Let’s talk about sex

How an innovative project in northern Nigeria led by Sightsavers and BBC Media Action is changing community attitudes and supporting women with disabilities to access family planning services 

Illustrative background - along both sides and the bottom are with different coloured blocks with designs in the middle that represent different contraception options. On the left side of the decorative background is an illustration of a woman's head and shoulders, she is wearing a red head scarf and around the woman in geometric illustrations that represent different contraception option

Under the leafy shade of a tree in the middle of a baking hot day, a group of women gather around a portable radio. Only a few moments ago they were noisily chatting and laughing together, but now they’re quiet and still as they listen to a devastating story unfold – an episode of the popular Hausa language radio drama Madubi. 

A group of 11 women sit under a tree while another woman speaks to them.

Nabila, a Madubi character who is pregnant and a wheelchair user, is reluctant to go to hospital to have her baby. Her midwife, Amina, tries to convince her it’s the safest place to go, but Nabila’s husband says that people with disabilities have bad experiences there. Amina finally convinces the couple, but when they arrive at the hospital they realise there’s no ramp to get Nabila into the building. As hospital staff attempt to lift the wheelchair up the entrance steps, one of them slips, causing everyone to fall. Nabila is injured when she hits the ground, and loses her baby. 

Actors recording an episode of Madubi

Actors recording an episode of Madubi

At the end of the episode, Ramatu, the group facilitator, leads a discussion around health care and maternity rights for women with disabilities. Group members share their experiences of accessing, or being denied, the health care they need. They talk about what needs to be done to make health care more inclusive, and the session wraps up with Ramatu giving out information on family planning and accessible health services. 

Joy Shu’aibu, country director for Sightsavers in Nigeria, explains why the project is so necessary.

“There are more than 25 million persons with disabilities in Nigeria. And it is common knowledge that women with disabilities face double stigma. They are more marginalised than men who have disabilities, because of the nature of our community.”

“The attitudes of the health care givers towards us is very, very discouraging. Most of them are not aware of inclusive health care. And then the accessibility to the facilities – most of the facilities are not accessible.”

Rose
Network of Women with Disabilities

A woman wearing a red dress sits outside and smiles at the camera.A woman wearing a red dress sits outside and smiles at the camera.

“If some [women with disabilities] go through these challenges, go through these barriers, they can give up accessing health care services.”

Hamidat
Women with Disabilities Self-Reliance Foundation

A woman wearing a black head scarf and purple shirt sits in an office and smiles at the camera.A woman wearing a black head scarf and purple shirt sits in an office and smiles at the camera.

“The attitudes of the health care givers towards us is very, very discouraging. Most of them are not aware of inclusive health care. And then the accessibility to the facilities – most of the facilities are not accessible.”

Rose
Network of Women with Disabilities

A woman wearing a red dress sits outside and smiles at the camera.

“If some [women with disabilities] go through these challenges, go through these barriers, they can give up accessing health care services.”

Hamidat
Women with Disabilities Self-Reliance Foundation

A woman wearing a black head scarf and purple shirt sits in an office and smiles at the camera.

The discussion sessions and radio episodes are part of a groundbreaking inclusive family planning project to improve sexual and reproductive health outcomes for people with disabilities through social behaviour change activities.

The project (led by Sightsavers and BBC Media Action through the Inclusive Futures initiative and developed in partnership with organisations of people with disabilities) includes consultative sessions run with three separate groups: unmarried women, married women, and men.

Meet the group leaders

Three of the group facilitators are Abubakar, who leads the men’s group, Ramatu, who leads the group of unmarried women and Zainab, who leads the married women’s sessions, Zainab and Ramatu, who are both women with disabilities, bring lived experience of the issues discussed in the project to their roles, which means the women taking part know they’re speaking to knowledgeable peers.

An illustration of three men stood in a line, each man has a disability: the man on the left uses a crutch, the man in the centre is visually impaired and the man on the right uses a wheel chair.

Abubakar

“It is of great importance to engage young unmarried men in order to create awareness for them to know the necessary steps to take when they get married. Before we started, most of them did not know who they were and had no goals.

“People with disabilities often see themselves as low valued, but based on the training they have received, they have come to the realisation that they are worthy and capable of achieving their life’s goals.”

A man wearing a grey shirt holds a flip chart which has an illustration about different family planning methods for people with disabilities.
An illustration of a young woman who uses a wheelchair with illustrated thought bubbles around her to reflect her thoughts about goals she'd like to pursue: a career, education and finding love.

Ramatu

“What I love about my role is I am making women with disabilities become champions in their community. My hope is inclusiveness.

“If sensitisation takes place in the community, to tell the community that women with disability can make decisions for themselves and make decisions together with them, I think it’ll be a better way for inclusiveness in the community.”

A woman wearing a purple headscarf sits in the centre of a group of people smiling while holding a flip chart with information about sexual and reproductive health.
An illustration of a woman who uses a wheel chair sat next to her husband at a table talking to a health worker about options for contraception.

