Relational, Ableist and Gendered Sites of Violence : Perspectives of Tanzanian Girls With Disabilities on Access to Sexual and Reproductive Health Services

This is a sel -a chi ed e sion o an o iginal a icle. This e sion may di e om he o iginal in pagina ion and ypog aphic de ails. Au ho (s): Ti le: Yea : Ve sion: Copy igh : Righ s: Righ s u l: Please ci e he o iginal e sion: CC BY 4.0 h ps://c ea i ecommons.o g/licenses/by/4.0/ Rela ional, Ableis and Gende ed Si es o Violence : Pe spec i es o Tanzanian Gi ls Wi h Disabili ies on Access o Sexual and Rep oduc i e Heal h Se ices © 2023 he Au ho s Published e sion Mesiäisleh o, Vi pi Mesiäisleh o, V. (2024). Rela ional, Ableis and Gende ed Si es o Violence : Pe spec i es o Tanzanian Gi ls Wi h Disabili ies on Access o Sexual and Rep oduc i e Heal h Se ices. Fo um o De elopmen S udies, 51(1), 25-47. h ps://doi.o g/10.1080/08039410.2023.2264857 2024 Full Te ms & Condi ions o access and use can be ound a h ps://www. and online.com/ac ion/jou nalIn o ma ion?jou nalCode=s ds20 Fo um o De elopmen S udies ISSN: (P in ) (Online) Jou nal homepage: h ps://www. and online.com/loi/s ds20 Rela ional, Ableis and Gende ed Si es o Violence: Pe spec i es o Tanzanian Gi ls Wi h Disabili ies on Access o Sexual and Rep oduc i e Heal h Se ices Vi pi Mesiäisleh o To ci e his a icle: Vi pi Mesiäisleh o (04 Oc 2023): Rela ional, Ableis and Gende ed Si es o Violence: Pe spec i es o Tanzanian Gi ls Wi h Disabili ies on Access o Sexual and Rep oduc i e Heal h Se ices, Fo um o De elopmen S udies, DOI: 10.1080/08039410.2023.2264857 To link o his a icle: h ps://doi.o g/10.1080/08039410.2023.2264857 © 2023 The Au ho (s). Published by In o ma UK Limi ed, ading as Taylo & F ancis G oup Published online: 04 Oc 2023. Submi you a icle o his jou nal View ela ed a icles View C ossma k da a Rela ional, Ableis and Gende ed Si es o Violence: Pe spec i es o Tanzanian Gi ls Wi h Disabili ies on Access o Sexual and Rep oduc i e Heal h Se ices Vi pi Mesiäisleh o Depa men o Social Sciences and Philosophy, Uni e si y o Jy äskylä, Jy äskylä, Finland Abs ac Adolescen gi ls’access o sexual and ep oduc i e heal h se ices is a c i ical de elopmen issue in Tanzania whe e he in e sec ion o disabili y and ado- lescence is compounded by ba ie s o sexual and ep oduc i e heal h se ice access and socially no malised gende -based iolence. Using he me hod o empa hy-based s o ies, I explo ed he pe cep ions o 136 Tanzanian adolescen gi ls wi h disabili ies o how gende -based iolence and access o sexual and ep o- duc i e heal h se ices a e in e wined. The findings demons a e ha he in e sec- ion o disabili y and adolescence wi hin sexual and ep oduc i e heal h se ices ende in isible a ious o ms o iolence, which a e no only gende ed bu also ableis . Recognising access o sexual and ep oduc i e heal h se ices as a dis inc si e o iolence and add essing he issue in ele an policies and p og ammes could s eng hen he sexual and ep oduc i e heal h o gi ls wi h disabili ies. Th ough an A ocen ic pe spec i e, he findings con ibu e o he cu en heo e ical cons uc s used o s udy disabili y and de elopmen . They call o a econside a ion o ela- ional dynamics in he con ex o accessible and p o ec ed sexual and ep oduc i e heal h se ices. Keywo ds: sexual and ep oduc i e heal h and igh s; access o sexual and ep oduc i e heal h se ices; gende -based iolence; adolescence; disabili y; Tanzania 1. In oduc ion This a icle is si ua ed a he nexus o schola ly li e a u e on de elopmen and disabil- i y s udies (G ech and Solda ic, 2016; Ka sui and Chalklen, 2020; Shakespea e, 2014), and wi hin he concep ual de elopmen o iolence in he con ex o sexual and ep o- duc i e heal h se ices (Chadwick, 2021; Lappeman and Swa z, 2021; La e y and de Vos, 2022; Wudneh e al., 2022). I d aws on he unde s anding ha ensu ing access o sa e, accessible, and good quali y adolescen sexual and ep oduc i e heal h se ices is c i ical o sus ainable de elopmen (S a s e al., 2018). The Sus ainable De elopmen Goals’ a ge 3.7 calls o uni e sal access o sexual and ep oduc i e heal h se ices, and he Uni ed Na ions (UN) Con en ion on he © 2023 The Au ho (s). Published by In o ma UK Limi ed, ading as Taylo & F ancis G oup This is an Open Access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion License (h p://c ea i ecommons. o g/licenses/by/4.0/), which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed. The e ms on which his a icle has been published allow he pos ing o he Accep ed Manusc ip in a eposi o y by he au ho (s) o wi h hei consen . Fo um o De elopmen S udies, 2023 h ps://doi.o g/10.1080/08039410.2023.2264857 Righ s o Pe sons wi h Disabili ies (CRPD) s ipula es obliga ions o make sexual and ep oduc i e heal h se ices a ailable o pe sons wi h disabili ies on an equal basis wi h o he s (UN, 2006, a . 25). Mo eo e , he UN Commi ee on he Elimina ion o Disc imina ion agains Women (CEDAW) gene al ecommenda ion No. 35 s a es ha ‘abuse and mis ea men o women and gi ls seeking sexual and ep oduc i e heal h in o ma ion, goods and se ices, a e o ms o gende -based iolence’ (CEDAW, 2017, emphasis added). In his ein, add essing iolence agains adoles- cen s, and imp o ing adolescen sexual and ep oduc i e heal h se ices ha e been iden ified as key p io i ies in esea ch on sexual and ep oduc i e heal h and igh s in A ica (Ali e al., 2018). Despi e ambi ious in e na ional policy amewo ks, he a ailable e idence om A ican con ex s demons a es ha al hough adolescen s wi h disabili ies ha e unique, and a imes g ea e needs o sexual and ep oduc i e heal h se ices, hey o en ace challenges accessing hem (Bu ke e al., 2017; Obasi e al., 2019; Rugoho and Maphosa, 2020). Fu he mo e, gi ls wi h disabili ies a e a an inc eased isk o gende -based iolence (Bangu a e al., 2021; Ca ew e al., 2017; Mee and Comb inck, 2015; Njelesani, 2018; Wudneh e al., 2022). Addi ionally, i has been es ablished ha in a ious con ex s iolence influences he access o pe sons wi h dis- abili ies o sexual and ep oduc i e heal h se ices (Mesiäisleh o e al., 2021; Pa el, 2017; Tilley e al., 2012; Wudneh e al., 2022). Using empa hy-based s o ies (EBS) as a me hod o s udy he pe spec i es o Tan- zanian gi ls wi h disabili ies, I explo e gende -based iolence in he con ex o access o sexual and ep oduc i e heal h se ices. I ask, how is gende -based iolence and access o sexual and ep oduc i e heal h in e wined, and specifically, how could he in e sec- ional pe spec i es o disabili y, adolescence and gende in o m he con ex ualised con- cep ualisa ion o iolence and p o ision o sexual and ep oduc i e heal h se ices. The opic is especially significan in he con ex o Tanzania, a coun y wi h mul iple in e - na ional and na ional commi men s o sexual and ep oduc i e heal h and igh s o ado- lescen gi ls wi h disabili ies and an expanding adolescen popula ion, which is expec ed o double by 2050 (Uni ed Republic o Tanzania, 2018). Thus, add essing adolescen s´ sexual and ep oduc i e heal h and igh s in a way ha educes