Background
Sexual and reproductive health and rights (SRHR) constitute an essential dimension of public health and a fundamental measure of social equity and human rights fulfillment. In Nepal, although progressive legal and policy frameworks have been instituted to safeguard these rights, a substantial segment of the population, especially persons with disabilities (PWDs) continues to experience significant inequities in access to and utilization of SRHR services. Despite possessing the same inherent SRH needs as others, PWDs encounter intersecting structural, social, and institutional barriers that restrict their ability to exercise these rights. This persistent gap between legal commitments and lived realities represents a pressing public health and human rights concern, necessitating rigorous empirical investigation.
A primary concern lies in the multidimensional barriers that obstruct access to SRHR services for PWDs. These barriers are interlinked and mutually reinforcing, encompassing structural, economic, informational, and attitudinal dimensions. Structural barriers include the physical inaccessibility of health facilities, absence of assistive infrastructure, and inadequate transportation systems, particularly in rural areas. Economic constraints further exacerbate exclusion, as PWDs often belong to the lowest income strata, rendering healthcare costs unaffordable. Informational barriers, such as the limited availability of SRHR materials in accessible formats, including Braille, audio, or sign language further restrict health literacy and informed decision-making among this population.[3]
The denial or neglect of SRHR among PWDs has far-reaching implications. Evidence suggests that women with disabilities are disproportionately exposed to sexual and gender-based violence, with some estimates indicating up to a threefold higher risk compared to non-disabled women. Violations of bodily autonomy such as coerced sterilization, forced abortion, and denial of reproductive choices further undermine their reproductive rights. These violations not only compromise physical health but also contribute to psychological distress, low self-esteem, and reduced health-seeking behaviors, perpetuating a cycle of exclusion and vulnerability.1
Nepal’s policy environment demonstrates formal commitment to disability-inclusive health. The country is a signatory to the Convention on the Rights of Persons with Disabilities (CRPD) and has enacted key domestic laws, including the Disability Rights Act (2017) and the Safe Motherhood and Reproductive Health Rights Act (2018), both of which prohibit discrimination and mandate inclusive service provision. Nonetheless, the translation of these legal provisions into practice remains inadequate. Structural inaccessibility, limited provider training, and insufficient integration of disability perspectives into SRHR programming continue to hinder effective implementation.
This mismatch between policy and practice underscores the urgent need for evidence-based inquiry into the systemic, social, and institutional factors that constrain access to SRHR for PWDs. Accordingly, this study seeks to examine the barriers influencing SRHR service access, the lived experiences of PWDs within the healthcare system, and the competencies of service providers in delivering disability-inclusive care. By generating empirical insights across these domains, the study aims to inform targeted policy reform and programmatic interventions to ensure that the SRHR of all persons with disabilities in Nepal are respected, protected, and fulfilled.
Scope of the Work
PHRD Nepal will work in close collaboration with the Sunaulo Parivar Nepal team and will be primarily responsible for organizing, managing, and implementing the research activities, ensuring timely delivery of a high-quality report. The development of the methodology, data collection tools, and fieldwork will be carried out in consultation with the Sunaulo Parivar Nepal team.
In the Preparatory Phase, PHRD Nepal will conduct a desk review of national and relevant international literature, laws, and policies on disability and SRHR. A detailed research proposal, including the methodology, tools, and ethical considerations, will be prepared and submitted to the Nepal Health Research Council (NHRC) for ethical approval. Qualitative data collection tools (FGD, IDI, and KII guides) will be developed and translated into local languages, and coordination meetings will be held with government and key stakeholders to finalize the research plan.
During the Fieldwork Phase, PHRD Nepal will conduct in-depth interviews and focus group discussions with persons with various disabilities of reproductive age, including youth with disabilities, as well as with health service providers, local government representatives, and other stakeholders. The fieldwork will ensure gender, disability type, and geographic diversity, and will follow inclusive, safe, and accessible data collection practices.
Study Location
The study will be conducted in two districts: Dhanusha District of Madhesh Province and Rupandehi District of Lumbini Province.
Study Population
The study population will include PWDs who are currently receiving SRH services, PWDs who are not accessing such services, as well as key stakeholders involved in service provision and management. These include healthcare providers, program managers, and trainers engaged in SRH service delivery and capacity-building for PWD-related programs.
Study Duration
October to December 2025
Study team
Dr. Janak Thapa, Mr. Raj Kumar Sangroula, Ms. Pragya Pokharel, and Ms. Pabitra Balampaki