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

This is a self-archived version of an original article. This version may differ from the original in pagination and typographic details. Author(s): Title: Year: Version: Copyright: Rights: Rights url: Please cite the original version: CC BY 4.0 https://creativecommons.org/licenses/by/4.0/ Relational, Ableist and Gendered Sites of Violence : Perspectives of Tanzanian Girls With Disabilities on Access to Sexual and Reproductive Health Services © 2023 the Authors Published version Mesiäislehto, Virpi Mesiäislehto, V. (2024). Relational, Ableist and Gendered Sites of Violence : Perspectives of Tanzanian Girls With Disabilities on Access to Sexual and Reproductive Health Services. Forum for Development Studies, 51(1), 25-47. https://doi.org/10.1080/08039410.2023.2264857 2024 Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=sfds20 Forum for Development Studies ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/sfds20 Relational, Ableist and Gendered Sites of Violence: Perspectives of Tanzanian Girls With Disabilities on Access to Sexual and Reproductive Health Services Virpi Mesiäislehto To cite this article: Virpi Mesiäislehto (04 Oct 2023): Relational, Ableist and Gendered Sites of Violence: Perspectives of Tanzanian Girls With Disabilities on Access to Sexual and Reproductive Health Services, Forum for Development Studies, DOI: 10.1080/08039410.2023.2264857 To link to this article: https://doi.org/10.1080/08039410.2023.2264857 © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group Published online: 04 Oct 2023. Submit your article to this journal View related articles View Crossmark data Relational, Ableist and Gendered Sites of Violence: Perspectives of Tanzanian Girls With Disabilities on Access to Sexual and Reproductive Health Services Virpi Mesiäislehto Department of Social Sciences and Philosophy, University of Jyväskylä, Jyväskylä, Finland Abstract Adolescent girls’access to sexual and reproductive health services is a critical development issue in Tanzania where the intersection of disability and adolescence is compounded by barriers to sexual and reproductive health service access and socially normalised gender-based violence. Using the method of empathy-based stories, I explored the perceptions of 136 Tanzanian adolescent girls with disabilities of how gender-based violence and access to sexual and reproductive health services are intertwined. The findings demonstrate that the intersection of disability and adolescence within sexual and reproductive health services render invisible various forms of violence, which are not only gendered but also ableist. Recognising access to sexual and reproductive health services as a distinct site of violence and addressing the issue in relevant policies and programmes could strengthen the sexual and reproductive health of girls with disabilities. Through an Afrocentric perspective, the findings contribute to the current theoretical constructs used to study disability and development. They call for a reconsideration of relational dynamics in the context of accessible and protected sexual and reproductive health services. Keywords: sexual and reproductive health and rights; access to sexual and reproductive health services; gender-based violence; adolescence; disability; Tanzania 1. Introduction This article is situated at the nexus of scholarly literature on development and disability studies (Grech and Soldatic, 2016; Katsui and Chalklen, 2020; Shakespeare, 2014), and within the conceptual development of violence in the context of sexual and reproductive health services (Chadwick, 2021; Lappeman and Swartz, 2021; Laverty and de Vos, 2022; Wudneh et al., 2022). It draws on the understanding that ensuring access to safe, accessible, and good quality adolescent sexual and reproductive health services is critical for sustainable development (Starrs et al., 2018). The Sustainable Development Goals’target 3.7 calls for universal access to sexual and reproductive health services, and the United Nations (UN) Convention on the © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons. org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. Forum for Development Studies, 2023 https://doi.org/10.1080/08039410.2023.2264857 Rights of Persons with Disabilities (CRPD) stipulates obligations to make sexual and reproductive health services available to persons with disabilities on an equal basis with others (UN, 2006, art. 25). Moreover, the UN Committee on the Elimination of Discrimination against Women (CEDAW) general recommendation No. 35 states that ‘abuse and mistreatment of women and girls seeking sexual and reproductive health information, goods and services, are forms of gender-based violence’ (CEDAW, 2017, emphasis added). In this vein, addressing violence against adolescents, and improving adolescent sexual and reproductive health services have been identified as key priorities in research on sexual and reproductive health and rights in Africa (Ali et al., 2018). Despite ambitious international policy frameworks, the available evidence from African contexts demonstrates that although adolescents with disabilities have unique, and at times greater needs for sexual and reproductive health services, they often face challenges accessing them (Burke et al., 2017; Obasi et al., 2019; Rugoho and Maphosa, 2020). Furthermore, girls with disabilities are at an increased risk of gender-based violence (Bangura et al., 2021; Carew et al., 2017; Meer and Combrinck, 2015; Njelesani, 2018; Wudneh et al., 2022). Additionally, it has been established that in various contexts violence influences the access of persons with disabilities to sexual and reproductive health services (Mesiäislehto et al., 2021; Patel, 2017; Tilley et al., 2012; Wudneh et al., 2022). Using empathy-based stories (EBS) as a method to study the perspectives of Tanzanian girls with disabilities, I explore gender-based violence in the context of access to sexual and reproductive health services. I ask, how is gender-based violence and access to sexual and reproductive health intertwined, and specifically, how could the intersectional perspectives of disability, adolescence and gender inform the contextualised conceptualisation of violence and provision of sexual and reproductive health services. The topic is especially significant in the context of Tanzania, a country with multiple international and national commitments to sexual and reproductive health and rights of adolescent girls with disabilities and an expanding adolescent population, which is expected to double by 2050 (United Republic of Tanzania, 2018). Thus, addressing adolescents´ sexual and reproductive health and rights in a way that reduces social inequalities will have an impact on the future of the nation (Neal et al., 2020). Moreover, the intersection of disability, adolescence and gender remains largely unexplored in Tanzania, and is limited to only a few studies (Mbwilo et al., 2010; Ngilangwa et al., 2016; Quinones et al., 2021; Sanga et al., 2022). As the gender-based violence experienced by adolescents with disabilities in Tanzania remains largely