social inequali ies will ha e an impac on he u u e o he na ion (Neal e al., 2020). Mo eo e , he in e sec ion o disabili y, adolescence and gende emains la gely unexplo ed in Tanzania, and is limi ed o only a ew s udies (Mbwilo e al., 2010; Ngi- langwa e al., 2016; Quinones e al., 2021; Sanga e al., 2022). As he gende -based iolence expe ienced by adolescen s wi h disabili ies in Tanzania emains la gely unknown, ecogni ion, p e en ion and add essing i is di ficul . In Tanzania, adoles- cence is cha ac e ised by limi ed access o sexual and ep oduc i e heal h se ices (Mchome e al., 2015; Nka a e al., 2019), and i has been sugges ed ha nega i e ado- lescen sexual and ep oduc i e heal h ou comes a e exace ba ed by disabili y (UNICEF, 2021). Fu he mo e, he s andpoin s o Tanzanian adolescen gi ls in he con ex o accessing sexual and ep oduc i e heal h se ices emain unde ep esen ed 2 Vi pi Mesiäisleh o in esea ch as well as in a socie y. This excludes he pe spec i es o his popula ion om con ex ualised unde s anding o he links be ween access o sexual and ep oduc- i e heal h se ices and gende -based iolence. This a icle is di ided in o six pa s. Fi s , I in oduce he concep ualisa ions o dis- abili y and iolence. Second, I p esen he s uc u al ac o s specific o he Tanzanian con ex . Thi d, in he me hods sec ion I p esen p ac ices o knowledge p oduc ion, esea che posi ionali y, e hical conside a ions and limi a ions o his s udy. Fou h, I p o ide he esul s o he analysis. Fi h comes he discussion o he concep ual ad ancemen ollowing on om he esul s, and finally I conclude wi h implica ions o de elopmen and disabili y esea ch, policy and p ac ice. 2. Defini ions o concep s and heo e ical inspi a ions Disabili y is a mul i ace ed, complex phenomenon. I is a mani es a ion o human di e - si y ha a ies ac oss di e en con ex s (Ka sui and Chalklen, 2020). Lack o wel a e egimes and o mal sa e y ne s o en cha ac e ise he expe ience o disabili y in global Sou h con ex s (G ech, 2011, p.91) whe e 80 pe cen o he wo ld’s pe sons wi h dis- abili ies li e (WHO and The Wo ld Bank, 2011). Unique aspec s ela ed o disabili y in he global Sou h and he human igh s pa adigm in oduced by he CRPD ha e in e - wined disabili y and de elopmen (Ka sui and Chalklen, 2020). The CRPD con inues o ame he e o s and schola ly wo k on ad ancing he well-being o pe sons wi h dis- abili ies globally. I s na ow and la gely global No h-o ien ed pe spec i es o disabil- i y, howe e , a e inc easingly being c i icised o lacking engagemen wi h local knowledges and s eng h-based s a egies (Abbay, 2015; G ech, 2011; G ech and Solda ic, 2016; Oya o, 2015; Rao and Kalyanpu , 2020). Acco ding o he CRPD, disabili y esul s om he in e ac ion be ween an indi id- ual’s impai men , and pe sonal and en i onmen al ac o s (UN, 2006), a defini ion which is employed he e. Fu he mo e, he in e sec ional unde s anding o disabili y, in ela ion o gende and adolescence (Bai d e al., 2021; La son e al., 2016)is use ul o expanding ou unde s anding o he mul i ace ed expe ience o disabili y and ela ed in e sec ing and unique o ms o dis/ad an age (McC ae, 2019). One such disad an age is lack o ecogni ion o adolescen gi ls wi h disabili ies as knowe s which pe pe ua es epis emic iolence agains hem (Do son, 2011; Ndlo u-Ga sheni, 2018; Ned, 2022). Dis ega ding he in e sec ional pe spec i es o iolence in he con ex o accessing sexual and ep oduc i e heal h se ices may isk his epis emic iolence being ansla ed in o o he o ms o s uc u al and sys emic iolence (Ned, 2022, p. 486). Gende -based iolence ma e s o gi ls and women, amilies and socie ies, and ou common u u e. I app oach gende -based iolence p ima ily as an in e na ional de el- opmen issue, an impedimen o he p og ess owa ds equali y o pe sons wi h disabil- i ies (UN, 2015; S a s e al., 2018). The UN Gene al Assembly (1993)defines gende - based iolence as ‘any ac o iolence ha esul s in, o is likely o esul in, physical, Fo um o De elopmen S udies 3 sexual o psychological ha m o su e ing o women’. The concep o iolence wi hin sexual and ep oduc i e heal h se ices is de eloping apidly (e.g. Chadwick, 2021; Lappeman and Swa z, 2021; Lé esque and Fe on-Pa ay e, 2021) and a defini ion o iolence ha embeds he indi idual, s uc u al and policy le els has p o en use ul (F eedman e al., 2014; Lappeman and Swa z, 2021). Violence can be unde - s ood as s uc u al and when wo en in o he ab ic o socie y i pe pe ua es social and heal h inequali ies (Fa me , 2013; Sadle e al., 2016, p. 50). S uc u al iolence mani- es s a o ganisa ional and ela ional le els ye is also el deeply by indi iduals (Lappeman and Swa z, 2021). Indi iduals may also become pe pe a o s wi hin sys ems o opp ession e en when hey do no wish o ha m o he s (Fa me , 2013; Lé - esque and Fe on-Pa ay e, 2021) and when hei ins i u ional oles a e complica ed by hei pe sonal eelings (Dubois, 2017). The ela ional sociology (Emi baye , 1997) and he eminis e hics o ca e pa adigm (Ki ay, 2011) shi a en ion beyond he singula and no ma i e unde s anding o iolence, based on he in e na ional human igh s s anda ds, o he ela ional and con ex ual na u e o he ne wo ks o ca e and iolence (Held, 2010). The con ex ualised iew is also c i ical om he pe spec i e o disabili y. In many A ican con ex s he exclusion o pe sons wi h disabili ies is embedded in he geopo- li ical and his o ical con ex s and colonial his o ies (MacLachlan & Swa z, 2009). This has esul ed in pe sons wi h disabili ies being neglec ed in daily li ing (Ned, 2022) and lacking p o ec ion (Nyamnjoh e al., 2022). The expe iences o iolence o child en wi h disabili ies and hei p o ec ion om iolence a e inc easingly heo ised om A ocen ic pe spec i es as opposed o he dominan Eu ocen ic o Wes e n pe spec i es (Bannink Mbazzi e al., 2020; Nyamnjoh e al., 2022). These A ocen ic pe spec i es d aw om A ican communi a ian philosophy (Menki i, 1984; Gyekye, 1987;2004) ha ou lines he unde s anding o pe sonhood – he basis o human wo h and en i lemen o p o ec ion –as ho oughly social and commu- ni y-based (E ieyibo and Ikuenobe, 2020). The po en ial o hese heo e ical ad ances lies in hei abili y o a fi m human wo h and he communi y’s obliga ions owa ds he p o ec ion o gi ls wi h disabili ies om iolence based on ho oughly A ican pe - spec i es (Imafidon, 2021). The schola ly de elopmen s desc ibed he e ha e amed he explo a ion o he s udied phenomenon h ough an A ocen ic and ela ional lens in a la gely uncha ed schola ly e ain. Nex , I con ex ualise he s uc u al iolence in he Tanzanian con ex o accessing sexual and ep oduc i e heal h se ices, a e which I p esen he me h- odological app oaches o add essing he epis emic injus ice o he s udied adolescen s. 3. Se ing he scene: In e sec ion o disabili y, adolescence, and gende in Tanzanian sexual and ep oduc i e heal h landscape The challenges ha Tanzanian adolescen gi ls wi h disabili ies ace in e ms o access o sexual and ep oduc i e heal h se ices a e se agains a landscape o complex 4 Vi pi Mesiäisleh o poli ical, discu si e and social no ms (Bylund e al., 2020; Sambaiga e al., 2019). Tanzania was among he fi s signa o ies o he CRPD and he Op ional P o ocol in he Eas A ican egion (Mi a, 2018). The na ion is commi ed o mul iple in e - na ional legal and policy ins umen s ha ea fi m i s obliga ions o espec , p o ec and ulfil he sexual and ep oduc i e heal h and igh s o gi ls wi h disabili ies as well as o ensu e hei eedom om iolence. 