'If we take the engine out, how will the car go?': beliefs, understanding and access to vasectomy services in Timor-Leste.

Vasectomy is a safe, highly effective and affordable method of permanent contraception, and one of the few currently available contraceptive methods for men. Despite this, vasectomy uptake remains overall low, making up just 2% of the global contraceptive method mix. To better understand access to vasectomy in a country with negligible uptake, we conducted participatory and operational research in the Democratic Republic of Timor-Leste (Timor-Leste). We held 14 participatory group discussions with 175 community participants (84 men, 91 women; aged 18-72) across seven municipalities (Ainaro, Baucau, Bobonaro, Dili, Lautem, Manufahi, and Oecusse), and individual in-depth interviews with 24 healthcare providers (16 women, 8 men; aged 25-56 years). Data were analysed using reflexive thematic analysis. Community awareness and understanding about vasectomy were limited, with concerns expressed about physical and social side effects. Healthcare providers had limited experience and knowledge about vasectomy, and about male sexual and reproductive health more generally. However, our findings also indicate a small but existing demand for vasectomy services that could be grown and better met through health systems strengthening initiatives. Insights from our research have informed programmatic decision-making in Timor-Leste and can be further used to inform national health policy and practice.

Is sex lost in translation? Linguistic and conceptual issues in the translation of sexual and reproductive health surveys.

Translated questionnaires are increasingly used in population health research. Nevertheless, translation is often not conducted with the same rigour as the process of survey development in the original language. This has serious limitations and may introduce bias in question relevance and meaning. This article describes and reflects on the process of translating a large and complex sexual and reproductive health survey from English into Simplified Chinese. We interrogated assumptions embedded in taken-for-granted translation practice to locate the sociocultural origins of these assumptions. We discuss how terminology and expression related to sexual and reproductive health may lose their conceptual or linguistic significance during translation in three different ways. Firstly, meanings can be lost in the negotiation of meanings associated with linguacultural and geographical variations of terminology. Secondly, meanings can be lost in the clash between everyday and professional sexual and reproductive health discourses. Thirdly, meanings can be lost due to the design of the source questionnaire and the intended mode of survey administration. We discuss ways to help overcome the unavoidable translation challenges that arise in the process of translating English sexual and reproductive health surveys for migrants from non-English speaking backgrounds.

'Direct' and 'instant': the role of digital technology and social media in young Filipinos' intimate relationships.

Young people today grow up in a social landscape in which digital technology and social media are ubiquitous in daily life and interpersonal relations, including intimate (romantic and sexual) relationships. This study sought to study Filipino young people's relationship motivations and contexts in the digital age. We found that digital technology and social media are transforming the way Filipino young people approach and behave in intimate relationships. Digital technology and social media are making it easier for young people to engage in social comparison with their peers and role models, expanding possibilities for social interaction, facilitating rapid relationship progression, and enabling digital togetherness and self-expression in a context where conservative religious and sociocultural norms and sexual double standards remain dominant. This social environment brings opportunities to engage in relationships in new ways but also exposure to risks that may lead to poor sexual and reproductive health outcomes. Our findings underscore the importance of comprehensive sexuality education in schools and at home, and highlight the need for critical dialogue about the social norms and stereotypes that perpetuate gender-based violence and inequality in online and offline spaces.

Exploring the identities and experiences of young queer people in Mongolia using visual research methods.