unknown, recognition, prevention and addressing it is difficult. In Tanzania, adolescence is characterised by limited access to sexual and reproductive health services (Mchome et al., 2015; Nkata et al., 2019), and it has been suggested that negative adolescent sexual and reproductive health outcomes are exacerbated by disability (UNICEF, 2021). Furthermore, the standpoints of Tanzanian adolescent girls in the context of accessing sexual and reproductive health services remain underrepresented 2 Virpi Mesiäislehto in research as well as in a society. This excludes the perspectives of this population from contextualised understanding of the links between access to sexual and reproductive health services and gender-based violence. This article is divided into six parts. First, I introduce the conceptualisations of disability and violence. Second, I present the structural factors specific to the Tanzanian context. Third, in the methods section I present practices of knowledge production, researcher positionality, ethical considerations and limitations of this study. Fourth, I provide the results of the analysis. Fifth comes the discussion of the conceptual advancement following on from the results, and finally I conclude with implications for development and disability research, policy and practice. 2. Definitions of concepts and theoretical inspirations Disability is a multifaceted, complex phenomenon. It is a manifestation of human diversity that varies across different contexts (Katsui and Chalklen, 2020). Lack of welfare regimes and formal safety nets often characterise the experience of disability in global South contexts (Grech, 2011, p.91) where 80 per cent of the world’s persons with disabilities live (WHO and The World Bank, 2011). Unique aspects related to disability in the global South and the human rights paradigm introduced by the CRPD have intertwined disability and development (Katsui and Chalklen, 2020). The CRPD continues to frame the efforts and scholarly work on advancing the well-being of persons with disabilities globally. Its narrow and largely global North-oriented perspectives to disability, however, are increasingly being criticised for lacking engagement with local knowledges and strength-based strategies (Abbay, 2015; Grech, 2011; Grech and Soldatic, 2016; Oyaro, 2015; Rao and Kalyanpur, 2020). According to the CRPD, disability results from the interaction between an individual’s impairment, and personal and environmental factors (UN, 2006), a definition which is employed here. Furthermore, the intersectional understanding of disability, in relation to gender and adolescence (Baird et al., 2021; Larson et al., 2016)is useful for expanding our understanding of the multifaceted experience of disability and related intersecting and unique forms of dis/advantage (McCrae, 2019). One such disadvantage is lack of recognition for adolescent girls with disabilities as knowers which perpetuates epistemic violence against them (Dotson, 2011; Ndlovu-Gatsheni, 2018; Ned, 2022). Disregarding the intersectional perspectives of violence in the context of accessing sexual and reproductive health services may risk this epistemic violence being translated into other forms of structural and systemic violence (Ned, 2022, p. 486). Gender-based violence matters to girls and women, families and societies, and our common future. I approach gender-based violence primarily as an international development issue, an impediment to the progress towards equality for persons with disabilities (UN, 2015; Starrs et al., 2018). The UN General Assembly (1993)defines genderbased violence as ‘any act of violence that results in, or is likely to result in, physical, Forum for Development Studies 3 sexual or psychological harm or suffering to women’. The concept of violence within sexual and reproductive health services is developing rapidly (e.g. Chadwick, 2021; Lappeman and Swartz, 2021; Lévesque and Ferron-Parayre, 2021) and a definition of violence that embeds the individual, structural and policy levels has proven useful (Freedman et al., 2014; Lappeman and Swartz, 2021). Violence can be understood as structural and when woven into the fabric of society it perpetuates social and health inequalities (Farmer, 2013; Sadler et al., 2016, p. 50). Structural violence manifests at organisational and relational levels yet is also felt deeply by individuals (Lappeman and Swartz, 2021). Individuals may also become perpetrators within systems of oppression even when they do not wish to harm others (Farmer, 2013; Lévesque and Ferron-Parayre, 2021) and when their institutional roles are complicated by their personal feelings (Dubois, 2017). The relational sociology (Emirbayer, 1997) and the feminist ethics of care paradigm (Kittay, 2011) shift attention beyond the singular and normative understanding of violence, based on the international human rights standards, to the relational and contextual nature of the networks of care and violence (Held, 2010). The contextualised view is also critical from the perspective of disability. In many African contexts the exclusion of persons with disabilities is embedded in the geopolitical and historical contexts and colonial histories (MacLachlan & Swartz, 2009). This has resulted in persons with disabilities being neglected in daily living (Ned, 2022) and lacking protection (Nyamnjoh et al., 2022). The experiences of violence of children with disabilities and their protection from violence are increasingly theorised from Afrocentric perspectives as opposed to the dominant Eurocentric or Western perspectives (Bannink Mbazzi et al., 2020; Nyamnjoh et al., 2022). These Afrocentric perspectives draw from African communitarian philosophy (Menkiti, 1984; Gyekye, 1987;2004) that outlines the understanding of personhood –the basis of human worth and entitlement to protection –as thoroughly social and community-based (Etieyibo and Ikuenobe, 2020). The potential of these theoretical advances lies in their ability to affirm human worth and the community’s obligations towards the protection of girls with disabilities from violence based on thoroughly African perspectives (Imafidon, 2021). The scholarly developments described here have framed the exploration of the studied phenomenon through an Afrocentric and relational lens in a largely uncharted scholarly terrain. Next, I contextualise the structural violence in the Tanzanian context of accessing sexual and reproductive health services, after which I present the methodological approaches to addressing the epistemic injustice of the studied adolescents. 3. Setting the scene: Intersection of disability, adolescence, and gender in Tanzanian sexual and reproductive health landscape The challenges that Tanzanian adolescent girls with disabilities face in terms of access to sexual and reproductive health services are set against a landscape of complex 4 Virpi Mesiäislehto political, discursive and social norms (Bylund et al., 2020; Sambaiga et al., 2019). Tanzania was among the first signatories of the CRPD and the Optional Protocol in the East African region (Mitra, 2018). The nation is committed to multiple international legal and policy instruments that reaffirm its obligations to respect, protect and fulfil the sexual and reproductive health and rights of girls with disabilities as well as to ensure their freedom from violence. 