1 Ne e heless he in e sec ion o ado- lescence and disabili y emains ambiguous in policies and legisla ion, which place dis- abili y unde he b oade ‘ ulne able g oups’ca ego y, igno e unique o ms o disabili y-specific iolence and dis ega d disabili y-specific ac ions. Fo ins ance, he Na ional Heal h Policy Heal h Sec o S a egic Plan (HSSP IV) and he Adolescen Heal h and De elopmen S a egy o 2018–2022 se he s anda d ha adolescen s, i espec i e o hei disabili y, ha e a igh o access sexual and ep o- duc i e heal h se ices ha a e app op ia e and ele an o hei needs. These s an- da ds, howe e , lack a defini ion o he e ms ‘ ele an ’o ‘app op ia e’, and con ain no specific guidance o adolescen s wi h disabili ies as se ice use s. The abo e sho alls a e also p esen in he Tanzania Na ional Plan o Ac ion o End Violence agains Women and Child en (NPA-VAWC 2017/2018-2021/2022) (Uni ed Republic o Tanzania, 2016) which is cu en ly being upda ed. The social and gende no ms ela ed o disabili y o en ha e a g ea e influence han policy and legisla ion on how pe sons wi h disabili ies, and hei sexual and ep oduc i e heal h, a e pe cei ed in hei communi ies (Onazi, 2020; Pe a, 2017). These no ms o en exclude Tanzanian adolescen s wi h disabili ies om communi y li e, deny hem access o educa ion, and lead o a ious nega i e heal h ou comes (Alde sey, 2012; Quinones e al., 2021). Fu he mo e, ex ensi e e idence indica es ha he s igma owa ds adolescen s in sexual and ep oduc i e heal h se ices is p e a- len in Tanzania and hinde s he access o adolescen s, including hose wi h disabil- i ies, o sexual and ep oduc i e heal h se ices (Mbeba e al., 2012; Mesiäisleh o e al., 2021; Nyblade e al., 2017). Gende -based iolence agains adolescen s is socially no malised in Tanzania (Abeid e al., 2014; Mlyakado and Li, 2019). Fu he - mo e, e idence ha women and gi ls wi h disabili ies a e disp opo iona ely a ec ed by gende -based iolence is g adually accumula ing (ADD In e na ional, 2016; G een- wood e al., 2016). Like o he o ms o gende -based iolence in Tanzania, iolence in sexual and ep oduc i e heal h ca e se ings is widesp ead and sys ema ic in na u e and is oo ed in pa ia chal s uc u es and gende ed s e eo ypes (Kujawski e al., 2015; Sando e al., 2016). 1 UN Con en ion on he Elimina ion o Disc imina ion agains Women (CEDAW) (1979), UN Con en ion on he Righ s o he Child (CRC) (1989), Agenda 2030 o Sus ainable De elop- men (2015); In e na ional Con e ence on Popula ion and De elopmen (ICPD) P og amme o Ac ion (1994), Nai obi S a emen ICPD+25 (2019), Mapu o P o ocol (2003), and he P o- ocol o he A ican Cha e on Human and Peoples’Righ s on he Righ s o Pe sons wi h Disabili ies in A ica (2018). Fo um o De elopmen S udies 5 The abo e con ex ual and s uc u al ac o s end o ma ginalise gi ls wi h disabil- i ies in Tanzanian socie y. Howe e , how hese ac o s a e mani es ed in ela ional e ms and a he indi idual le el emains la gely unknown. This a icle examines he la gely unexplo ed epis emic s andpoin s o Tanzanian gi ls wi h disabili ies o gain a mo e comp ehensi e unde s anding o his opic and o coun e ac he coloni- ali y o knowledge p oduc ion. 4. Me hods This s udy is g ounded in he cons uc i is pa adigm (Denzin and Lincoln, 2018) and aims o unde s and he social wo ld o i s pa icipan s. In my ques o ich explo a o y da a, I used quali a i e pa icipa o y disabili y esea ch me hodology. A esea ch iad consis ing o he esea che , a Tanzanian esea ch ad iso y commi ee and a Tanzanian esea ch assis an wi h disabili ies was es ablished in collabo a ion wi h he Tanzania Fede a ion o Disabled People’s O ganisa ions. This c oss-disabili y iad ensu ed ha pe sons wi h disabili ies main ained an ac i e s ance h oughou he esea ch, which was c ucial o de eloping app op ia e me hods, in e p e ing da a, and alida ing he esul s (G ischow e al., 2021; Kupe e al., 2021; Wickenden and Kembha i-Tam, 2014). The expe membe s o he commi ee had knowledge o he s a us o gi ls wi h disabili ies beyond hei own expe iences, making hem insigh - ul sou ces o in o ma ion (Ka sui and Moj ahedi, 2015; Sande son e al., 2013). My posi ion as a Eu opean woman in he ou ies, a de elopmen s udies schola , and a mid-ca ee in e na ional de elopmen p o essional has influenced he esea ch o some ex en . Howe e , he pa icipa o y esea ch design, esiding in Tanzania o o e nine yea s and he expe iences in engaging wi h adolescen s wi h disabili ies in com- muni y de elopmen p og ammes p o ed use ul in making sense o he s udied phenomena. As I do no sha e he expe ience o disabili y wi h hose whom I ha e col- labo a ed wi h in his esea ch I p ac iced sel - eflexi i y o ecognise and a oid assump ions based on my own expe iences. Al hough my mind was al eady ideologi- cally wi ed in o he human igh s ideology, my long- e m p esence and expe iences in Tanzania allowed me o c i ically eflec on i . A pu posi e sampling ame was es ablished oge he wi h he esea ch iad o iden i y and ec ui he s udy pa icipan s. The da a we e collec ed in h ee egions ac oss 13 loca ions. The pa icipan s we e 136 gi ls wi h disabili ies, aged 10–19. Some o hese adolescen s we e dea (n= 42), and one dea pa icipan also had phys- ical disabili ies. Some pa icipan s had physical disabili ies (n= 33). O hose wi h albinism (n= 32) some also had pa ial ision (n= 11). O he pa icipan s had in ellec- ual disabili ies (n= 13), blindness (n= 12), and pa ial ision (n= 4). The esea ch employed he me hod o empa hy-based s o ies, which is based on cons uc i is epis emologies, and sees eali y as con ex ually and socially cons uc ed (Eskola, 1997). Empa hy-based s o ies (EBS) a e fic ional sho s o ies na a ed by s udy pa icipan s as a esponse o a ame s o y (Pos i-Ahokas, 2013). Al hough 6 Vi pi Mesiäisleh o he p ima y ocus o me hod o empa hy-based s o ies is no o in es iga e he expe i- ences o he pa icipan s, bu a he hei pe cep ions; i enables pa icipan s o disclose hei li ed expe iences i hey so wish. me hod o empa hy-based s o ies is an e hically sensi i e da a collec ion me hod, as i allows pa icipan s o dis ance hemsel es om sensi i e and s ess ul opics (Wallin e al., 2018). The ame s o ies cen ed on wo p o agonis s, Fa uma and Nu u, and wo scen- a ios based on he common easons ha adolescen gi ls seek sexual and ep oduc i e heal h se ices in Tanzania: p egnancy and sexually ansmi ed in ec ions (STI) (Mbeba e al., 2012). To cap u e he pe spec i es o he pa icipan s, I used he ollow- ing ame s o ies: Fa uma John is an 18-yea -old gi l wi h disabili ies, and she is p egnan . She needs o a end he heal