The double burden: barriers and facilitators to socioeconomic inclusion for women with disability in Bangladesh.

Purpose: Recent evidence suggests that, globally, women with disability suffer multiple forms of discrimination and exclusion from mainstream society when compared with their female peers and men without disability. In Bangladesh, which is a grossly overpopulated low-income country in South Asia, women with disability have poor health outcomes within a gender-biased cultural context. This study aimed to define the current barriers and facilitators to socioeconomic inclusion for women with physical disability living in the community in Bangladesh and to highlight the impact of these barriers on health.
Methods: Semi-structured in-depth interviews were conducted with 15 women who had either a spinal cord injury or amputation, and who had been discharged for at least 3 months after inpatient admission. Mixed purposeful sampling (a mixture of typical case sampling and criterion sampling) was used to recruit the study participants. A thematic analysis was conducted to extract themes from the data. The social determinants of health framework and the International Classification of Functioning (ICF) model were then used to contextualise the data.
Results: Five major themes were identified including: exclusion from formal education, exclusion from the work force, exclusion from public facilities, exclusion from marriage and increased risk of violence and exclusion from community activities and social groups. Facilitators to inclusion include: provision of accessible buildings and transport, community- based advocacy services and vocational training services.
Conclusions: The combination of physical disability and female gender presents multiple complex barriers to inclusion in the socioeconomic and cultural life of Bangladesh. Practical interventions through both up-scaling and expansion of disability-specific programming and sustained policy implementation are required to facilitate individual empowerment and better health outcomes for women with disability.