“You end up doing what they want … because you are afraid of them:” a qualitative exploration of barriers to sexual and reproductive health among Zimbabwean refugee women with disabilities in South Africa

Abstract

Zimbabwean refugee women with disabilities living in South Africa experience persistent exclusion from sexual and reproductive health [SRH] care. This study examines the constraints on SRH autonomy and reproductive justice among Zimbabwean refugee women with disabilities as they access SRH care in South Africa. The focus is on understanding how multiple and intersectional oppressions based on gender, migration, and ability statuses produce SRH exclusion and limit reproductive health choices for these women. A qualitative study using a modified photovoice approach was conducted with 10 Zimbabwean refugee women. Participants, who were recruited with support from a community organisation in the Western Cape, were given memory cards to photograph reminders of their experiences in Zimbabwe and on their journey to South Africa, as well as images of their current experiences in the Western Cape. Interviews to discuss the photographs and participants’ experiences accessing SRH in South Africa were conducted in English, Shona, and Ndebele. Data were analysed using reflexive thematic analysis. Four themes were identified: (1)experiencing patriarchal control and economic dependency as constraints on reproductive freedoms (2), dealing with community control over one’s body and choices (3), navigating institutional barriers and limited access to SRH, and (4) using traditional healing methods as an adaptive response to exclusion from formal health care services. Participants reported encountering multiple barriers to accessing SRH services across the Western Cape at the interpersonal, community, and institutional levels. Attempts to access SRH were often met with exclusion by family members, neighbours, and health care providers. Many women delayed or avoided formal SRH care and, in some cases, relied on informal or unsafe alternatives. Zimbabwean refugee women with disabilities face cumulative and intersecting barriers to SRH access that are structurally embedded across social and institutional contexts. Addressing these inequities requires disability-inclusive, refugee-responsive, and gender-sensitive SRH policies, along with accountability mechanisms to ensure equitable implementation. This study also highlights the need for targeted interventions to improve SRH access and reproductive justice for refugee women with disabilities in South Africa.