h clinic. A e isi ing he clinic, she eels happy and sa e. Tell us wha happened a he clinic ha made he eel happy. Nu u Hassan is a 15-yea -old gi l wi h disabili ies. Nu u has a disease in he p i a e pa s, and she is expe iencing discom o . She needs o see he doc o . In he mee ing wi h he heal h p o essional some hing goes e ibly w ong. A e wa ds Nu u is eally upse . Tell us wha happened when she me he heal h p o essional. Tell us wha dis u bed he so much. The ame s o ies we e de eloped by he esea ch iad and pilo ed p io o da a collec ion. The s o ies we e compounded wi h audio and isual aids. The pa ici- pan s ook pa in he s o y elling e bally, by w i ing in Kiswahili o by using Tan- zanian sign language. The e bally collec ed s o ies we e ansc ibed e ba im and hen ansla ed om Kiswahili in o English. The quali y o he ansla ions was moni o ed by he esea ch iad. The da a comp ised 257 EBS na a ed by he 136 gi ls wi h disabili ies. The EBS we e on a e age 902 cha ac e s long. In addi ion, wo ocus g oup discussions (FGD) (B een, 2006) we e held wi h he esea ch ad iso y commi ee, du ing which p elimina y esul s we e discussed and final esul s we e alida ed. This iangula ion o he da a om he EBS and he FDG s eng hened he alidi y o he esea ch and educed esea che bias, as mul iple s eams o knowledge we e u ilised. The design and me hodology o he s udy we e in o med by a ious e hical con- side a ions, such as ensu ing he meaning ul pa icipa ion o pe sons wi h disabili ies ac oss di e en esea ch phases and gua an eeing easonable accommoda ion and accessibili y ( an de Heijden e al., 2019). To ensu e in o med consen , in o ma ion sessions we e held wi h he pa icipan s and hei gua dians on he esea ch si es. An ‘explain-back’p o ocol (Tale ski e al., 2020) was used in he p ocess o ob aining in o med consen , ollowed by he w i en consen o he pa icipan s and hei gua - dians. The Na ional Resea ch E hics Commi ee a he Na ional Ins i u e o Medical Resea ch in Tanzania g an ed e hical app o al o his esea ch. 2 2 E hical clea ance e e ence NIMR/HQ/R.8a/Vol. IX/2970 Fo um o De elopmen S udies 7 adolescen sexuali y (Bylund e al., 2020; Nyblade e al., 2017) and human wo h being based on senio i y (Nyamnjoh e al., 2022). As hese in e sec ing sys ems o opp ession may p oduce nega i e sexual and ep oduc i e heal h ou comes, li e- h ea- ening si ua ions and u he ma ginalisa ion, ecognising sexism, ableism and ageism will help un eil iolence in he con ex o accessing sexual and ep oduc i e heal h se ices agains gi ls wi h disabili ies. Based on he in e sec ional pe spec i es b ough o h in his s udy, I concu wi h Lé esque and Fe on-Pa ay e (2021) ha acknowledging he pa icula , in ima e con ex o sexual and ep oduc i e heal h se ices, cen ing he oices o hose a ec ed by iolence wi hin hese con ex s, and iden i ying he sys ems o opp ession inhe en o he specific na u e o sexual and ep oduc i e heal h se ices is cen al o e hinking iolence in access o sexual and ep oduc i e heal h se ices. Disabili y- specific and gende ed iolence, when ex ended o he pa icula , in ima e con ex s o sexual and ep oduc i e heal h ca e, would hen equi e inc easingly specific con- cep ualisa ions such as ep oduc i e iolence (Al unjan, 2021; Chiweshe e al., 2021; La e y and de Vos, 2022), obs e ic iolence (Chadwick, 2016) and gynaecological iolence (Rozée and Schan z, 2021). Thus, I concu wi h Lappeman and Swa z (2021) ha de elopmen o accu a e e minology has implica ions o how esea ch esul s a e eflec ed in policy and p ac ice. The cu en s udy he e o e sugges s ha he concep ualisa ions o iolence in he con ex o accessing sexual and ep oduc i e heal h se ices need o be mo e specific. They should no all be me ely placed unde he b oade ca ego y o gende -based io- lence (Chadwick, 2021), ins ead hey should be app oached h ough in e sec ional pe - spec i es, including hose based on disabili y (Chadwick and Jace Ma uso, 2021). These pe spec i es could be u he used o iden i y and add ess he specific mis ea men ha occu s bo h in sexual and ep oduc i e heal h se ices, and when accessing hem. Fu - he mo e, applying hese mo e de ailed concep ualisa ions in his c i ical a ea o esea ch is o pa amoun impo ance o un eiling and add essing disc imina ion, non-consensual ca e and abuse ha unde pin he expe iences o gi ls wi h disabili ies wo ldwide. 6.2. Re aming accessibili y and p o ec ion h ough A ocen ic disabili y heo ies The Tanzanian con ex highligh s o he limi a ions o cu en concep ualisa ions when disabili y, access o sexual and ep oduc i e heal h se ices and gende -based iolence o e lap. The findings o his s udy suppo Ka sui’s(2012) iew ha he human igh s model o disabili y ounded on he CRPD, o e s e y li le o no immedia e elie o pe sons wi h disabili ies who equi e day- o-day assis ance o o e come ba ie s in en i onmen s whe e no o malised suppo sys ems a e a ailable (see Heikkilä e al., 2020). This is pa icula ly so when o mal and ins i u ionalised accessibili y does no exis and in si ua ions in which accessible s uc u es may ail ei he momen- a ily o o longe (Ka sui and Chalklen, 2020). As he findings o he s udy po ayed, 14 Vi pi Mesiäisleh o o e coming ba ie s o sa ely accessing sexual and ep oduc i e heal h se ices akes mo e han an indi idual claiming hei igh s. When designing se ices ha espond o he cha ac e is ics o adolescen gi ls wi h disabili ies, his s udy sugges conside ing he ela ionali y and collec i e dynamics be ween indi iduals and he in o mal amilial and communal ne wo ks o ca e (Le esque e al., 2013; Onazi, 2020) ha a e di e en o hose ha a e non-A ican (e.g. Ami , 2002). The ela ional dynamics p esen ed in his s udy eflec he A ican e hic o in e dependence, h ough which indi iduals a e iewed in ela ional a he han indi idualis ic e ms (Be ghs, 2017; Onazi, 2020). The findings concu wi h no el disabili y heo isa ions eme ging om he A ican con inen , which ha e he po en ial o ame hese ela ional dynamics in esea ch on access o and p o ec ion in sexual and ep oduc i e heal h se ices and add ess he decon ex ualisa ion o global No h-o ien ed disabili y heo isa ions (Imafidon, 2021; Nyamnjoh e al., 2022). Cen al o A ocen ic disabili y heo isa ions is he concep o pe sonhood ha is he basis on which a pe son wi h disabili ies is conside ed a ull membe o socie y and can enjoy se ices and p o ec ion on an equal basis wi h o he s (Imafidon, 2021; Nyamnjoh e al., 2022). The pe spec i es o he s udied adolescen s depic ed how na i- ga ing access o sexual and ep oduc i e heal h se ices esembled wha Onazi (2020) desc ibed as ‘asymme ical obliga ions’. Acco ding o Onazi (2020), asymme ical obliga ions a e no based on mu ual ecip oci y; hey a e obliga ions o hose who, in a ce ain ime and place, a e in a posi ion o suppo and assis o he s. This highligh s he ambi alence o disabili y and dena u alises pe sons wi h disabili ies as ulne able by de aul . Such unde s anding wea es pe sons wi h disabili ies igh e in o he social ab ic o he socie y –in o mal ne wo ks o suppo , ca e and p o ec ion – ha ha e he po en ial o ad ance sexual and ep oduc i e heal h and p o ec agains gende -based iolence when gaps in o malised suppo s exis s (Nyamnjoh e al., 2022). The concep o asymme ical obliga ions may be beneficial o e-imagining an accessible and p o ec ed access o sexual and ep oduc i e heal h se ices ha is esponsi e o he cha ac e is ics o adolescen gi ls wi h disabili ies whe e in e depen- dence ends o be alued o e independence. Rela ional dynamics should he e o e be unde s ood as an unde - heo ised esou ce o add essing iolence agains adolescen gi ls wi h disabili ies and access o sexual and ep oduc i e heal h se ices in social con ex s like Tanzania. 