Abstract / Summary
Abstract Background Adolescents and young people with disabilities (AYPWDs) experience substantial barriers to accessing sexual and reproductive health (SRH) services despite global commitments to equitable healthcare. Evidence quantifying these barriers and their determinants remains limited in Ghana. This study examined barriers to SRH service access, service utilisation and denial among AYPWDs in three municipalities of the Bono Region, Ghana. Methods An analytic cross-sectional study was conducted among 440 AYPWDs aged 15–24 years using probability proportional-to-size sampling. Data were collected using a validated 10-item barrier scale (Cronbach's α = 0.882) and analysed using descriptive statistics, chi-square tests, one-way ANOVA, exploratory factor analysis (EFA), and multivariable logistic and linear regression. Results Overall, 67.3% (296/440) of participants had utilised SRH services during the previous 12 months, while 28.6% (126/440) reported having been denied SRH information or services because of their disability. Lack of information on disability rights to SRH services (mean = 3.24 ± 1.24), fear of stigma or judgement (mean = 3.20 ± 1.07), and concerns regarding privacy and confidentiality (mean = 3.19 ± 1.07) were the highest-rated barriers. EFA identified two reliable barrier dimensions comprising institutional, social and informational barriers (Cronbach's α = 0.889) and physical/transport barriers (Cronbach's α = 0.778). Compared with participants without formal education, those with tertiary education had significantly higher odds of SRH service utilisation (adjusted odds ratio [AOR] = 5.32, 95% CI: 2.55–11.11) and markedly lower odds of reporting service denial (AOR = 0.12, 95% CI: 0.05–0.27). Severe disability was associated with lower odds of SRH service utilisation (AOR = 0.49, 95% CI: 0.26–0.94), while municipality of residence, disability severity and disability type remained independently associated with perceived barrier scores. Conclusion AYPWDs in the three municipalities studied experience multiple interconnected structural, informational, and physical barriers to accessing SRH services. Educational attainment was strongly associated with improved service utilisation and reduced experiences of service denial, whereas disability severity, disability type and geographic location remained important determinants of perceived barriers. These findings provide region-specific evidence to support strengthening disability-inclusive SRH policies, provider training, communication support, accessible infrastructure and routine disability-disaggregated health information systems in Ghana.