Identification and enumeration

To ensure that women with disabilities from different backgrounds (e.g. rural vs. urban, and literate vs. non-literate) are represented in our study, we will conduct a comprehensive community level identification and enumeration of all sexually active reproductive aged women who identify themselves or are identified by family members as having some disability. This community level enumeration is important because although the Ghana Federation of Disability Organisations, local district assemblies, and other disability groups often have some database of registered members, our engagement with leaders of various disability groups in the study districts showed that this data is not sufficient as many persons with disabilities are often not registered with either the district assembly or the Ghana Federation of Disability Organisations. Therefore, a community level enumeration allows for identification of all potentially eligible participants.

To effectively undertake the community level enumeration, community health volunteers will be engaged in each of the study districts to do a house-to-house listing of all women with disabilities aged 15–49 years who have physical or visual disabilities. We propose to use community health volunteers because disability in Ghana still carries considerable stigma such that using a ‘stranger’ to do this household enumeration may be less successful [22, 24]. However, as community health volunteers are community members who may be well known and trusted because of the roles they already play in serving as a link between the formal healthcare system and local communities, women with disabilities and their families are likely to better cooperate.

We will design a simple Enumeration Form and train community health volunteers to use the form to enlist all women with physical and visual disability in their respective communities. The form will ask for basic information such as name, community, age, contact number, house number/name, disability type, and whether the disabled woman/girl is sexually active (i.e. have had penetrative sex before). Each of the women with disabilities would also be asked if she would be interested in taking part in the larger study, which will last for a period of 12 months.

In addition to using the enumeration form, we will also train the community health volunteers to administer an adapted screening tool from the Washington Group on Disability Statistics [6]. This screening tool has been successfully used in other low-income contexts to screen and identify women with disabilities [6]. The tool has 35 questions to detect disability type and social function and communication disabilities based on the International Classification of Functioning, Disability and Health [6]. The screening tool captures severity of disability by asking respondents to rank their status on a four-point Likert scale [6]. This tool will allow us to not only identify women/girls with disability but to determine the severity of their disability.