7. Conclusions This s udy is he fi s known s udy in Tanzania o explo e how gende -based iolence in e wines wi h access o sexual and ep oduc i e heal h se ices and o ocus on he in e sec ionali y o disabili y and adolescence. I con ibu es o e hinking he concep- ual appa a us o gende -based iolence h ough in e sec ional and con ex ual lenses. I highligh s he po en ial o in e sec ional ames o iden i y, esis and add ess he no malisa ion o he ableis , sexis and ageis sys ems o opp ession ha impede Fo um o De elopmen S udies 15 access o sexual and ep oduc i e heal h se ices, esul in iolence and con ibu e o u he ma ginalisa ion. Re hinking gende -based iolence h ough in e sec ionali y could po en ially lead o he ollowing: fi s , by ejec ing he no malisa ion o he inac- cessibili y o sexual and ep oduc i e heal h se ices and by e aming i as s uc u al iolence, a mo e disabili y-inclusi e in e sec ional policy and p og amma ic in e en- ions on adolescen s’access o sexual and ep oduc i e heal h se ices could be designed and implemen ed. Second, depa ing om gene al defini ions o gende - based iolence h ough p ecision in concep ualising gende -based iolence (e.g. ep o- duc i e, gynaecological and obs e ic), and i s linkages o ealising access o sexual and ep oduc i e heal h se ices ha e implica ions o legal and policy amewo ks. Thi d, concep ualisa ions o sexual and ep oduc i e heal h ca e and p o ec ion agains gende -based iolence ha d aw om A ocen ic disabili y heo isa ions could en ich he human igh s model o disabili y and esea ch pa adigms a he nexus o disabili y and de elopmen s udies in con ex s like Tanzania. Acknowledgemen s I would like o exp ess my g a i ude o all he s udy pa icipan s o hei i id and ich empa hy-based s o ies. I am also g a e ul o he commi men , ene gy, and ime ha he esea ch assis an and he esea ch ad iso y commi ee membe s in es ed in his esea ch. Wi hou he coope a ion o he Tanzania Fede a ion o he Disabled People’s O ganisa ions, his esea ch would no ha e been possible o wo hwhile. I also would like o ecognise he adminis a i e suppo o D . Richa d Sambaiga om he Depa men o Sociology a he Uni- e si y o Da es Salaam. Disclosu e s a emen No po en ial conflic o in e es was epo ed by he au ho (s). Funding This wo k was suppo ed by Emil Aal osen Sää iö, Jy äskylän Yliopis o, Keski-Suomen Rahas o, Finnish Socie y o Disabili y Resea ch. Au ho Vi pi Mesiäisleh o (PhD) is an in e na ional de elopmen p o essional wi h 10 yea s o expe i- ence in Eas e n A ica. He expe ise is in ad ancing sexual and ep oduc i e heal h and igh s (SRHR) o pe sons wi h disabili ies in he global Sou h con ex s. She has expe ience in disabil- i y inclusion om communi y-based, ci il socie y-d i en, bila e al and mul ila e al de elop- men coope a ion. Mesiäisleh o has collabo a ed wi h a wide ange o s akeholde s o ad ance he ealisa ion o SRHR, including wi h o ganisa ions o pe sons wi h disabili ies, eli- gious and adi ional leade s, go e nmen s, ci il socie y o ganisa ions, and UN agencies in bo h global Sou h and No h. In 2022, she co-edi ed an in e na ional esea ch book i led ‘Embodied Inequali ies in Disabili y and De elopmen ’. 16 Vi pi Mesiäisleh o Re e ences Abbay, F., 2015,‘E alua ion o disabili y human igh s unde he A ican Regional Human Righ s Sys em’,A ican Jou nal o In e na ional and Compa a i e Law, Vol. 23, No. 3, pp. 476–502. doi:10.3366/ajicl.2015.0132 Abeid, M., P. Muganyizi, P. Olsson, E. Da j and P. Axemo, 2014,‘Communi y pe cep ions o ape and child sexual abuse: A quali a i e s udy in u al Tanzania’,BMC In e na ional Heal h and Human Righ s, Vol. 14, pp. 23. doi:10.1186/1472-698X-14-23 ADD In e na ional, 2016,Disabili y and Gende -Based Violence: Pee Resea ch in Kibaha and Mku anga, Tanzania: ADD In e na ional. Alde sey, H., 2012,‘Family pe cep ions o in ellec ual disabili y: Unde s anding and suppo in Da es Salaam’,A ican Jou nal o Disabili y, Vol. 1, pp. 32. doi:10.4102/ajod. 1i1.32 Ali, M., M. Fa on, L. Oued aogo, R. K. Mahaini, K. Mille and R. Kab a, 2018,‘Resea ch gaps and eme ging p io i ies in sexual and ep oduc i e heal h in A ica and he eas e n Medi e anean egions’,Rep oduc i e Heal h, Vol. 15, pp. 39. doi:10.1186/s12978-018- 0484-9 Al unjan, T., 2021,Rep oduc i e Violence and In e na ional C iminal Law, In e na ional C iminal Jus ice Se ies, The Hague: T.M.C. Asse P ess. Ami , V., 2002,Realizing Communi y: Concep s, Social Rela ionships and Sen imen s, London: Rou ledge. Bai d, S., L. Camfield, A. Ghimi e, B. A. Hamad, N. Jones, K. Pincock and T. Woldehanna, 2021,‘In e sec ionali y as a amewo k o unde s anding adolescen ulne abili ies in low and middle income coun ies: Expanding ou commi men o lea e no one behind’, The Eu opean Jou nal o De elopmen Resea ch, Vol. 33, pp. 1143–1162. doi:10.1057/ s41287-021-00440-x Bangu a, I. R., J. Njelesani and D. Njelesani, 2021,‘“Nigh wi es”and he educa ion o gi ls wi h disabili ies in Sie a Leone.’Ox o d Resea ch Encyclopedia o Educa ion.h ps:// ox o d e.com/educa ion/ iew/10.1093/ac e o e/9780190264093.001.0001/ac e o e-97801 90264093-e-439. Bannink Mbazzi, F., R. Nalugya, E. Kawesa, H. Nambejja, P. Nizeyimana, P. Ojok, G. Van Ho e and J. Seeley, 2020,‘Obun u Bulamu’: De elopmen and es ing o an indigenous in e en ion o disabili y inclusion in Uganda. Be ghs, M., 2017,‘P ac ices and discou ses o ubun u: Implica ions o an A ican model o disabili y?’,A ican Jou nal o Disabili y, Vol. 6, pp. e1–e8. doi:10.4102/ajod. 6i0.292 B een, R. L., 2006,‘A p ac ical guide o ocus-g oup esea ch’,Jou nal o Geog aphy in Highe Educa ion, Vol. 30, pp. 463–475. doi:10.1080/03098260600927575 Bukuluki, P., P. Kisaakye, S. P. Wandiembe, T. Musuya, E. Le iyo and D. Bazi a, 2021, ‘An examina ion o physical iolence agains women and i s jus ifica ion in de elopmen se - ings in Uganda’,PLoS One, Vol. 16, pp. e0255281. doi:10.1371/jou nal.pone.0255281 Bu ke, E., F. Kébé, I. Flink, M. an Reeuwijk and A. le May, 2017,‘A quali a i e s udy o explo e he ba ie s and enable s o young people wi h disabili ies o access sexual and ep oduc i e heal h se ices in Senegal’,Rep oduc i e Heal h Ma e s, Vol. 25, pp. 43– 54. doi:10.1080/09688080.2017.1329607 Bylund, S., M. Målq is , N. Pe e and S. He zig an Wees, 2020,‘Nego ia ing social no ms, he legacy o e ical heal h ini ia i es and con adic ing heal h policies: A quali a i e s udy o heal h p o essionals’pe cep ions and a i udes o p o iding adolescen sexual and ep o- duc i e heal h ca e in A usha and Kilimanja o egion, Tanzania’,Global Heal h Ac ion, Vol. 13, pp. 1775992. doi:10.1080/16549716.2020.1775992 Fo um o De elopmen S udies 17 Ca ew, M. T., S. H. B aa hen, L. Swa z, X. Hun and P. Rohlede , 2017,‘The sexual li es o people wi h disabili ies wi hin low- and middle-income coun ies: A scoping s udy o s udies published in English’,Global Heal h Ac ion, Vol. 10, pp. 1337342. doi:10.1080/ 16549716.2017.1337342 Casebol , M. T., 2020,‘Ba ie s o ep oduc i e heal h se ices o women wi h disabili y in low- and middle-income coun ies: A e iew o he li e a u e’,Sexual & Rep oduc i e Heal hca e, Vol. 24, pp. 100485. doi:10.1016/j.s hc.2020.100485 CEDAW, 2017, Gene al ecommenda ion No. 35 on gende -based iolence agains women, upda ing gene al ecommenda ion No. 19. Chadwick, R. J., 2016,‘Obs e ic iolence in Sou h A ica’,Sou h A ican Medical Jou nal, Vol. 106, pp. 423. doi:10.7196/SAMJ.2016. 