There is limited evidence about the lives of queer Mongolian youth. This is despite mental health problems being a pressing concern among young Mongolians, and international evidence suggesting queer youth may experience more mental health challenges than their non-queer peers. We explored the experiences of queer youth in their immediate environments and navigation of their identities in Mongolian society. In this study, twelve young queer-identifying people aged 18-25 from Ulaanbaatar, Mongolia participated in photo-elicitation interviews. Visual research methods allowed participants to generate rich (visual, textual, and oral) data about their lived experiences. We analysed data using a thematic approach and identified three main themes, each with three sub-themes. Participants reported that peer bullying and gendered expectations at school, heteronormativity and gender role expectation in family settings, along with strong stereotypes about queerness in broader society, substantially impacted participants' mental and physical wellbeing. Mongolian queer youth need strong support from their immediate environments, such as school and family. Stigma and misconception around queerness remain persistent among the public but young people are continuously resisting the prejudice expressed towards them. Understanding these challenges is crucial to increasing inclusivity in policies and programmes to enhance the wellbeing of young queer Mongolians.

Participatory Qualitative Research in a Multilingual Context: The Use of Panel Translation to Better Understand and Improve Sexual and Reproductive Health in Timor-Leste.

Understanding and respecting different linguistic and socio-cultural needs of health service users is critical to design, adapt and provide appropriate health services. We explored access to male family planning methods in The Democratic Republic of Timor-Leste, a linguistically and culturally diverse nation, by conducting 14 participatory group discussions (PGDs) with 175 participants across seven municipalities. Participants (84 men and 91 women, aged 18 to 72) spoke 13 different languages. PGDs were audio-recorded and translated to English using a multilingual panel translation approach that enabled rigorous and reflexive discussion and learning between researchers about context and meaning. Planning for language diversity helped us to centre participant voices and to hear perspectives that may have otherwise been excluded or misrepresented. Our study affirms the need for research teams to include diverse members who help ensure meaning and voice is not lost across cultural and linguistic differences. Linguistic respect, inclusion and transparency are required to realise improved health and development outcomes.

Overt acts of perceived discrimination reported by British working-age adults with and without disability.

BACKGROUND: Exposure to discrimination can have a negative impact on health. There is little robust evidence on the prevalence of exposure of people with disabilities to discrimination, the sources and nature of discrimination they face, and the personal and contextual factors associated with increased risk of exposure. METHODS: Secondary analysis of de-identified cross-sectional data from the three waves of the UK's 'Life Opportunities Survey'. RESULTS: In the UK (i) adults with disabilities were over three times more likely than their peers to be exposed to discrimination, (ii) the two most common sources of discrimination were strangers in the street and health staff and (iii) discrimination was more likely to be reported by participants who were younger, more highly educated, who were unemployed or economically inactive, who reported financial stress or material hardship and who had impairments associated with hearing, memory/speaking, dexterity, behavioural/mental health, intellectual/learning difficulties and breathing. CONCLUSIONS: Discrimination faced by people with disabilities is an under-recognised public health problem that is likely to contribute to disability-based health inequities. Public health policy, research and practice needs to concentrate efforts on developing programs that reduce discrimination experienced by people with disabilities.

Early union, 'disgrasya', and prior adversity and disadvantage: pathways to adolescent pregnancy among Filipino youth.

BACKGROUND: Few studies explore what it means to be an adolescent parent in the Philippines from the young parents' perspective. This study sought to improve understanding of how adolescent mothers and young fathers experienced pregnancy in Palawan, Philippines. METHODS: We conducted narrative analysis of 27 semi-structured interviews with 15 Filipino young parents. FINDINGS: Our findings point to three pathways to adolescent pregnancy differentiated by life circumstances and perceived self-efficacy: through early unions, through 'disgrasya' (accident) in romantic relationships, and when pregnancy is directly related to adversity and disadvantage. Some young people adopted agentic narratives and had intended pregnancies within early unions. Young people who had unintended pregnancies in romantic relationships recounted constrained choice narratives, taking responsibility for their decisions while emphasising external factors' influence on their decision-making. Other young mothers described the ways that prior adversity and disadvantage gave rise to unfavourable circumstances-including sexual violence-that led to unintended pregnancy but shared narratives showing how they had reclaimed agency in their lives. CONCLUSION: Our findings highlight the need to (1) address underlying poverty and structural inequalities that limit Filipino young people's life choices and contribute to their pathways to adolescent pregnancy; (2) provide Filipino young people with access to essential sexual and reproductive health information, services, and supplies; and (3) change social norms to rectify gender-based power imbalances and sexual violence.