1 Nevertheless the intersection of adolescence and disability remains ambiguous in policies and legislation, which place disability under the broader ‘vulnerable groups’category, ignore unique forms of disability-specific violence and disregard disability-specific actions. For instance, the National Health Policy Health Sector Strategic Plan (HSSP IV) and the Adolescent Health and Development Strategy of 2018–2022 set the standard that adolescents, irrespective of their disability, have a right to access sexual and reproductive health services that are appropriate and relevant for their needs. These standards, however, lack a definition of the terms ‘relevant’or ‘appropriate’, and contain no specific guidance for adolescents with disabilities as service users. The above shortfalls are also present in the Tanzania National Plan of Action to End Violence against Women and Children (NPA-VAWC 2017/2018-2021/2022) (United Republic of Tanzania, 2016) which is currently being updated. The social and gender norms related to disability often have a greater influence than policy and legislation on how persons with disabilities, and their sexual and reproductive health, are perceived in their communities (Onazi, 2020; Peta, 2017). These norms often exclude Tanzanian adolescents with disabilities from community life, deny them access to education, and lead to various negative health outcomes (Aldersey, 2012; Quinones et al., 2021). Furthermore, extensive evidence indicates that the stigma towards adolescents in sexual and reproductive health services is prevalent in Tanzania and hinders the access of adolescents, including those with disabilities, to sexual and reproductive health services (Mbeba et al., 2012; Mesiäislehto et al., 2021; Nyblade et al., 2017). Gender-based violence against adolescents is socially normalised in Tanzania (Abeid et al., 2014; Mlyakado and Li, 2019). Furthermore, evidence that women and girls with disabilities are disproportionately affected by gender-based violence is gradually accumulating (ADD International, 2016; Greenwood et al., 2016). Like other forms of gender-based violence in Tanzania, violence in sexual and reproductive health care settings is widespread and systematic in nature and is rooted in patriarchal structures and gendered stereotypes (Kujawski et al., 2015; Sando et al., 2016). 1 UN Convention on the Elimination of Discrimination against Women (CEDAW) (1979), UN Convention on the Rights of the Child (CRC) (1989), Agenda 2030 for Sustainable Development (2015); International Conference on Population and Development (ICPD) Programme of Action (1994), Nairobi Statement ICPD+25 (2019), Maputo Protocol (2003), and the Protocol to the African Charter on Human and Peoples’Rights on the Rights of Persons with Disabilities in Africa (2018). Forum for Development Studies 5 The above contextual and structural factors tend to marginalise girls with disabilities in Tanzanian society. However, how these factors are manifested in relational terms and at the individual level remains largely unknown. This article examines the largely unexplored epistemic standpoints of Tanzanian girls with disabilities to gain a more comprehensive understanding of this topic and to counteract the coloniality of knowledge production. 4. Methods This study is grounded in the constructivist paradigm (Denzin and Lincoln, 2018) and aims to understand the social world of its participants. In my quest for rich exploratory data, I used qualitative participatory disability research methodology. A research triad consisting of the researcher, a Tanzanian research advisory committee and a Tanzanian research assistant with disabilities was established in collaboration with the Tanzania Federation of Disabled People’s Organisations. This cross-disability triad ensured that persons with disabilities maintained an active stance throughout the research, which was crucial for developing appropriate methods, interpreting data, and validating the results (Grischow et al., 2021; Kuper et al., 2021; Wickenden and Kembhavi-Tam, 2014). The expert members of the committee had knowledge of the status of girls with disabilities beyond their own experiences, making them insightful sources of information (Katsui and Mojtahedi, 2015; Sanderson et al., 2013). My position as a European woman in her fourties, a development studies scholar, and a mid-career international development professional has influenced the research to some extent. However, the participatory research design, residing in Tanzania for over nine years and the experiences in engaging with adolescents with disabilities in community development programmes proved useful in making sense of the studied phenomena. As I do not share the experience of disability with those whom I have collaborated with in this research I practiced self-reflexivity to recognise and avoid assumptions based on my own experiences. Although my mind was already ideologically wired into the human rights ideology, my long-term presence and experiences in Tanzania allowed me to critically reflect on it. A purposive sampling frame was established together with the research triad to identify and recruit the study participants. The data were collected in three regions across 13 locations. The participants were 136 girls with disabilities, aged 10–19. Some of these adolescents were deaf (n= 42), and one deaf participant also had physical disabilities. Some participants had physical disabilities (n= 33). Of those with albinism (n= 32) some also had partial vision (n= 11). Other participants had intellectual disabilities (n= 13), blindness (n= 12), and partial vision (n= 4). The research employed the method of empathy-based stories, which is based on constructivist epistemologies, and sees reality as contextually and socially constructed (Eskola, 1997). Empathy-based stories (EBS) are fictional short stories narrated by study participants as a response to a frame story (Posti-Ahokas, 2013). Although 6 Virpi Mesiäislehto the primary focus of method of empathy-based stories is not to investigate the experiences of the participants, but rather their perceptions; it enables participants to disclose their lived experiences if they so wish. method of empathy-based stories is an ethically sensitive data collection method, as it allows participants to distance themselves from sensitive and stressful topics (Wallin et al., 2018). The frame stories centred on two protagonists, Fatuma and Nuru, and two scenarios based on the common reasons that adolescent girls seek sexual and reproductive health services in Tanzania: pregnancy and sexually transmitted infections (STI) (Mbeba et al., 2012). To capture the perspectives of the participants, I used the following frame stories: Fatuma John is an 18-year-old girl with disabilities, and she is pregnant. She needs to attend the health clinic. After visiting the clinic, she feels happy and safe. Tell us what happened at the clinic that made her feel happy. Nuru Hassan is a 15-year-old