Barriers to Accessing Sexual and Reproductive Healthcare and Information
Access to sexual and reproductive health care and information is difficult for most of the population in Iran. Traditional and religious beliefs about sexuality, lack of any sexual health education in official school curricula, and the absence of public information programs have contributed to low levels of awareness.
Due to additional barriers, persons with disabilities experience greater difficulties accessing these services and information. Women with physical disabilities told us that they rarely visit gynecologists or undergo sexual health preventative care due to financial and mobility restrictions, a lack of professional assistance to facilitate doctors’ visits, and a lack of information about the importance of this care.
For example, Vajiheh, a woman with a physical disability who uses a wheelchair said, “Going out is so difficult and expensive for me that I do my best to limit it to the most urgent cases. Because I have a spinal cord injury, I don’t feel anything in my body below my chest. So, I have not noticed any problems in my sexual organs. I don’t give priority to this issue. I really don’t remember when I last visited a gynecologist.”
Reliance on family members, due to the lack of availability of personal assistants or sign language interpretation, interferes with women’s comfort in seeking gynecological care. Fatemeh, a 32-year-old woman with a physical disability using a wheelchair, said that it had been two years since she was able to visit a gynecologist despite her feeling that she needed to do so. She said, “The only close person I have is my brother. But I really feel embarrassed to ask him to prepare me for a gynecology checkup and lift me on the gynecology exam table.” Shahla, a 24-year-old deaf woman said that she is not able to have a gynecological examination, unless her mother accompanies and interprets for her. “But this is very embarrassing to share everything when my mom is there. So it’s better not to go,” she said.
Inaccessible buildings and facilities may also prevent women who use wheelchairs from accessing diagnostic services. For example, mammography machines are overwhelmingly inaccessible, with only one accessible machine in Tehran with a months-long waiting list.
Two mothers of girls with intellectual or psychosocial disabilities said that when they spoke with health care professionals about how to teach their daughters to manage their menstruation, the medical workers advised them to artificially delay their girls’ puberty through medication. Reihaneh, mother of Yasamin, a 14-year-old girl with intellectual disabilities, said, “When Yasamin was about to start menstruating, our family doctor suggested that we could delay it by injecting some drugs in her. But when I consulted with one of my friends who was a gynecologist, she said it would have lots of side effects. So we decided not to do it.”