Zainab

“One of the key messages we try to get across in the sessions is that family planning is for everyone. [Some people] feel persons with disability should not even think of having a family, getting intimate or protecting themselves.

“This project has helped them to realise their human rights, by opening their eyes to the fact that accessing family planning services is not a privilege to persons with disability. It's a right.”

A woman wearing a peach coloured head scarf and sunglasses smiles at the camera.

This is what inclusion looks like

The project’s social behaviour change approach means people and communities are empowered to adopt inclusive and healthy behaviours. As part of this, women with disabilities have  helped co-create and design the project, and led activities with community leaders, health workers, the media and other stakeholders. This has been vital in making sure the sessions and radio drama are effective and culturally sensitive, and reach the right people in the right way.

The family planning project has already begun to change not only individual lives, but also community attitudes and even government policies. By bringing together disability organisations, health care providers and government representatives, it’s become a significant, scaleable example of disability inclusion in action. 

The project includes resources like this animated video, produced to raise awareness of family planning services:

From the inclusive radio show… to a board game with a difference

Although the radio drama Madubi is used to support the programme sessions, its reach is much wider. As a show broadcast weekly (in partnership with local radio stations and the BBC World Service) with a potential audience of 1.9 million people across northern Nigeria, it offers the opportunity to educate millions of people outside the project.

Radio producer Deji Arosho explains more and shares how the programme is informed by research and consultation with disability organisations.

“We have research to show that [Madubi] is very popular and it’s been effective in behaviour change communication… We invite [people with disabilities] to come and meet with the writers. They spend three days with the writers sharing their experiences, and we use those insights...  throughout the scripting process. We are always going back to ask questions.  

“Working with people with disabilities in both the scripting and recording of the drama has greatly enriched the drama, so it’s more authentic. The drama is more reflective of the larger society including people with disabilities, because we have involved OPDs and other people with disabilities.” 

A man and a woman sit in a recording studio reading from a script.

The radio episodes, which range from shocking and serious to upbeat and entertaining, are just part of how the project keeps participants engaged. The project is also spreading the word to the wider community through a digital media campaign; using social media cards to address myths and facts about family planning, and using influencers to raise awareness about family planning among people with disabilities. So far, the digital campaign has reached over one million people.

A woman wearing a purple head scarf hold a flip chart with illustrations about family planning. The woman is pointing towards the flip chart and smiling.

The sessions also include posters, flip charts, peer-to-peer sessions, video animations and testimonials... and The Ideal Family – a family planning board game originally created by MSI Reproductive Choices, and adapted by the project to be disability inclusive.

As part of the game, participants gain or lose counters depending on the lifestyle and family planning decisions they make. The counters represent family finances, and the game is designed to help participants reflect on the consequences of having large families and how they can make informed choices.

A group of men sit on the floor smiling and laughing while playing a colourful board game.

The board game is particularly popular in the men’s group, offering a chance for the participants to bond as well as increasing education around sensitive issues that may not always be easy to talk about, in an engaging and non-confrontational way.

Abubakar explains why the game is such an effective learning tool.

“The board game session is where those who are unmarried learn how to plan their lives and prepare for marriage, and how to make their family better. They are also taught the different methods of family planning available – implants, tablets, injections, female and male sterilisation – this will help them have a good life in the future especially for them as youths. Knowing this will help them overcome challenges when they get married.” 

The future of the project

Where next for the family planning project, with its innovative social behaviour change approach?

Joy Shu’aibu speaks passionately about the results seen so far, as well as the potential for this and similar projects to have a huge impact in global development, in health care and beyond.

“One of the things that we have noted [from the project] is that there’s an increased awareness and responsiveness of health care workers. We’ve trained more than 1,500 health care workers who provide sexual reproductive health services so that they understand the barriers that women with disabilities face. 

“We’ve got commitment from the government to make minor renovations on health care facilities so that women with disabilities can access care. And thanks to advocacy work carried out under the project, the state government has now adopted the national policy on sexual and reproductive health and rights for people with disabilities. This will make it easier for women with disabilities living in Kaduna to access good quality inclusive family planning services.

“If you really want to make a lasting impact, you have to come from the place of evidence. We’re trying to generate evidence to show how it works. So once we’re able to consolidate this evidence, it will be clear that these are interventions that can work.”

A woman in a blue and white striped head scarf sits in the middle of a group of women while reading her family planning booklet.
The programme facilitator holds the family planning flip chart towards to women, on the left is a woman wearing a maroon head scarf and dress and on the right is a woman wearing an orange head scarf and dress. The woman on the left is looking towards the woman sat next to her on the left and smiles.
A group of four women, all of whom are wearing colourful headscarves, hold up their family planning booklets and smile at the camera.
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The co-created Inclusive Family Planning project in Kaduna is part of the Inclusive Futures global development initiative. The project is funded by the UK Foreign, Commonwealth and Development Office (FCDO) and is led by Sightsavers and BBC Media Action, in partnership with the Joint National Association of Persons with Disabilities (JONAPWD) and the Network of Women with Disabilities (NDW).  Joy Shu’aibu’s quotes are taken from an interview with the science and development podcast SciDev.

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