girl with disabilities. Nuru has a disease in her private parts, and she is experiencing discomfort. She needs to see the doctor. In the meeting with the health professional something goes terribly wrong. Afterwards Nuru is really upset. Tell us what happened when she met the health professional. Tell us what disturbed her so much. The frame stories were developed by the research triad and piloted prior to data collection. The stories were compounded with audio and visual aids. The participants took part in the storytelling verbally, by writing in Kiswahili or by using Tanzanian sign language. The verbally collected stories were transcribed verbatim and then translated from Kiswahili into English. The quality of the translations was monitored by the research triad. The data comprised 257 EBS narrated by the 136 girls with disabilities. The EBS were on average 902 characters long. In addition, two focus group discussions (FGD) (Breen, 2006) were held with the research advisory committee, during which preliminary results were discussed and final results were validated. This triangulation of the data from the EBS and the FDG strengthened the validity of the research and reduced researcher bias, as multiple streams of knowledge were utilised. The design and methodology of the study were informed by various ethical considerations, such as ensuring the meaningful participation of persons with disabilities across different research phases and guaranteeing reasonable accommodation and accessibility (van der Heijden et al., 2019). To ensure informed consent, information sessions were held with the participants and their guardians on the research sites. An ‘explain-back’protocol (Talevski et al., 2020) was used in the process of obtaining informed consent, followed by the written consent of the participants and their guardians. The National Research Ethics Committee at the National Institute of Medical Research in Tanzania granted ethical approval for this research. 2 2 Ethical clearance reference NIMR/HQ/R.8a/Vol. IX/2970 Forum for Development Studies 7 adolescent sexuality (Bylund et al., 2020; Nyblade et al., 2017) and human worth being based on seniority (Nyamnjoh et al., 2022). As these intersecting systems of oppression may produce negative sexual and reproductive health outcomes, life-threatening situations and further marginalisation, recognising sexism, ableism and ageism will help unveil violence in the context of accessing sexual and reproductive health services against girls with disabilities. Based on the intersectional perspectives brought forth in this study, I concur with Lévesque and Ferron-Parayre (2021) that acknowledging the particular, intimate context of sexual and reproductive health services, centring the voices of those affected by violence within these contexts, and identifying the systems of oppression inherent to the specific nature of sexual and reproductive health services is central for rethinking violence in access to sexual and reproductive health services. Disabilityspecific and gendered violence, when extended to the particular, intimate contexts of sexual and reproductive health care, would then require increasingly specific conceptualisations such as reproductive violence (Altunjan, 2021; Chiweshe et al., 2021; Laverty and de Vos, 2022), obstetric violence (Chadwick, 2016) and gynaecological violence (Rozée and Schantz, 2021). Thus, I concur with Lappeman and Swartz (2021) that development of accurate terminology has implications for how research results are reflected in policy and practice. The current study therefore suggests that the conceptualisations of violence in the context of accessing sexual and reproductive health services need to be more specific. They should not all be merely placed under the broader category of gender-based violence (Chadwick, 2021), instead they should be approached through intersectional perspectives, including those based on disability (Chadwick and Jace Mavuso, 2021). These perspectives could be further used to identify and address the specific mistreatment that occurs both in sexual and reproductive health services, and when accessing them. Furthermore, applying these more detailed conceptualisations in this critical area of research is of paramount importance for unveiling and addressing discrimination, non-consensual care and abuse that underpin the experiences of girls with disabilities worldwide. 6.2. Reframing accessibility and protection through Afrocentric disability theories The Tanzanian context highlights other limitations of current conceptualisations when disability, access to sexual and reproductive health services and gender-based violence overlap. The findings of this study support Katsui’s(2012) view that the human rights model of disability founded on the CRPD, offers very little or no immediate relief for persons with disabilities who require day-to-day assistance to overcome barriers in environments where no formalised support systems are available (see Heikkilä et al., 2020). This is particularly so when formal and institutionalised accessibility does not exist and in situations in which accessible structures may fail either momentarily or for longer (Katsui and Chalklen, 2020). As the findings of the study portrayed, 14 Virpi Mesiäislehto overcoming barriers to safely accessing sexual and reproductive health services takes more than an individual claiming their rights. When designing services that respond to the characteristics of adolescent girls with disabilities, this study suggest considering the relationality and collective dynamics between individuals and the informal familial and communal networks of care (Levesque et al., 2013; Onazi, 2020) that are different to those that are non-African (e.g. Amit, 2002). The relational dynamics presented in this study reflect the African ethic of interdependence, through which individuals are viewed in relational rather than individualistic terms (Berghs, 2017; Onazi, 2020). The findings concur with novel disability theorisations emerging from the African continent, which have the potential to frame these relational dynamics in research on access to and protection in sexual and reproductive health services and address the decontextualisation of global North-oriented disability theorisations (Imafidon, 2021; Nyamnjoh et al., 2022). Central to Afrocentric disability theorisations is the concept of personhood that is the basis on which a person with disabilities is considered a full member of society and can enjoy services and protection on an equal basis with others (Imafidon, 2021; Nyamnjoh et al., 2022). The perspectives of the studied adolescents depicted how navigating access to sexual and reproductive health services resembled what Onazi (2020) described as ‘asymmetrical obligations’. According to Onazi (2020), asymmetrical obligations are not based on mutual reciprocity; they are obligations for those who, in a certain time and place, are in a position to support and assist others. This highlights the ambivalence of disability and denaturalises persons with disabilities as vulnerable by default. Such understanding weaves persons with disabilities tighter into the social fabric of the society –informal networks of support, care and protection –that have the potential to advance sexual and reproductive health and protect against gender-based violence when gaps in formalised supports exists (Nyamnjoh et al., 2022). The concept of asymmetrical obligations may be beneficial for re-imagining an accessible and protected access to sexual and reproductive health services that is responsive to the characteristics of adolescent girls with disabilities where interdependence tends to be valued over independence. Relational dynamics should therefore be understood as an under-theorised resource for addressing violence against adolescent girls with disabilities and access to sexual and reproductive health services in social contexts like Tanzania. 