106i5.10708 Chadwick, R., 2021,‘B eaking he ame: Obs e ic iolence and epis emic up u e’,Agenda, Vol. 35, pp. 104–115. doi:10.1080/10130950.2021.1958554 Chadwick, R. and J. M.-J. Jace Ma uso, 2021,‘On ep oduc i e iolence: F aming no es’, Agenda, Vol. 35, pp. 1–11. doi:10.1080/10130950.2021.1987074 Chilwalo, M., 2020,‘Communi y-based, endogenous and ubun u inspi ed child p o ec ion mechanisms: case o he gi l powe p og am in add essing school- ela ed gende -based iolence in Chibombo Dis ic o Zambia’,A ican Jou nal o Social Wo k, Vol. 10, pp. 10–15. Chiweshe, M. T., T. Fe e s and E. Coas , 2021,‘Whose bodies a e hey? Concep ualising ep oduc i e iolence agains adolescen s in E hiopia, Malawi and Zambia’,Agenda, Vol. 35, pp. 12–23. doi:10.1080/10130950.2021.1964220 Coas , E., N. Jones, U. M. F ancoise, W. Yade e, R. Isimbi, K. Gezahegne and L. Lunin, 2019, ‘Adolescen sexual and ep oduc i e heal h in E hiopia and Rwanda: A quali a i e explo a- ion o he ole o social No ms’,Sage Open,Vol. 9, pp. 215824401983358. doi:10.1177/ 2158244019833587 Denzin, N. K. and Y. S. Lincoln, 2018,The SAGE handbook o quali a i e esea ch, Los Angeles: Sage. Dolan, Ch is, 2014,‘Has pa ia chy been s ealing he eminis s’clo hes? conflic - ela ed sexual iolence and UN secu i y council esolu ions’,IDS Bulle in, Vol. 45, No. 1, pp. 80–84. Do son, K., 2011,‘T acking epis emic iolence, acking p ac ices o Silencing’,Hypa ia, Vol. 26, pp. 236–257. doi:10.1111/j.1527-2001.2011.01177.x Dubois, V., 2017,Bu eauc a and he Poo : Encoun e s in F ench Wel a e O fices, Fa nham: Ashga e. Emi baye , M., 1997,‘Mani es o o a ela ional Sociology’,Ame ican Jou nal o Sociology, Vol. 103, No. 2, pp. 281–317. doi:10.1086/231209 Eskola, J., 1997,Eläy ymismene elmäopas [The Guide o he Me hod o Empah y-Based S o ies], Tampe e: Tampe een yliopis o. E ieyibo, E. and P. Ikuenobe, 2020,Menki i on Communi y and Becoming a Pe son, Lanham: Lexing on Books. Fa me , P., 2013,‘On su e ing and s uc u al iolence: A iew om below’,Race/E hnici y: Mul idisciplina y Global Con ex s, Vol. 3, pp. 11–28. Flick, U., 2017,Designing Quali a i e Resea ch, The Sage Quali a i e Resea ch Ki , Thousand Oaks, CA: SAGE Publica ions. F eedman, L. P., K. Ramsey, T. Abuya, B. Bellows, C. Ndwiga, C. E. Wa en, S. Kujawski, W. Moyo, M. E. K uk and G. Mba uku, 2014,‘Defining dis espec and abuse o women in childbi h: A esea ch, policy and igh s agenda’,Bulle in o he Wo ld Heal h O ganiza ion,Vol. 92, pp. 915–917. doi:10.2471/BLT.14.137869 18 Vi pi Mesiäisleh o Goodley, D., 2014,Dis/Abili y S udies: Theo ising Disablism and Ableism, New Yo k: Rou ledge. G ech, S., 2011,‘Recolonising deba es o pe pe ua ed coloniali y? Decen ing he spaces o dis- abili y, de elopmen and communi y in he Global Sou h’,In e na ional Jou nal o Inclusi e Educa ion, Vol. 15, No. 1, pp. 87–100. doi:10.1080/13603116.2010.496198 G ech, S. and K. Solda ic, 2016,Disabili y in he Global Sou h, In e na ional Pe spec i es on Social Policy, Adminis a ion, and P ac ice, Cham: Sp inge In e na ional Publishing AG. G eenwood, M., B. Fakih, M. S e , S. Bechange and M. M isho, 2016,‘Hea my oice: A com- muni y-based pa icipa o y s udy ga he ing he li ed expe iences o people wi h disabili ies and olde people in Tanzania’,Knowledge Managemen o De elopmen Jou nal, Vol. 2016, pp. 63–78. G ischow, J., A. Naami, W. Mp ah and M. M oa o-M’Ca hy, 2021,‘Me hodologically hink- ing: Doing disabili y esea ch in Ghanaian cul u al Communi ies’,Scandina ian Jou nal o Disabili y Resea ch, Vol. 23, pp. 169–179. doi:10.16993/sjd .702 Gyekye, K., 1987,An Essay on A ican Philosophical Though , Philadelphia: Temple Uni e si y P ess. Gyekye, K., 2004, Pe son and communi y in A ican hough , in P. Coe zee and A. Roux, eds., The A ican Philosophy Reade , New Yo k: Rou ledge, pp. 348–365. A ailable a : h p:// www.gale ie-in e .de/kimme le/ ameTex 9.h m. Heikkilä, M., H. Ka sui and M. Mus aniemi-Laakso, 2020,‘Disabili y and ulne abili y: A human igh s eading o he esponsi e s a e’,The In e na ional Jou nal o Human Righ s, Vol. 24, pp. 1180–1200. doi:10.1080/13642987.2020.1715948 Held, V., 2010,‘Can he e hics o ca e handle iolence?’,E hics and Social Wel a e, Vol. 4, pp. 115–129. doi:10.1080/17496535.2010.484256 Imafidon, E., 2021,‘A ican communi a ian philosophy o pe sonhood and disabili y: The asymme y o alue and powe in access o heal hca e’,In e na ional Jou nal o C i ical Di e si y S udies, Vol. 4, pp. 46–57. doi:10.13169/in ec i di es ud.4.1.0046. Jewkes, R., 2010,‘Emo ional abuse: A neglec ed dimension o pa ne iolence’,The Lance , Vol. 376, pp. 851–852. doi:10.1016/S0140-6736(10)61079-3 Kabia, E., R. Mbau, K. W. Mu aya, R. Mo gan, S. Molyneux and E. Ba asa, 2018,‘How do gende and disabili y influence he abili y o he poo o benefi om p o-poo heal h finan- cing policies in Kenya? An in e sec ional analysis’,In e na ional Jou nal o Equi y in Heal h, Vol. 17, pp. 149. doi:10.1186/s12939-018-0853-6 Ka sui, H., 2012,Disabili ies, Human Righ s and In e na ional Coope a ion: Human Righ s- Based App oach and Li ed Expe iences o Uganda Women wi h Disabili ies, Publica ion Se ies No.8, Helsinki: The Cen e o Human Righ s o Pe sons wi h Disabili ies. Ka sui, H. and S. Chalklen, 2020,Disabili y, Globaliza ion and Human Righ s, In e disciplina y Disabili y S udies, London: Rou ledge. Ka sui, H. and M. Moj ahedi, 2015,‘In e sec ion o disabili y and gende : Mul i-laye ed expe i- ences o E hiopian women wi h disabili ies’,De elopmen in P ac ice, Vol. 25, pp. 563– 573. doi:10.1080/09614524.2015.1031085 Kennedy, B. L. and R. Tho nbe g, 2018, Deduc ion, induc ion, and abduc ion, in Flick Uwe ed, The SAGE Handbook o Quali a i e Da a Collec ion, London: SAGE Publica ions L d, pp. 49–64. Ki ay, E., 2011,‘The e hics o ca e, dependence, and disabili y’,Ra io Ju is, Vol. 24, pp. 49– 58. doi:10.1111/j.1467-9337.2010.00473.x. Kujawski, S., G. Mba uku, L. P. F eedman, K. Ramsey, W. Moyo and M. E. K uk, 2015, ‘Associa ion be ween dis espec and abuse du ing childbi