Expert Talk

Expert Talk with Silvia Quan, Sarah Keogh and Sandra Krause
Photographer: Patrick Meinhold / Bayer AG

Strategies for Advancing Sexual and Reproductive Health and Rights for Hard-to-reach and Vulnerable Groups

Expert Talk with advocates for persons with disabilities, refugees and youth

A trio of experts deepened the discussion on reaching vulnerable groups, including living in fragile settings. Silvia Quan, an advocate for persons with disabilities from the International Disability Alliance, Sarah Keogh, an expert in the barriers faced by young people, from the Guttmacher Institute, and Sandra Krause, the Director of the Women’s Refugee Committee, and member of the Inter-agency Working Group on Reproductive Health in Crisis gathered on the stage.

“Dealing with SRHR of persons with disabilities has been overlooked for decades,” Quan told the delegates. “When we speak about persons with disabilities, it is usually a taboo, so is speaking about SRHR. So joining the two together, SRHR for people with disabilities, it is a major taboo. There are too many harmful stereotypes, particularly that people - mainly young people or women and girls with disabilities - are asexual or hypersexual. These myths have helped create very poor solutions.”

She continued that one of the main challenges in this work, is defending the right of people with disabilities to choose. The absence of good information about disability and lack of legal capacity greatly reduces the opportunity of persons with disabilities to claim their rights.

Adolescents battling unintended pregnancy and discrimination

Sarah Keogh turned the audience’s attention to young people aged 10 to 14, a critical age for laying the foundations of positive sexual and reproductive health. They too, she explained, find themselves outside the thinking of policymakers and health systems. This age group experiences some 770 thousand births a year, with about a third of them unintended.

“This age of early child bearing has a lot of detrimental consequences on educational opportunity and therefore earning potential throughout the rest of their lives,” Keogh told delegates. She described the isolation of Lesbian, Gay, Bisexual, Transgender, Queer, Questioning and Intersex (LGBTQI) youth in countries where homosexuality or gender non-conformity are stigmatised. “These young people have very few places to go. Sexuality education will often include something about sexual orientation, but in practice a lot of the teachers are very uncomfortable teaching these topics, so they just leave them out. In some countries they even teach that homosexuality is deviant or criminal behaviour.”


Keogh applied an intersectional lens to SRHR, connecting the struggles of different marginalised groups. She explained that inequalities play out particularly strongly amongst young people. “For example, poor adolescents tend to start sexual activity earlier, which makes them more vulnerable to unintended pregnancy, which perpetuates the cycle of poverty. Rural youth are more vulnerable to child marriage, and married adolescents face their own challenges accessing services or resources, which are often restricted or controlled by the husband.” She added that these same young people face higher risk of HIV and STI exposure due to unequal power dynamics, because they have very little negotiating power when it comes to condom use.

“In every fragile context, you will find organisations working to address the needs of people living with disabilities, LGBTQI populations and displaced people. We need to work with development partners to identify existing capacity and provide financial support,” she said.

Krause also encouraged delegates to embrace intersectionality in their thinking when approaching and enabling the agency of vulnerable groups. “You have to look at the capacities of people with disabilities, adolescents and youth. Their agency, their capital. Their skills. And really facilitate their participation in all aspects of global, national and local levels. We need to hear their voices. They need to participate in assessments, program planning accountability to ensure they are getting the services that they need,” she said.

Reaching people living in fragile settings

The expert panel then took some time to reflect on the importance of reaching people in fragile settings as a key to successfully implementing the 2030 Agenda. According to Sandra Krause, in conflict-affected settings the biggest concern for very young adolescents is security. They are fearful of sexual violence and sexual exploitation and abuse, outright abduction and sex trafficking. Krause added that safe spaces are essential in order for education, including SRHR education, to take place.

The right to make choices about one’s own body

One of the major challenges in achieving the goals of the 2030 Agenda, is the continued violation of vulnerable people to make choices about their bodies. “It is still a widespread practice that girls and women with disabilities are sterilised without their consent,” warned Silvia Quan. Many young girls are subjected to hormonal or even surgical treatments for menstrual management, including procedures to prevent their development into women so they are easier to carry and keep clean. These practices, Quan explained, go ahead without any consultation with disability communities at any level of government.

Quan added that these practices are regularly carried out within facilities where many persons with disabilities live. They are largely invisible to society and government, which opens the door for human rights violations. “Governments must recognise the full legal capacity for all persons with disabilities and prohibit practices which hinder the ability of girls and young women with disabilities to freely choose. One of the most important international mechanisms to protect these rights is the Convention on the Rights of Persons with Disabilities.”

Education is key for defending everyone’s rights

As the panel turned to solutions, Sarah Keogh underscored the value of education. “Young people need information before they start sexual activity, so that they know how to protect themselves when the time comes, not after the fact.”

She explained that with many younger adolescents still in in school, the classroom was a key venue for delivering rights and comprehensive sexuality education. She would like to see educational institutions and health facilities examine how they promote harmful gender norms or delivery judgements when providing sexual and reproductive health information for young people. Keogh outlined strategies for moving forward, including training health and education providers to offer non-judgemental contraception information and reaching out to those who cannot reach the facilities on their own, such as married girls in restrictive relationships and refugees.