7. Conclusions This study is the first known study in Tanzania to explore how gender-based violence intertwines with access to sexual and reproductive health services and to focus on the intersectionality of disability and adolescence. It contributes to rethinking the conceptual apparatus of gender-based violence through intersectional and contextual lenses. It highlights the potential of intersectional frames to identify, resist and address the normalisation of the ableist, sexist and ageist systems of oppression that impede Forum for Development Studies 15 access to sexual and reproductive health services, result in violence and contribute to further marginalisation. Rethinking gender-based violence through intersectionality could potentially lead to the following: first, by rejecting the normalisation of the inaccessibility of sexual and reproductive health services and by reframing it as structural violence, a more disability-inclusive intersectional policy and programmatic interventions on adolescents’access to sexual and reproductive health services could be designed and implemented. Second, departing from general definitions of genderbased violence through precision in conceptualising gender-based violence (e.g. reproductive, gynaecological and obstetric), and its linkages to realising access to sexual and reproductive health services have implications for legal and policy frameworks. Third, conceptualisations of sexual and reproductive health care and protection against gender-based violence that draw from Afrocentric disability theorisations could enrich the human rights model of disability and research paradigms at the nexus of disability and development studies in contexts like Tanzania. Acknowledgements I would like to express my gratitude to all the study participants for their vivid and rich empathy-based stories. I am also grateful for the commitment, energy, and time that the research assistant and the research advisory committee members invested in this research. Without the cooperation of the Tanzania Federation of the Disabled People’s Organisations, this research would not have been possible or worthwhile. I also would like to recognise the administrative support of Dr. Richard Sambaiga from the Department of Sociology at the University of Dar es Salaam. Disclosure statement No potential conflict of interest was reported by the author(s). Funding This work was supported by Emil Aaltosen Säätiö, Jyväskylän Yliopisto, Keski-Suomen Rahasto, Finnish Society for Disability Research. Author Virpi Mesiäislehto (PhD) is an international development professional with 10 years of experience in Eastern Africa. Her expertise is in advancing sexual and reproductive health and rights (SRHR) of persons with disabilities in the global South contexts. She has experience in disability inclusion from community-based, civil society-driven, bilateral and multilateral development cooperation. Mesiäislehto has collaborated with a wide range of stakeholders to advance the realisation of SRHR, including with organisations of persons with disabilities, religious and traditional leaders, governments, civil society organisations, and UN agencies in both global South and North. In 2022, she co-edited an international research book titled ‘Embodied Inequalities in Disability and Development’. 16 Virpi Mesiäislehto References Abbay, F., 2015,‘Evaluation of disability human rights under the African Regional Human Rights System’,African Journal of International and Comparative Law, Vol. 23, No. 3, pp. 476–502. doi:10.3366/ajicl.2015.0132 Abeid, M., P. Muganyizi, P. Olsson, E. Darj and P. Axemo, 2014,‘Community perceptions of rape and child sexual abuse: A qualitative study in rural Tanzania’,BMC International Health and Human Rights, Vol. 14, pp. 23. doi:10.1186/1472-698X-14-23 ADD International, 2016,Disability and Gender-Based Violence: Peer Research in Kibaha and Mkuranga, Tanzania: ADD International. Aldersey, H., 2012,‘Family perceptions of intellectual disability: Understanding and support in Dar es Salaam’,African Journal of Disability, Vol. 1, pp. 32. doi:10.4102/ajod.v1i1.32 Ali, M., M. Farron, L. Ouedraogo, R. K. Mahaini, K. Miller and R. Kabra, 2018,‘Research gaps and emerging priorities in sexual and reproductive health in Africa and the eastern Mediterranean regions’,Reproductive Health, Vol. 15, pp. 39. doi:10.1186/s12978-0180484-9 Altunjan, T., 2021,Reproductive Violence and International Criminal Law, International Criminal Justice Series, The Hague: T.M.C. Asser Press. Amit, V., 2002,Realizing Community: Concepts, Social Relationships and Sentiments, London: Routledge. Baird, S., L. Camfield, A. Ghimire, B. A. Hamad, N. Jones, K. Pincock and T. Woldehanna, 2021,‘Intersectionality as a framework for understanding adolescent vulnerabilities in low and middle income countries: Expanding our commitment to leave no one behind’, The European Journal of Development Research, Vol. 33, pp. 1143–1162. doi:10.1057/ s41287-021-00440-x Bangura, I. R., J. Njelesani and D. Njelesani, 2021,‘“Night wives”and the education of girls with disabilities in Sierra Leone.’Oxford Research Encyclopedia of Education.https:// oxfordre.com/education/view/10.1093/acrefore/9780190264093.001.0001/acrefore-97801 90264093-e-439. Bannink Mbazzi, F., R. Nalugya, E. Kawesa, H. Nambejja, P. Nizeyimana, P. Ojok, G. Van Hove and J. Seeley, 2020,‘Obuntu Bulamu’: Development and testing of an indigenous intervention for disability inclusion in Uganda. Berghs, M., 2017,‘Practices and discourses of ubuntu: Implications for an African model of disability?’,African Journal of Disability, Vol. 6, pp. e1–e8. doi:10.4102/ajod.v6i0.292 Breen, R. L., 2006,‘A practical guide to focus-group research’,Journal of Geography in Higher Education, Vol. 30, pp. 463–475. doi:10.1080/03098260600927575 Bukuluki, P., P. Kisaakye, S. P. Wandiembe, T. Musuya, E. Letiyo and D. Bazira, 2021, ‘An examination of physical violence against women and its justification in development settings in Uganda’,PLoS One, Vol. 16, pp. e0255281. doi:10.1371/journal.pone.0255281 Burke, E., F. Kébé, I. Flink, M. van Reeuwijk and A. le May, 2017,‘A qualitative study to explore the barriers and enablers for young people with disabilities to access sexual and reproductive health services in Senegal’,Reproductive Health Matters, Vol. 25, pp. 43– 54. doi:10.1080/09688080.2017.1329607 