This study sought to improve understanding of how adolescent mothers and young fathers experienced adolescent pregnancy in Palawan, Philippines. By analysing the narratives of 15 Filipino young parents, we found three pathways to adolescent pregnancy differentiated by life circumstances and perceived self-efficacy: intended pregnancy through early, cohabiting unions; unintended pregnancy through 'disgrasya' (accident) in romantic relationships; and unintended pregnancy following prior difficult life circumstances where pregnancy led to reclaiming of agency. Our findings highlight the need to address poverty and inequalities, ensure that Filipino adolescents have access to sexual and reproductive health information, services and supplies, and change social norms that perpetuate gender-based power imbalances and sexual violence.

Reproductive coercion and abuse in Australia: what do we need to know?

Reproductive coercion and abuse refers to patterns of controlling and manipulative behaviours used to interfere with a person's reproductive health and decision-making. Unintended pregnancy, forced abortion or continuation of a pregnancy, and sexually transmissible infections all may result from reproductive coercion, which is closely associated with intimate partner and sexual violence. Clinicians providing sexual and reproductive healthcare are in a key position to identify and support those affected. Yet, reproductive coercion and abuse is not currently screened for in most settings and addressing disclosures poses many challenges. This article discusses what reproductive coercion and abuse is, who it affects, how it impacts, and potential strategies to improve identification and response.

Using Videoconferencing Focus Groups in Sexual and Reproductive Health Research With Chinese Im/Migrants in Australia.

Videoconferencing focus groups have emerged as a popular method for collecting qualitative data. However, its use in sexual and reproductive health research is still very much in its infancy. Based on participants' feedback and researchers' reflections on using videoconferencing focus groups to collect sexual and reproductive health data with 39 heterosexual and non-heterosexual Chinese im/migrants in Australia, we discuss some of the key lessons learned, and considerations involved in shifting from face-to-face to online focus groups. Overall, videoconferencing focus groups appeared to be a highly feasible and acceptable way to discuss "sensitive" topics with Chinese im/migrants. Importantly, researchers need to be both creative and reflexive during the research process and must not forget that the success of a study lies not only in troubleshooting technical issues but also in cultivating and maintaining a trusting relationship with research participants.

'I'm proud of how far I've come. I'm just ready to work': mental health recovery narratives within the context of Australia's Disability Employment Services.

BACKGROUND: Employment is recognised as facilitating the personal and clinical recovery of people with psychosocial disability. Yet this group continue to experience considerable barriers to work, and, constitute a significant proportion of individuals engaged with Disability Employment Services (DES). Recognition of the role of recovery-oriented practice within DES remains limited, despite these approaches being widely promoted as best-practice within the field of mental health. METHODS: The Improving Disability Employment Study (IDES) aims to gather evidence on factors influencing employment outcomes for Australians with disability. Descriptive analysis and linear regression of IDES survey data from 369 DES participants, alongside narrative analysis of data collected through 56 in-depth interviews with 30 DES participants with psychosocial disability, allowed us to explore factors influencing mental health, well-being and personal recovery within the context of DES. RESULTS: Psychosocial disability was reported as the main disability by 48% of IDES respondents. These individuals had significantly lower scores on measures of mental health and well-being (44.9, 48.4 respectively, p ≤ 0.01), compared with respondents with other disability types (52.2, 54.3 p ≤ 0.01). Within this group, individuals currently employed had higher mental health and well-being scores than those not employed (47.5 vs 36.9, 55.5 vs 45.4 respectively, p ≤ 0.01). Building on these findings, our qualitative analysis identified five personal recovery narratives: 1) Recovery in spite of DES; 2) DES as a key actor in recovery; 3) DES playing a supporting role in fluctuating journeys of recovery; 4) Recovery undermined by DES; and, 5) Just surviving regardless of DES. Narratives were strongly influenced by participants' mental health and employment status, alongside the relationship with their DES worker, and, participants' perspectives on the effectiveness of services provided. CONCLUSION: These findings re-iterate the importance of work in supporting the mental health and well-being of people with psychosocial disability. Alongside access to secure and meaningful work, personal recovery was facilitated within the context of DES when frontline workers utilised approaches that align with recovery-orientated practices. However, these approaches were not consistently applied. Given the number of people with psychosocial disability moving through DES, encouraging greater consideration of recovery-oriented practice within DES and investment in building the capacity of frontline staff to utilise such practice is warranted.

