exacerbate the cation of children with disabilities to be a waste of resources, vulnerability of both the family and the individual with dis- often because of the social perception that PWDs are inca- ability. Caregivers are usually inadequately supported by pable of contributing to society (Gavu et al., 2015; Kassah social services, as many families have little access to finan- et al., 2014; Opoku et al., 2017). Due to this perception, cial and educational resources to learn about how to take care people with physical disabilities are often physically for the person. This lack of support often leads to impatience excluded from educational spaces. Despite the Disability caused by misunderstanding of the disability (Kassah, 1998; Act’s call for all public buildings to be accessible, presently Opoku et al., 2017; Zuurmond et al., 2018). Lack of social most educational architecture is still inaccessible. This supports for the caregivers also exacerbates this problem, as includes lack of accommodation both outside the buildings frustration is compounded by feelings of social isolation and in the form of ramps, as well as inside lecture halls, thereby loneliness (Opoku et al., 2017; Zuurmond et al., 2018). demonstrating that physical accessibility remains a huge bar- Zuurmond et al. (2018) note that this often leads to caregiv- rier to education for those with physical disabilities (Gavu ers experiencing physical and emotional exhaustion, extreme et al., 2015; Gregorius, 2016). Second, stigma and negative stress, anxiety, and depression. attitudes of non-disabled Ghanaians make the social environ- When caregivers experience intense emotional and physi- ment difficult, as PWDs feel isolated and socially excluded, cal strain, this can contribute to the abuse of vulnerable sub- and they refuse to attend school as a result (Gregorius, 2016; populations as previously described. Strain can negatively Opoku et al., 2017). This demotivating factor can be strongly affect parenting quality, as parents may take their stress out internalized. Using a unique narrative research approach to on children through physical, emotional, or verbal abuse this topic, Gregorius (2016) found that social isolation at (Zuurmond et al., 2018). In addition, social isolation can school led to low self-esteem, internalized stigma, and the make caregivers feel powerless, which may lead some care- belief that they deserve to be excluded as they blame them- givers to “withhold, misuse or delay support needed by care selves for failed integration with peers. These feelings may recipients as a way of gaining control and power” (Kassah cause people with disabilities to drop out of school earlier et al., 2014, p. 666). However, Kassah et al. (2014) caution than non-disabled individuals, which often creates higher against rationalizing abuse on the grounds that caregiver illiteracy rates and lower levels of employable skills among stress can lead to victim blaming, and as such may perpetuate this community (Opoku et al., 2017). abusive cycles if discussions surrounding this topic are not Other notable barriers to education include gender dis- carefully handled. crimination and financial difficulties. According to Naami Mfoafo-M’Carthy et al. 5 (2015), education levels among PWDs are generally higher (Kassah, 2008; Mprah et al., 2014). In effect, people with for men than women. Bourgeois (2011) speculates that this disabilities use begging as a way to work toward eventual imbalance is due to the intersecting oppression experienced social inclusion. The government has tried to eradicate beg- by women for being both female and disabled, leading to ging through both criminalization and welfare approaches, double discrimination. Nevertheless, for both men and such as providing financial support, but neither has stuck as women with disabilities poverty is an issue, and so they often this does not give people with physical disability the eco- cannot afford the same levels of education as non-disabled nomic independence for which they strive (Kassah, 2008). people (Gavu et al., 2015). In general, the literature demon- Aside from economic independence and social inclusion, strates that both structural and societal barriers prevent peo- there are numerous other reasons that keep begging a promi- ple with physical disability from accessing quality education, nent source of income for PWDs. To begin with, the lack of which may have consequences for future employment and employment avenues as previously outlined leaves many income generation. people with disabilities in poverty (Kassah, 2008; Naami, 2015; Naami et al., 2012). As a result, individuals start beg- ging to be able to afford basic needs such as food, housing, Employment and Finances and necessary medical equipment for their disability. In addi- Often tied to lower levels of education, high unemployment tion, many people with disabilities have found begging to be rates are one of the biggest issues facing people with physi- more lucrative than the menial employment avenues that are cal disabilities (Naami, 2015; Naami et al., 2012). Even if traditionally provided to them. Kassah (2008) found that they can find work, it is usually seasonal and poorly paid, some individuals who participate in begging make up to and it does little to reduce the high poverty rates among 40,000 Ghanaian cedis (equivalent of 40 new Ghana cedis or PWDs (Naami, 2015; Naami et al., 2012). Employment also US$8) daily, versus the average daily income of 19,000 cedis does little to improve social exclusion, as PWDs face pay (19 Ghana