Bylund, S., M. Målqvist, N. Peter and S. Herzig van Wees, 2020,‘Negotiating social norms, the legacy of vertical health initiatives and contradicting health policies: A qualitative study of health professionals’perceptions and attitudes of providing adolescent sexual and reproductive health care in Arusha and Kilimanjaro region, Tanzania’,Global Health Action, Vol. 13, pp. 1775992. doi:10.1080/16549716.2020.1775992 Forum for Development Studies 17 Carew, M. T., S. H. Braathen, L. Swartz, X. Hunt and P. Rohleder, 2017,‘The sexual lives of people with disabilities within lowand middle-income countries: A scoping study of studies published in English’,Global Health Action, Vol. 10, pp. 1337342. doi:10.1080/ 16549716.2017.1337342 Casebolt, M. T., 2020,‘Barriers to reproductive health services for women with disability in lowand middle-income countries: A review of the literature’,Sexual & Reproductive Healthcare, Vol. 24, pp. 100485. doi:10.1016/j.srhc.2020.100485 CEDAW, 2017, General recommendation No. 35 on gender-based violence against women, updating general recommendation No. 19. Chadwick, R. J., 2016,‘Obstetric violence in South Africa’,South African Medical Journal, Vol. 106, pp. 423. doi:10.7196/SAMJ.2016.v106i5.10708 Chadwick, R., 2021,‘Breaking the frame: Obstetric violence and epistemic rupture’,Agenda, Vol. 35, pp. 104–115. doi:10.1080/10130950.2021.1958554 Chadwick, R. and J. M.-J. Jace Mavuso, 2021,‘On reproductive violence: Framing notes’, Agenda, Vol. 35, pp. 1–11. doi:10.1080/10130950.2021.1987074 Chilwalo, M., 2020,‘Community-based, endogenous and ubuntu inspired child protection mechanisms: case of the girl power program in addressing school-related gender-based violence in Chibombo District of Zambia’,African Journal of Social Work, Vol. 10, pp. 10–15. Chiweshe, M. T., T. Fetters and E. Coast, 2021,‘Whose bodies are they? Conceptualising reproductive violence against adolescents in Ethiopia, Malawi and Zambia’,Agenda, Vol. 35, pp. 12–23. doi:10.1080/10130950.2021.1964220 Coast, E., N. Jones, U. M. Francoise, W. Yadete, R. Isimbi, K. Gezahegne and L. Lunin, 2019, ‘Adolescent sexual and reproductive health in Ethiopia and Rwanda: A qualitative exploration of the role of social Norms’,Sage Open,Vol. 9, pp. 215824401983358. doi:10.1177/ 2158244019833587 Denzin, N. K. and Y. S. Lincoln, 2018,The SAGE handbook of qualitative research, Los Angeles: Sage. Dolan, Chris, 2014,‘Has patriarchy been stealing the feminists’clothes? conflict-related sexual violence and UN security council resolutions’,IDS Bulletin, Vol. 45, No. 1, pp. 80–84. Dotson, K., 2011,‘Tracking epistemic violence, tracking practices of Silencing’,Hypatia, Vol. 26, pp. 236–257. doi:10.1111/j.1527-2001.2011.01177.x Dubois, V., 2017,Bureaucrat and the Poor: Encounters in French Welfare Offices, Farnham: Ashgate. Emirbayer, M., 1997,‘Manifesto for a relational Sociology’,American Journal of Sociology, Vol. 103, No. 2, pp. 281–317. doi:10.1086/231209 Eskola, J., 1997,Eläytymismenetelmäopas [The Guide to the Method of Empahty-Based Stories], Tampere: Tampereen yliopisto. Etieyibo, E. and P. Ikuenobe, 2020,Menkiti on Community and Becoming a Person, Lanham: Lexington Books. Farmer, P., 2013,‘On suffering and structural violence: A view from below’,Race/Ethnicity: Multidisciplinary Global Contexts, Vol. 3, pp. 11–28. Flick, U., 2017,Designing Qualitative Research, The Sage Qualitative Research Kit, Thousand Oaks, CA: SAGE Publications. Freedman, L. P., K. Ramsey, T. Abuya, B. Bellows, C. Ndwiga, C. E. Warren, S. Kujawski, W. Moyo, M. E. Kruk and G. Mbaruku, 2014,‘Defining disrespect and abuse of women in childbirth: A research, policy and rights agenda’,Bulletin of the World Health Organization,Vol. 92, pp. 915–917. doi:10.2471/BLT.14.137869 18 Virpi Mesiäislehto Goodley, D., 2014,Dis/Ability Studies: Theorising Disablism and Ableism, New York: Routledge. Grech, S., 2011,‘Recolonising debates or perpetuated coloniality? Decentring the spaces of disability, development and community in the Global South’,International Journal of Inclusive Education, Vol. 15, No. 1, pp. 87–100. doi:10.1080/13603116.2010.496198 Grech, S. and K. Soldatic, 2016,Disability in the Global South, International Perspectives on Social Policy, Administration, and Practice, Cham: Springer International Publishing AG. Greenwood, M., B. Fakih, M. Steff, S. Bechange and M. Mrisho, 2016,‘Hear my voice: A community-based participatory study gathering the lived experiences of people with disabilities and older people in Tanzania’,Knowledge Management for Development Journal, Vol. 2016, pp. 63–78. Grischow, J., A. Naami, W. Mprah and M. Mfoafo-M’Carthy, 2021,‘Methodologically thinking: Doing disability research in Ghanaian cultural Communities’,Scandinavian Journal of Disability Research, Vol. 23, pp. 169–179. doi:10.16993/sjdr.702 Gyekye, K., 1987,An Essay on African Philosophical Thought, Philadelphia: Temple University Press. Gyekye, K., 2004, Person and community in African thought, in P. Coetzee and A. Roux, eds., The African Philosophy Reader, New York: Routledge, pp. 348–365. Available at: http:// www.galerie-inter.de/kimmerle/frameText9.htm. Heikkilä, M., H. Katsui and M. Mustaniemi-Laakso, 2020,‘Disability and vulnerability: A human rights reading of the responsive state’,The International Journal of Human Rights, Vol. 24, pp. 1180–1200. doi:10.1080/13642987.2020.1715948 Held, V., 2010,‘Can the ethics of care handle violence?’,Ethics and Social Welfare, Vol. 4, pp. 115–129. doi:10.1080/17496535.2010.484256 Imafidon, E., 2021,‘African communitarian philosophy of personhood and disability: The asymmetry of value and power in access to healthcare’,International Journal of Critical Diversity Studies, Vol. 4, pp. 46–57. doi:10.13169/intecritdivestud.4.1.0046. Jewkes, R., 2010,‘Emotional abuse: A neglected dimension of partner violence’,The Lancet, Vol. 376, pp. 851–852. doi:10.1016/S0140-6736(10)61079-3 Kabia, E., R. Mbau, K. W. Muraya, R. Morgan, S. Molyneux and E. Barasa, 2018,‘How do gender and disability influence the ability of the poor to benefit from pro-poor health financing policies in Kenya? An intersectional analysis’,International Journal for Equity in Health, Vol. 17, pp. 149. doi:10.1186/s12939-018-0853-6 Katsui, H., 2012,Disabilities, Human Rights and International Cooperation: Human RightsBased Approach and Lived Experiences of Uganda Women with Disabilities, Publication Series No.8, Helsinki: The Center for Human Rights of Persons with Disabilities. Katsui, H. and S. Chalklen, 2020,Disability, Globalization and Human Rights, Interdisciplinary Disability Studies, London: Routledge. Katsui, H. and M. Mojtahedi, 2015,‘Intersection of disability and gender: Multi-layered experiences of Ethiopian women with disabilities’,Development in Practice, Vol. 25, pp. 563– 573. doi:10.1080/09614524.2015.1031085 Kennedy, B. L. and R. Thornberg, 2018, Deduction, induction, and abduction, in Flick Uwe ed, The SAGE Handbook of Qualitative Data Collection, London: SAGE Publications Ltd, pp. 49–64. Kittay, E., 2011,‘The ethics of care, dependence, and disability’,Ratio Juris, Vol. 24, pp. 49– 58. doi:10.1111/j.1467-9337.2010.00473.x. Kujawski, S., G. Mbaruku, L. P. Freedman, K. Ramsey, W. Moyo