h and women’s confidence in Fo um o De elopmen S udies 19 heal h acili ies in Tanzania’,Ma e nal and Child Heal h Jou nal, Vol. 19, pp. 2243–2250. doi:10.1007/s10995-015-1743-9 Kupe , H., S. Hameed, V. Reichenbe ge , N. Sche e , J. Wilbu , M. Zuu mond, I. Mac agga , T. B igh and T. Shakespea e, 2021,‘Pa icipa o y esea ch in disabili y in low- and middle-income coun ies: Wha ha e we lea n and wha should we Do?’,Scandina ian Jou nal o Disabili y Resea ch, Vol. 23, pp. 328–337. doi:10.16993/sjd .814 Lappeman, M. and L. Swa z, 2021,‘How gen le mus iolence agains women be in o de o no be iolen ? Re hinking he wo d “ iolence”in obs e ic se ings’,Violence Agains Women, Vol. 27, pp. 987–1000. doi:10.1177/1077801221996444 La son, E., A. Geo ge, R. Mo gan and T. Po ea , 2016,‘10 Bes esou ces on …in e sec ion- ali y wi h an emphasis on low- and middle-income coun ies’,Heal h Policy and Planning, Vol. 31, pp. 964–969. doi:10.1093/heapol/czw020 La e y, C. and D. de Vos, 2022,‘Rep oduc i e iolence as a ca ego y o analysis: Disen angling he ela ionship be ween ‘ he sexual’and ‘ he ep oduc i e’in ansi ional Jus ice’,In e na ional Jou nal o T ansi ional Jus ice, Vol. 15, pp. 616–635. doi:10. 1093/ij j/ijab022 Lé esque, S. and A. Fe on-Pa ay e, 2021,‘To use o no o use he e m “obs e ic iolence”: Commen a y on he a icle by Swa z and Lappeman’,Violence Agains Women, Vol. 27, pp. 1009–1018. doi:10.1177/1077801221996456 Le esque, J.-F., M. F. Ha is and G. Russell, 2013,‘Pa ien -cen ed access o heal h ca e: Concep ualising access a he in e ace o heal h sys ems and popula ions’,In e na ional Jou nal o Equi y in Heal h, Vol. 12, pp. 18. doi:10.1186/1475-9276-12-18 Mabeyo, Z. M. and A. Kiwelu, 2019, Indigenous and inno a i e models o p oblem sol ing in Tanzania: S eng hs and obs acles o hei adop ion, in J.M. Twiki ize and H. Spi ze eds, Social Wo k P ac ice in A ica: Indigenous and Inno a i e App oaches, Foun ain: Foun ain Publishe s, pp. 95–110. MacLachlan, M. and L. Swa z, 2009,Disabili y & In e na ional De elopmen : Towa ds Inclusi e Global Heal h, Do d ech : Sp inge . Mbeba, R. M., M. S. Mkuye, G. E. Magembe, W. L. Yo ham, A. O. Mellah and S. B. Mkuwa, 2012,‘Ba ie s o sexual ep oduc i e heal h se ices and igh s among young people in M wa a dis ic , Tanzania: A quali a i e s udy’,Pan A ican Medical Jou nal, Vol. 13, Suppl. 1, pp. 13. Mbwilo, G., B. Smide and C. Aa s, 2010,‘Family pe cep ions in ca ing o child en and ado- lescen s wi h men al disabili ies: A quali a i e s udy om Tanzania’,Tanzania Jou nal o Heal h Resea ch, Vol. 12, pp. 129–137. doi:10.4314/ h b. 12i2.56400 McC ae, L., 2019, Disciplining disabili y: In e sec ions be ween c i ical disabili y s udies and cul u al s udies, in K. Ellis, R. Ga land-Thomson and M. Ken eds, Mani es os o he Fu u e o C i ical Disabili y S udies: Volume 1, London: Rou ledge, pp. 217–229. Mchome, Z., E. Richa ds, S. Nnko, J. Dusabe, E. Mapella and A. Obasi, 2015,‘A‘mys e y clien ’e alua ion o adolescen sexual and ep oduc i e heal h se ices in heal h acili ies om wo egions in Tanzania’,PLoS One, Vol. 10, pp. e0120822. doi:10.1371/jou nal. pone.0120822 McKenzie, J. A., 2016,‘An explo a ion o an e hics o ca e in ela ion o people wi h in ellec- ual disabili y and hei amily ca egi e s in he Cape Town me opole in Sou h A ica’, Al e , Vol. 10, pp. 67–78. doi:10.1016/j.al e .2015.12.001 Mee , T. and H. Comb inck, 2015,‘In isible in e sec ions: Unde s anding he complex s igma- isa ion o women wi h in ellec ual disabili ies in hei ulne abili y o gende -based io- lence’,Agenda, Vol. 29, pp. 14–23. doi:10.1080/10130950.2015.1039307 20 Vi pi Mesiäisleh o Menki i, I., 1984, Pe son and communi y in A ican adi ional hough , in R. W igh ed,A ican Philosophy: An In oduc ion, Lanham, MD: Uni e si y P ess o Ame ica, pp. 171–182. Mesiäisleh o, V., H. Ka sui and R. Sambaiga, 2021,‘Dispa i ies in accessing sexual and ep o- duc i e heal h se ices a he in e sec ion o disabili y and emale adolescence in Tanzania’, In e na ional Jou nal o En i onmen al Resea ch and Public Heal h, Vol. 18, pp. 1657. doi:10.3390/ije ph18041657 Mi a, S., 2018,Disabili y, Heal h and Human De elopmen , Palg a e S udies in Disabili y and In e na ional De elopmen , New Yo k: Palg a e Macmillan US. Mlyakado, B. P. and J. C.-M. Li, 2019,‘Sexual exploi a ion o adolescen s uden s in Tanzania: Implica ion o social se ices’,In e na ional Social Wo k, Vol. 62, pp. 1104–1116. doi:10. 1177/0020872818774111 Muluneh, M. D., V. S ulz, L. F ancis and K. Agho, 2020, ‘Gende based iolence agains women in Sub-Saha an A ica: A sys ema ic e iew and me a-analysis o c oss-sec ional S udies’,In e na ional Jou nal o En i onmen al Resea ch and Public Heal h, Vol. 17, pp. 903. doi:10.3390/ije ph17030903 Nama o u, F., R. P ee and I. Goicolea, 2018, ‘Gende -based iolence among people wi h dis- abili ies is a neglec ed public heal h opic’,Global Heal h Ac ion, Vol. 11, pp. 1694758. doi:10.1080/16549716.2019.1694758 Ndlo u-Ga sheni, S. J., 2018,Epis emic F eedom in A ica: Dep o incializa ion and Decoloniza ion, 1s ed, Re hinking De elopmen , Mil on: Rou ledge. Neal, S., A. A. Channon, V. Chand a-Mouli and N. Madise, 2020,‘T ends in adolescen fi s bi hs in sub-Saha an A ica: A ale o inc easing inequi y?’,In e na ional Jou nal o Equi y in Heal h, Vol. 19, pp. 151. doi:10.1186/s12939-020-01251-y Ned, L. Y., 2022,‘A ican enaissance as a p emise o eimagined disabili y s udies in A ica’, Jou nal o Black S udies, Vol. 53, pp. 485–504. doi:10.1177/00219347221074391 Ngilangwa, D. P., S. Rajesh, M. Kawala, R. Mbeba, B. Sambili, S. Mkuwa, R. No onha, A. J. Me emo and J. Nyage o, 2016,‘Accessibili y o sexual and ep oduc i e heal h and igh s educa ion among ma ginalized you h in selec ed dis ic s o Tanzania’,Pan A ican Medical Jou nal, Vol. 25, pp. 1–7. doi:10.11604/pamj.supp.2016.25.2.10922. Njelesani, J., 2018,‘F om he day hey a e bo n: a quali a i e s udy explo ing iolence agains child en wi h disabili ies in Wes A ica’,BMC Public Heal h, Vol. 18, pp. 1–7. doi:10. 1186/s12889-018-5057-x. Nka a, H., R. Teixei a and H. Ba os, 2019,‘A scoping e iew on sexual and ep oduc i e heal h beha io s among Tanzanian adolescen s’,Public Heal h Re iews, Vol. 40, pp. 4. doi:10.1186/s40985-019-0114-2 Nyamnjoh, A.