cedis or US$3.8). Finally, many individuals have discrimination, harassment from co-workers who assume identified begging as a confidence-builder. Some people they are incapable, and verbal abuse by employers. with disabilities view begging as a legitimate form of work Authors writing in this area cite several reasons for unem- in which they gain both financial rewards and freedom from ployment among PWDs, including employers’ failure to rec- dependence on others (Kassah, 1998, 2008). Another article ognize the potential in people with disabilities, employers’ states that begging also demonstrates resilience, as individu- fear of the perceived spiritual evil associated with physical als experiencing disability are being innovative and solution- disability, and the high costs of disability accommodation oriented in the face of widespread oppression. The authors (Naami, 2015; Naami et al., 2012). Of these factors, stigma also noted that begging has the potential to overcome pov- toward the economic potential of PWDs is particularly sig- erty and to gain entry into other work opportunities, such as nificant. Ghanaians with physical disabilities generally want self-employment if they have the necessary capital (Opoku to work, but the “economic productivity of persons with dis- et al., 2017) though this is rare. Although these positives do abilities is often perceived as insignificant” (Mprah et al., not show up in a great deal of the literature, they are worthy 2014, p. 31; Naami et al., 2012). This situation is worsened to note as they offer an alternative view on the subject of by structural barriers to employment for PWDs, which beggars. include scarcity of employable skills programs for profes- On the contrary, it is important to note that, as many of our sional development and lower levels of education (Naami authors report, begging in Ghana generally is not praised but et al., 2012). In addition, Naami et al. (2012) point out that rather criticized and stigmatized, even within the community people with disabilities are excluded in general policy mak- of PWDs. For example, Bourgeois (2011) found that PWDs ing, which means they are often left out of employment poli- who play sports use this skill to separate themselves from cies at both national and local levels. This is significant as it beggars, whom they consider inferior and unworthy of asso- means that companies are not mandated to include people ciation. For this reason, although it is a prominent source of with disabilities, hence contributing to structural barriers to income, not all within the disability community engage in, or employment. even approve of, begging on the street. Stigma toward beg- ging is prominent among the non-disabled community as well, leading most of our authors to recommend solutions for Begging as Income reducing it and finding alternatives for PWDs. Throughout Employment discrimination has led many PWDs to search the literature, there is a call for government support of for alternative sources of income, with the most prominent increasing access to capital for people with physical disabili- being begging on the streets (Bourgeois, 2011; Kassah, 1998, ties (Kassah, 2008; Naami, 2015; Naami et al., 2012). 2008; Naami, 2015; Opoku et al., 2017). Begging is both Multiple authors suggest that loans and grants specifically illegal and fraught with perceptions of immorality; however, for start-ups by individuals with disabilities may help reduce it persists because economic independence can increase an the number of beggars, as they will more easily be able to individual’s social and cultural status in Ghanaian society obtain self-employment (Kassah, 2008; Naami, 2015; Naami 6 SAGE Open et al., 2012). Notably, Naami (2015) also recommends public Nevertheless, there is no clear definition in the literature education forums focusing on the capabilities of PWDs to about what constitutes reasonable levels of access, although demystify PWDs in the workplace, which may lead to the authors suggest that affordability, acceptable service pro- increased employment and decreased begging. On a more viders, levels of accommodation, timeliness, geography of general note, there is a push for attitude changes toward peo- facilities, and awareness of available services are the most ple with disabilities in the workplace (Kassah, 2008; Naami, important elements. In Ghana, one of the greatest barriers is 2015; Naami et al., 2012). The authors realize that none of remoteness from facilities for PWDs in rural areas, who have the literature reviewed explored attitudinal changes in soci- the most trouble accessing health care because of the uneven ety toward PWDs. Until this is further explored, there is the coverage of institutions across the country and the lack of indication that begging will persist among Ghanaians with health care providers in rural areas (Dassah et al., 2018). physical disabilities. That means that many PWDs must travel to major cities for health care, but most cannot afford to pay for transportation (Ganle et al., 2016). Gender Issues Affordability in general has been identified as another Unemployment and poverty affect people with disabilities barrier to health care for PWDs. In 2003, the National Health more than the general population; to compound this, within Insurance Scheme (NHIS) was introduced in an attempt to the disabled population, women face more discrimination help impoverished and marginalized people with disabilities and higher unemployment rates than men (Bourgeois, 2011; pay for health care–related costs (Bourgeois, 