and M. E. Kruk, 2015, ‘Association between disrespect and abuse during childbirth and women’s confidence in Forum for Development Studies 19 health facilities in Tanzania’,Maternal and Child Health Journal, Vol. 19, pp. 2243–2250. doi:10.1007/s10995-015-1743-9 Kuper, H., S. Hameed, V. Reichenberger, N. Scherer, J. Wilbur, M. Zuurmond, I. Mactaggart, T. Bright and T. Shakespeare, 2021,‘Participatory research in disability in lowand middle-income countries: What have we learnt and what should we Do?’,Scandinavian Journal of Disability Research, Vol. 23, pp. 328–337. doi:10.16993/sjdr.814 Lappeman, M. and L. Swartz, 2021,‘How gentle must violence against women be in order to not be violent? Rethinking the word “violence”in obstetric settings’,Violence Against Women, Vol. 27, pp. 987–1000. doi:10.1177/1077801221996444 Larson, E., A. George, R. Morgan and T. Poteat, 2016,‘10 Best resources on …intersectionality with an emphasis on lowand middle-income countries’,Health Policy and Planning, Vol. 31, pp. 964–969. doi:10.1093/heapol/czw020 Laverty, C. and D. de Vos, 2022,‘Reproductive violence as a category of analysis: Disentangling the relationship between ‘the sexual’and ‘the reproductive’in transitional Justice’,International Journal of Transitional Justice, Vol. 15, pp. 616–635. doi:10. 1093/ijtj/ijab022 Lévesque, S. and A. Ferron-Parayre, 2021,‘To use or not to use the term “obstetric violence”: Commentary on the article by Swartz and Lappeman’,Violence Against Women, Vol. 27, pp. 1009–1018. doi:10.1177/1077801221996456 Levesque, J.-F., M. F. Harris and G. Russell, 2013,‘Patient-centred access to health care: Conceptualising access at the interface of health systems and populations’,International Journal for Equity in Health, Vol. 12, pp. 18. doi:10.1186/1475-9276-12-18 Mabeyo, Z. M. and A. Kiwelu, 2019, Indigenous and innovative models of problem solving in Tanzania: Strengths and obstacles for their adoption, in J.M. Twikirize and H. Spitzer eds, Social Work Practice in Africa: Indigenous and Innovative Approaches, Fountain: Fountain Publishers, pp. 95–110. MacLachlan, M. and L. Swartz, 2009,Disability & International Development: Towards Inclusive Global Health, Dordrecht: Springer. Mbeba, R. M., M. S. Mkuye, G. E. Magembe, W. L. Yotham, A. O. Mellah and S. B. Mkuwa, 2012,‘Barriers to sexual reproductive health services and rights among young people in Mtwara district, Tanzania: A qualitative study’,Pan African Medical Journal, Vol. 13, Suppl. 1, pp. 13. Mbwilo, G., B. Smide and C. Aarts, 2010,‘Family perceptions in caring for children and adolescents with mental disabilities: A qualitative study from Tanzania’,Tanzania Journal of Health Research, Vol. 12, pp. 129–137. doi:10.4314/thrb.v12i2.56400 McCrae, L., 2019, Disciplining disability: Intersections between critical disability studies and cultural studies, in K. Ellis, R. Garland-Thomson and M. Kent eds, Manifestos for the Future of Critical Disability Studies: Volume 1, London: Routledge, pp. 217–229. Mchome, Z., E. Richards, S. Nnko, J. Dusabe, E. Mapella and A. Obasi, 2015,‘A‘mystery client’evaluation of adolescent sexual and reproductive health services in health facilities from two regions in Tanzania’,PLoS One, Vol. 10, pp. e0120822. doi:10.1371/journal. pone.0120822 McKenzie, J. A., 2016,‘An exploration of an ethics of care in relation to people with intellectual disability and their family caregivers in the Cape Town metropole in South Africa’, Alter, Vol. 10, pp. 67–78. doi:10.1016/j.alter.2015.12.001 Meer, T. and H. Combrinck, 2015,‘Invisible intersections: Understanding the complex stigmatisation of women with intellectual disabilities in their vulnerability to gender-based violence’,Agenda, Vol. 29, pp. 14–23. doi:10.1080/10130950.2015.1039307 20 Virpi Mesiäislehto Menkiti, I., 1984, Person and community in African traditional thought, in R. Wright ed,African Philosophy: An Introduction, Lanham, MD: University Press of America, pp. 171–182. Mesiäislehto, V., H. Katsui and R. Sambaiga, 2021,‘Disparities in accessing sexual and reproductive health services at the intersection of disability and female adolescence in Tanzania’, International Journal of Environmental Research and Public Health, Vol. 18, pp. 1657. doi:10.3390/ijerph18041657 Mitra, S., 2018,Disability, Health and Human Development, Palgrave Studies in Disability and International Development, New York: Palgrave Macmillan US. Mlyakado, B. P. and J. C.-M. Li, 2019,‘Sexual exploitation of adolescent students in Tanzania: Implication for social services’,International Social Work, Vol. 62, pp. 1104–1116. doi:10. 1177/0020872818774111 Muluneh, M. D., V. Stulz, L. Francis and K. Agho, 2020, ‘Gender based violence against women in Sub-Saharan Africa: A systematic review and meta-analysis of cross-sectional Studies’,International Journal of Environmental Research and Public Health, Vol. 17, pp. 903. doi:10.3390/ijerph17030903 Namatovu, F., R. Preet and I. Goicolea, 2018, ‘Gender-based violence among people with disabilities is a neglected public health topic’,Global Health Action, Vol. 11, pp. 1694758. doi:10.1080/16549716.2019.1694758 Ndlovu-Gatsheni, S. J., 2018,Epistemic Freedom in Africa: Deprovincialization and Decolonization, 1st ed, Rethinking Development, Milton: Routledge. Neal, S., A. A. Channon, V. Chandra-Mouli and N. Madise, 2020,‘Trends in adolescent first births in sub-Saharan Africa: A tale of increasing inequity?’,International Journal for Equity in Health, Vol. 19, pp. 151. doi:10.1186/s12939-020-01251-y Ned, L. Y., 2022,‘African renaissance as a premise for reimagined disability studies in Africa’, Journal of Black Studies, Vol. 53, pp. 485–504. doi:10.1177/00219347221074391 Ngilangwa, D. P., S. Rajesh, M. Kawala, R. Mbeba, B. Sambili, S. Mkuwa, R. Noronha, A. J. Meremo and J. Nyagero, 2016,‘Accessibility to sexual and reproductive health and rights education among marginalized youth in selected districts of Tanzania’,Pan African Medical Journal, Vol. 25, pp. 1–7. doi:10.11604/pamj.supp.2016.25.2.10922. Njelesani, J., 2018,‘From the day they are born: a qualitative study exploring violence against children with disabilities in West Africa’,BMC Public Health, Vol. 18, pp. 1–7. doi:10. 1186/s12889-018-5057-x. Nkata, H., R. Teixeira and H. Barros, 2019,‘A scoping review on sexual and reproductive health behaviors among Tanzanian adolescents’,Public Health Reviews, Vol. 40, pp. 4. doi:10.1186/s40985-019-0114-2 Nyamnjoh, A.