-N., S. Swa z, K. C. Mo ha and M. Z. Radasi, 2022,‘The con ibu ion o heo ies o pe sonhood in he e alua ion o child en in A ican socie ies’,Cu en Sociology, Vol. 70, No. 4, pp. 618–633. doi:10.1177/0011392120985869. Nyblade, L., M. S ock on, D. Nya o and J. Wamoyi, 2017,‘Pe cei ed, an icipa ed and expe i- enced s igma: Explo ing mani es a ions and implica ions o young people’s sexual and ep oduc i e heal h and access o ca e in No h-Wes e n Tanzania’,Cul u e, Heal h & Sexuali y, Vol. 19, pp. 1092–1107. doi:10.1080/13691058.2017.1293844 Obasi, M., S. Mano ey, K. A. Kyei, M. K. Addo, S. Talboys, L. Gay and F. Baiden, 2019, ‘Sexual and ep oduc i e heal h o adolescen s in schools o people wi h disabili ies’, Pan A ican Medical Jou nal, Vol. 33. doi:10.11604/pamj.2019.33.299.18546 Onazi, O., 2020, An A ican pa h o disabili y jus ice: Communi y, ela ionships and obliga ions. Fo um o De elopmen S udies 21 Oya o, L. O., 2015,‘A ica a c oss oads: The uni ed na ions con en ion on he igh s o pe sons wi h disabili ies’,Ame ican Uni e si y In e na ional Law Re iew, Vol. 30, No. 2, pp. 347–377. Pa el, P., 2017,‘Fo ced s e iliza ion o women as disc imina ion’,Public Heal h Re iews, Vol. 38, pp. 15. doi:10.1186/s40985-017-0060-9 Pe a, C., 2017,‘Disabili y is no asexuali y: The childbea ing expe iences and aspi a ions o women wi h disabili y in Zimbabwe’,Rep oduc i e Heal h Ma e s, Vol. 25, pp. 10–19. doi:10.1080/09688080.2017.1331684 Pos i-Ahokas, H., 2013,‘Empa hy-based s o ies cap u ing he oice o emale seconda y school s uden s in Tanzania’,In e na ional Jou nal o Quali a i e S udies in Educa ion, Vol. 26, pp. 1277–1292. doi:10.1080/09518398.2012.731533 Quinones, S., T. M. Pale mo, T. M. Lukongo, P. Luchemba, R. Mi i, K. De ies, R. de G oo , A. Khu shid and H. Kupe , 2021,‘Disabili y s a us and mul i-dimensional pe sonal well-being among adolescen s in he Sou he n Highlands Region o Tanzania: Resul s o a c oss-sec ional s udy’,BMJ Open, Vol. 11, pp. e044077. doi:10.1136/bmjopen-2020-044077 Rao, S. and M. Kalyanpu , 2020,‘Uni e sal no ions o de elopmen and disabili y: Towa ds whose imagined ision?’,Disabili y and he Global Sou h, Vol. 7, No. 1, pp. 1830–1851. Re o á, A., 2020, ‘Cogna es o ubun u: Humani y/pe sonhood in he Swahili philosophy o U u’,Decolonial Sub e sions, Vol. 1, No. 1, pp. 31–60. h p://decolonialsub e sions.o g/ docs/pd s/5_2020.03.29_Re o a.pd . Ringson, J. and A. Che eni, 2020,‘E ficacy o he ex ended amily sys em in suppo ing o phans and ulne able child en in Zimbabwe: An indigenous knowledge pe spec i e’, A ican Jou nal o Social Wo k, Vol. 10, pp. 99–108. Rozée, V. and C. Schan z, 2021,‘Les iolences gynécologiques e obs é icales : cons uc ion d’une ques ion poli ique e de san é publique [Gynecological and obs e ic iolence: The cons uc ion o a poli ical and public heal h issue]’,San é Publique, Vol. Vol. 33, pp. 629–634. doi:10.3917/spub.215.0629 Rugoho, T. and F. Maphosa, 2020,Sexual and Rep oduc i e Heal h o Adolescen s wi h Disabili ies, Singapo e: Sp inge Singapo e P . Limi ed. Sadle , M., M. J. San os, D. Ruiz-Be dún, G. L. Rojas, E. Skoko, P. Gillen and J. A. Clausen, 2016, ‘Mo ing beyond dis espec and abuse: Add essing he s uc u al dimensions o obs e ic io- lence’,Rep oduc i e Heal h Ma e s, Vol. 24, pp. 47–55. doi:10.1016/j. hm.2016.04.002 Sambaiga, R., H. Haukanes, K. M. Moland and A. Blys ad, 2019,‘Heal h, li e and igh s: A discou se analysis o a hyb id abo ion egime in Tanzania’,In e na ional Jou nal o Equi y in Heal h, Vol. 18, pp. 135. doi:10.1186/s12939-019-1039-6 Sande son, T., K. Kuma and L. Se an -G een, 2013,‘Would you decide o keep he powe ?: Reflexi i y on he in e iewe –in e p e e –in e iewee iad in in e iews wi h emale Punjabi heuma oid a h i is pa ien s’,In e na ional Jou nal o Quali a i e Me hods, Vol. 12, pp. 511–528. doi:10.1177/160940691301200126 Sando, D., H. Ra cli e, K. McDonald, D. Spiegelman, G. Lya uu, M. Mwanyika-Sando, F. Emil, M. N. Wegne , G. Chalamilla and A. Lange , 2016,‘The p e alence o dis espec and abuse du ing acili y-based childbi h in u ban Tanzania’,BMC P egnancy and Childbi h, Vol. 16, pp. 236. doi:10.1186/s12884-016-1019-4 Sanga, L. S., M. Possi and J. S. Ndabi, 2022,‘Seconda y school eache s’a i udes owa ds p o- ision o sexual and ep oduc i e heal h educa ion o lea ne s wi h dea ness in Tanzania’, Pape s in Educa ion and De elopmen , Vol. 40, pp. 110–127. Shakespea e, T., 2014,Disabili y Righ s and W ongs Re isi ed, London: Rou ledge. 22 Vi pi Mesiäisleh o S a s, A. M., A. C. Ezeh, G. Ba ke , A. Basu, J. T. Be and, R. Blum, A. M. Coll-Seck, e al., 2018,‘Accele a e p og ess –Sexual and ep oduc i e heal h and igh s o all: Repo o he Gu mache –Lance Commission’,The Lance , Vol. 391, pp. 2642–2692. doi:10.1016/ S0140-6736(18)30293-9 S ylianou, A. M., J. L. Pos mus and S. McMahon, 2013,‘Measu ing abusi e beha io s: Is econ- omic abuse a unique o m o abuse?’,Jou nal o In e pe sonal Violence, Vol. 28, pp. 3186– 3204. doi:10.1177/0886260513496904 Tale ski, J., A. Wong Shee, B. Rasmussen, G. Kemp and A. Beauchamp, 2020,‘Teach-back: A sys ema ic e iew o implemen a ion and impac s’,PLoS One, Vol. 15, pp. e0231350. doi:10.1371/jou nal.pone.0231350 Tilley, E., J. Walmsley, S. Ea le and D. A kinson, 2012,‘The silence is oa ing: S e iliza ion, ep oduc i e igh s and women wi h in ellec ual disabili ies’,Disabili y & Socie y, Vol. 27, pp. 413–426. doi:10.1080/09687599.2012.654991 Timme mans, S. and I. Ta o y, 2022,Da a Analysis in Quali a i e Resea ch: Theo izing wi h Abduc i e Analysis, Chicago: Uni e si y o Chicago P ess. UN, 1993,Decla a ion on he Elimina ion o Violence agains Women. UN, 2006,Con en ion on he Righ s o Pe sons wi h Disabili ies (CRPD). UN, 2015,Sus ainable De elopmen Goals, New Yo k: Uni ed Na ions. UNICEF, 2021,Si ua ion Analysis o Child en and Young People Wi h Disabili ies in Mainland Tanzania and Zanziba . Uni ed Republic o Tanzania, 2016,Na ional Plan o Ac ion o End Violence Agains Women and Child en in Tanzania 2017/18–2021/22. Uni ed Republic o Tanzania, 2018,Na ional Popula ion P ojec ions, Da es Salaam: Na ional Bu eau o S a is ics. Vaismo adi, M., H. Tu unen and T. Bondas, 2013,‘Con en analysis and hema ic analysis: Implica ions o conduc ing a quali a i e desc ip i e s udy: Quali a i e desc ip i e s udy’,Nu sing & Heal h Sciences, Vol. 15, pp. 398–405. doi:10.1111/nhs.12048 Valen ine, A., I. Akobi shoe and M. Mi a, 2019,‘In ima e pa ne iolence among women wi h disabili ies in Uganda’,In e na ional Jou nal o En i onmen al Resea ch and Public Heal h, Vol. 16, pp. 947. doi:10.3390/ije ph16060947 an de Heijden, I., J. Ha ies and N. Ab ahams, 2019,‘E hical conside a ions o disabili y- inclusi e gende -based iolence esea ch: Reflec ions om a Sou h A ican quali a i e case s udy’,Global Public Heal h, Vol. 14, pp. 737–749. doi:10.1080/17441692.2018. 1542015 Wallin, A., M. Ko o-Ljungbe g and J. Eskola, 2018,‘The me hod o empa hy-based s o ies’, In e na ional Jou nal o Resea ch & Me hod in Educa ion, Vol. 42, pp. 525–535. doi:10. 1080/1743727X.2018.1533937 Wa d, Jeanne, 2016,‘I ’s no abou he gende bina y, I ’s abou he gende hie a chy: AReply o ‘Le ing Go o he Gende Bina y’,In e na ional Re iew o he Red C oss, Vol. 98, No. 1, pp. 275–298. WHO, Wo ld Bank, 2011,Wo ld Repo on Disabili y, Gene a: Wo ld Heal h O ganiza ion. Wickenden, M. and G. Kembha i-Tam, 2014,‘Ask us oo! Doing pa icipa o y esea ch wi h disabled child en in he global sou h’,Childhood, Vol. 21, pp. 400–417. doi:10.1177/ 0907568214525426 Wudneh, A., A. Che ine , M. Abebe, Y. Bayisa, N. Mengis u and W. Molla, 2022,‘Obs e ic iolence and disabili y o e laps: obs e ic iolence du ing child bi h among womens wi h Disabili ies: a quali a i e s udy’,BMC Women’s Heal h,Vol. 22, pp. 299. doi:10.1186/ s12905-022-01883-y Fo um o De elopmen S udies 23