2011; Dassah Naami, 2015). This double oppression leads to women being et al., 2018). However, the current literature critiques the especially unlikely to find work (Naami, 2015; Naami et al., NHIS for its unclear criteria on who is considered disabled 2012). When women are employed, they usually experience and what is considered impoverished (Bourgeois, 2011; lower pay due to the perception that they are a pointless Dassah et al., 2018). Due to the lack of clarity, not as many investment because they are less capable than men (Naami people qualify as expected and there appears to be no other et al., 2012). According to Naami et al. (2012), this stereo- significant form of financial help for individuals with physi- type is often internalized by women after years of discrimi- cal disability. nation and it can manifest in two ways. First, women with When it comes to service providers, general trends have disabilities lack the self-confidence to apply for jobs and shown that most people with disabilities face discriminatory instead remain unemployed. Second, women with disability attitudes from health care professionals (Badu et al., 2016; tend to use pre-emptive aggression as a self-preservation Ganle et al., 2016). This is discussed in more detail in the tool, leading to the stereotype that women with physical dis- next section; however, it is important to note that discrimina- abilities contribute to a hostile work environment. Either tory attitudes form an access barrier due to poor disability way, the result is an increase in poverty and unemployment training for health care students (Badu et al., 2016; Ganle among women and a significant gender gap in employment et al., 2016). As with the caregivers described above, poor driven by discrimination. training leads to poor understanding of physical disability, Breaking down employment sectors, Naami (2015) and therefore stereotypes and frustration tend to permeate reports that women are often overrepresented in the fields of service provider attitudes. Consequentially, PWDs become production and sales, while men are overrepresented in the reluctant to seek out health care (Badu et al., 2016; Ganle service field. Significantly, all of these sectors are relatively et al., 2016). unskilled. For both genders, there is a lack of disability rep- Finally, the supply of medication and hospital beds is also resentation in managerial positions, which speaks to the lim- an issue in Ghana. Pharmacies are often sold out of medica- ited opportunity allowed to people with disabilities even tion for those coping with painful disabilities, and there are when they are employed (Naami, 2015). This imbalance not enough beds in hospitals for those needing inpatient reflects a lack of skills and training opportunities for treatment (Dassah et al., 2018). This affects treatments and Ghanaians with physical disabilities. Employment of an indi- leads to long wait times for crucial services needed by those vidual with disability does not automatically mean equity if with physical disabilities. Generally, the literature provides they do not have the same opportunities for professional evidence that Ghana’s health care system is not yet fully wel- growth as a non-disabled person. The literature calls for coming to people with physical disabilities. access to employable skills programs for PWDs, especially for women, to empower their capacity in the job field (Naami Health care provider attitudes toward people with disabili- et al., 2012). ties. As briefly mentioned, many people with physical dis- abilities experience discriminatory or oppressive attitudes from service providers when accessing health care. While Health care there is not a great deal of literature on this subject, it is Access barriers. According to Dassah et al. (2018), access is a important to note as access to health care is a basic right, and key measure in the success of a health care system. the dismissal of this group by health care providers is a direct Mfoafo-M’Carthy et al. 7 violation of this right. For instance, in a study on health care authors speculate that this may be due to the fact that public provider attitudes toward physical disability (including hear- policies reflect social values, and as people with physical ing and visual impairment), Badu et al. (2016) report that disability are marginalized in the wider community, this mar- there is support among health service providers for steriliza- ginalization may be mirrored in their omission from health tion of people with disabilities. This support relates directly care policies. Nevertheless, Owiredu et al. (2015) found that to the stigma and lack of education surrounding the capabili- rates and prevalence of sexual dysfunction are similar in both ties of this community. Giving medical students the opportu- disabled and non-disabled communities. While this is a spe- nity to participate in disability training, along with practical cific statistic, it is significant because it demonstrates a need experiences working with people with disabilities, may help for sexual health policies and practices applicable to the demystify PWDs and make health care providers more com- community of physically disabled. In general, the literature fortable working with physical disability (Badu et al., 2016). reveals a call for reform in this policy area (Ganle et al., Another significant issue stemming from stigmatization is 2016; Mprah et al., 2014). the impatience of health service providers when working with physical disability. Badu et al. (2016) point out that