-N., S. Swartz, K. C. Motha and M. Z. Radasi, 2022,‘The contribution of theories of personhood in the revaluation of children in African societies’,Current Sociology, Vol. 70, No. 4, pp. 618–633. doi:10.1177/0011392120985869. Nyblade, L., M. Stockton, D. Nyato and J. Wamoyi, 2017,‘Perceived, anticipated and experienced stigma: Exploring manifestations and implications for young people’s sexual and reproductive health and access to care in North-Western Tanzania’,Culture, Health & Sexuality, Vol. 19, pp. 1092–1107. doi:10.1080/13691058.2017.1293844 Obasi, M., S. Manortey, K. A. Kyei, M. K. Addo, S. Talboys, L. Gay and F. Baiden, 2019, ‘Sexual and reproductive health of adolescents in schools for people with disabilities’, Pan African Medical Journal, Vol. 33. doi:10.11604/pamj.2019.33.299.18546 Onazi, O., 2020, An African path to disability justice: Community, relationships and obligations. Forum for Development Studies 21 Oyaro, L. O., 2015,‘Africa at crossroads: The united nations convention on the rights of persons with disabilities’,American University International Law Review, Vol. 30, No. 2, pp. 347–377. Patel, P., 2017,‘Forced sterilization of women as discrimination’,Public Health Reviews, Vol. 38, pp. 15. doi:10.1186/s40985-017-0060-9 Peta, C., 2017,‘Disability is not asexuality: The childbearing experiences and aspirations of women with disability in Zimbabwe’,Reproductive Health Matters, Vol. 25, pp. 10–19. doi:10.1080/09688080.2017.1331684 Posti-Ahokas, H., 2013,‘Empathy-based stories capturing the voice of female secondary school students in Tanzania’,International Journal of Qualitative Studies in Education, Vol. 26, pp. 1277–1292. doi:10.1080/09518398.2012.731533 Quinones, S., T. M. Palermo, T. M. Lukongo, P. Luchemba, R. Mitti, K. Devries, R. de Groot, A. Khurshid and H. Kuper, 2021,‘Disability status and multi-dimensional personal well-being among adolescents in the Southern Highlands Region of Tanzania: Results of a cross-sectional study’,BMJ Open, Vol. 11, pp. e044077. doi:10.1136/bmjopen-2020-044077 Rao, S. and M. Kalyanpur, 2020,‘Universal notions of development and disability: Towards whose imagined vision?’,Disability and the Global South, Vol. 7, No. 1, pp. 1830–1851. Rettová, A., 2020, ‘Cognates of ubuntu: Humanity/personhood in the Swahili philosophy of Utu’,Decolonial Subversions, Vol. 1, No. 1, pp. 31–60. http://decolonialsubversions.org/ docs/pdfs/5_2020.03.29_Rettova.pdf. Ringson, J. and A. Chereni, 2020,‘Efficacy of the extended family system in supporting orphans and vulnerable children in Zimbabwe: An indigenous knowledge perspective’, African Journal of Social Work, Vol. 10, pp. 99–108. Rozée, V. and C. Schantz, 2021,‘Les violences gynécologiques et obstétricales : construction d’une question politique et de santé publique [Gynecological and obstetric violence: The construction of a political and public health issue]’,Santé Publique, Vol. Vol. 33, pp. 629–634. doi:10.3917/spub.215.0629 Rugoho, T. and F. Maphosa, 2020,Sexual and Reproductive Health of Adolescents with Disabilities, Singapore: Springer Singapore Pvt. Limited. Sadler, M., M. J. Santos, D. Ruiz-Berdún, G. L. Rojas, E. Skoko, P. Gillen and J. A. Clausen, 2016, ‘Moving beyond disrespect and abuse: Addressing the structural dimensions of obstetric violence’,Reproductive Health Matters, Vol. 24, pp. 47–55. doi:10.1016/j.rhm.2016.04.002 Sambaiga, R., H. Haukanes, K. M. Moland and A. Blystad, 2019,‘Health, life and rights: A discourse analysis of a hybrid abortion regime in Tanzania’,International Journal for Equity in Health, Vol. 18, pp. 135. doi:10.1186/s12939-019-1039-6 Sanderson, T., K. Kumar and L. Serrant-Green, 2013,‘Would you decide to keep the power?: Reflexivity on the interviewer–interpreter–interviewee triad in interviews with female Punjabi rheumatoid arthritis patients’,International Journal of Qualitative Methods, Vol. 12, pp. 511–528. doi:10.1177/160940691301200126 Sando, D., H. Ratcliffe, K. McDonald, D. Spiegelman, G. Lyatuu, M. Mwanyika-Sando, F. Emil, M. N. Wegner, G. Chalamilla and A. Langer, 2016,‘The prevalence of disrespect and abuse during facility-based childbirth in urban Tanzania’,BMC Pregnancy and Childbirth, Vol. 16, pp. 236. doi:10.1186/s12884-016-1019-4 Sanga, L. S., M. Possi and J. S. Ndabi, 2022,‘Secondary school teachers’attitudes towards provision of sexual and reproductive health education to learners with deafness in Tanzania’, Papers in Education and Development, Vol. 40, pp. 110–127. Shakespeare, T., 2014,Disability Rights and Wrongs Revisited, London: Routledge. 22 Virpi Mesiäislehto Starrs, A. M., A. C. Ezeh, G. Barker, A. Basu, J. T. Bertrand, R. Blum, A. M. Coll-Seck, et al., 2018,‘Accelerate progress –Sexual and reproductive health and rights for all: Report of the Guttmacher–Lancet Commission’,The Lancet, Vol. 391, pp. 2642–2692. doi:10.1016/ S0140-6736(18)30293-9 Stylianou, A. M., J. L. Postmus and S. McMahon, 2013,‘Measuring abusive behaviors: Is economic abuse a unique form of abuse?’,Journal of Interpersonal Violence, Vol. 28, pp. 3186– 3204. doi:10.1177/0886260513496904 Talevski, J., A. Wong Shee, B. Rasmussen, G. Kemp and A. Beauchamp, 2020,‘Teach-back: A systematic review of implementation and impacts’,PLoS One, Vol. 15, pp. e0231350. doi:10.1371/journal.pone.0231350 Tilley, E., J. Walmsley, S. Earle and D. Atkinson, 2012,‘The silence is roaring: Sterilization, reproductive rights and women with intellectual disabilities’,Disability & Society, Vol. 27, pp. 413–426. doi:10.1080/09687599.2012.654991 Timmermans, S. and I. Tavory, 2022,Data Analysis in Qualitative Research: Theorizing with Abductive Analysis, Chicago: University of Chicago Press. UN, 1993,Declaration on the Elimination of Violence against Women. UN, 2006,Convention on the Rights of Persons with Disabilities (CRPD). UN, 2015,Sustainable Development Goals, New York: United Nations. UNICEF, 2021,Situation Analysis of Children and Young People With Disabilities in Mainland Tanzania and Zanzibar. United Republic of Tanzania, 2016,National Plan of Action to End Violence Against Women and Children in Tanzania 2017/18–2021/22. United Republic of Tanzania, 2018,National Population Projections, Dar es Salaam: National Bureau of Statistics. Vaismoradi, M., H. Turunen and T. Bondas, 2013,‘Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study: Qualitative descriptive study’,Nursing & Health Sciences, Vol. 15, pp. 398–405. doi:10.1111/nhs.12048 Valentine, A., I. Akobirshoev and M. Mitra, 2019,‘Intimate partner violence among women with disabilities in Uganda’,International Journal of Environmental Research and Public Health, Vol. 16, pp. 947. doi:10.3390/ijerph16060947 van der Heijden, I., J. Harries and N. Abrahams, 2019,‘Ethical considerations for disabilityinclusive gender-based violence research: Reflections from a South African qualitative case study’,Global Public Health, Vol. 14, pp. 737–749. doi:10.1080/17441692.2018. 1542015 Wallin, A., M. Koro-Ljungberg and J. Eskola, 2018,‘The method of empathy-based stories’, International Journal of Research & Method in Education, Vol. 42, pp. 525–535. doi:10. 1080/1743727X.2018.1533937 Ward, Jeanne, 2016,‘It’s not about the gender binary, It’s about the gender hierarchy: AReply to ‘Letting Go of the Gender Binary’,International Review of the Red Cross, Vol. 98, No. 1, pp. 275–298. WHO, World Bank, 2011,World Report on Disability, Geneva: World Health Organization. Wickenden, M. and G. Kembhavi-Tam, 2014,‘Ask us too! Doing participatory research with disabled children in the global south’,Childhood, Vol. 21, pp. 400–417. doi:10.1177/ 0907568214525426 Wudneh, A., A. Cherinet, M. Abebe, Y. Bayisa, N. Mengistu and W. Molla, 2022,‘Obstetric violence and disability overlaps: obstetric violence during child birth among womens with Disabilities: a qualitative study’,BMC Women’s Health,Vol. 22, pp. 299. doi:10.1186/ s12905-022-01883-y Forum for Development Studies 23