Conclusion there are too many patients and not enough practitioners, Overall, the authors’ survey of the literature shows that peo- meaning that practitioners are overworked and do not feel ple with physical disabilities in Ghana are still in a precari- they have enough time to spend with people with disabilities. ous fight for basic rights. Although the passage of the Persons This lack of time leads to frustration toward these individuals With Disability Act in 2006 was a meaningful step in the if they move at a slower pace. In addition, due to stereotypes right direction, there is disagreement within the literature about the economic incapability of people with disabilities, regarding whether this has improved the situation for indi- their health care may not be prioritized by busy service pro- viduals experiencing disability. While some authors state viders as it may be seen as a waste of resources (Dassah that the social situation of PWDs has improved since the et al., 2018; Mprah et al., 2014). More research is needed implementation of the Disability Act (Reynolds, 2010; into how to improve health care provider attitudes toward Sossou & Yogtiba, 2016), most others argue that people liv- people with physical disability to protect their human rights. ing with disability are still widely discriminated. In the pub- lic sphere, stigma and discrimination occurs in key areas of Sexual and reproductive health. The subject of sexual and Ghanaian society including education, employment, and reproductive health among the population of physically dis- health care. This extends to the private sphere as well, where abled arose numerous times in the literature. Among the gen- PWDs are often socially excluded and abused by family eral public, there is the perception that people with physical members. In response, most authors agree that better disabil- disabilities are inherently asexual, a label that is applied to ity training for the public, health care providers, teachers, both men and women alike (Bourgeois, 2011; Ganle et al., and caregivers alike may help to demystify people with dis- 2016; Mprah et al., 2014). Neither men nor women with dis- abilities and create positive attitudinal changes, thereby abilities fit the traditional gender norms of femininity or increasing social inclusion and opportunities for those masculinity; instead, they are seen as having no sexual involved. For this to occur, further research is needed into potential at all (Bourgeois, 2011). As a result, they are often what this training would look like, and how widespread atti- excluded from sexual and reproductive health services. One tudinal changes could be. Unfortunately, the authors found of the biggest exclusions is in access to information for peo- nothing in the literature addressing the question of imple- ple with physical disabilities. Health care providers are gen- mentation of policies to reduce barriers to social inclusion as erally not educated on disability-specific medical advice mandated by Ghana’s Disability Act. when it comes to sex or reproduction (Ganle et al., 2016; Consequently, more research is needed into how to over- Mprah et al., 2014). For example, Ganle et al. (2016) reported come barriers so that the Disability Act can function to its the case of a woman who used a wheelchair who was told by full potential in enhancing disability rights. Even so, this health care providers to walk every day when she was preg- review has revealed that Ghana’s disability movement has nant, advice that she obviously could not heed. In addition, made substantial progress since the 1990s through continued information about sexually transmitted infections and con- efforts by governments, activists, and researchers, and traception is not readily available to PWDs based on the through the increased willingness to include PWDs in policy assumption that they do not have sexual needs (Mprah et al., decisions affecting their well-being. If this can be sustained, 2014; Owiredu et al., 2015). Situations such as this lead peo- then the advancement of disability rights in Ghana will con- ple with physical disabilities to fend for themselves when it tinue to move in an inclusive direction. comes to their sexual and reproductive health. A unique viewpoint on this subject was presented by Declaration of Conflicting Interests Mprah et al. (2014), who noticed that most health care poli- cies on sexual and reproductive health standards omit physi- The author(s) declared no potential conflicts of interest with respect cal disability altogether with no clear reason why. The to the research, authorship, and/or publication of this article. 8 SAGE Open Funding Kuyini, A. B., Alhassan, A.-R. K., & Mahama, F. K. (2011). The Ghana community-based rehabilitation program for people The author(s) received no financial support for the research, author- with disabilities: What happened at the end of donor support? ship, and/or publication of this article. Journal of Social Work in Disability & Rehabilitation, 10(4), 247–267. https://doi.org/10.1080/1536710X.2011.622981 ORCID iD Metts, R. L., & Metts, N. (2000). Official development assistance Magnus Mfoafo-M’Carthy https://orcid.org/0000-0001-8351- to disabled people in Ghana. Disability & Society, 15(3), 475– Mprah, W. K., Anafi, P., & Sekyere, F. O. (2014). Does disability matter? 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SAGE Open – SAGE
Published: Jan 15, 2020
Keywords: Ghana; human rights; social sciences; disability; physical disability; family
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