Male involvement interventions and improved couples' emotional relationships in Tanzania and Zimbabwe: 'When we are walking together, I feel happy'.

Male involvement in maternal and child health is recognised as a valuable strategy to improve care-seeking and uptake of optimal home care practices for women and children in low- and middle-income settings. However, the specific mechanisms by which involving men can lead to observed behaviour change are not well substantiated. A qualitative study conducted to explore men's and women's experiences of male involvement interventions in Tanzania and Zimbabwe found that, for some women and men, the interventions had fostered more loving partner relationships. Both male and female participants identified these changes as profoundly meaningful and highly valued. Our findings illustrate key pathways by which male involvement interventions were able to improve couples' emotional relationships. Findings also indicate that these positive impacts on couple relationships can motivate and support men's behaviour change, to improve care-seeking and home care practices. Men's and women's subjective experiences of partner relationships following male involvement interventions have not been well documented to date. Findings highlight the importance of increased love, happiness and emotional intimacy in couple relationships - both as a wellbeing outcome valued by men and women, and as a contributor to the effectiveness of male involvement interventions.

Inequalities in the Age of Universal Health Coverage: Young Chileans with Diabetes Negotiating for Their Right to Health.

While universal health coverage (UHC) has been praised as a powerful means to reduce inequalities and improve access to health globally, little has been said about how patients experience and understand its implementation locally. In this article, we explore the experiences of young Chileans with type 1 diabetes when seeking care in Santiago, within Chile's UHC program, which sought to improve people's access to health care. We argue that the implementation of UHC, within a structurally fragmented health system, did not lead to the promised equitable health care delivery. Although UHC aimed to equitably provide universal care, locally it materialized in heterogeneous configurations forcing individuals into positions of precarity and generating new inequalities. Furthermore, for the young people in the study, UHC intersected with their health insurance and socioeconomic status, impacting on the health care they could access, consequently making diabetes care and management a difficult challenge.

Enabling Action: Reflections upon Inclusive Participatory Research on Health with Women with Disabilities in the Philippines.

People with disabilities experience health disparities arising from social, environmental, and system-level factors. Evidence from a range of settings suggests women with disabilities have reduced access to health information and experience barriers to screening, prevention, and care services. This results in greater unmet health needs, particularly in relation to sexual and reproductive health. Women with disabilities are also more likely to experience physical and sexual violence than women without disabilities, further undermining their health. Community-based participatory research (CBPR) can generate knowledge and underpin action to address such health disparities and promote health equity. However, the potential and challenges of disability inclusion in CBPR, particularly in contexts of poverty and structural inequality such as those found in low- and middle-income countries, are not well documented. In this paper, we reflect on our experience of implementing and evaluating W-DARE, a three-year program of disability-inclusive CBPR aiming to increase access to sexual and reproductive health and violence-response services for women with disabilities in the Philippines. We discuss strategies for increasing disability inclusion in research and use a framework of reflexive solidarity to consider the uneven distribution of the benefits, costs, and responsibilities for action arising from the W-DARE program.

Adolescent sexual initiation and pregnancy: what more can be learned through further analysis of the demographic and health surveys in the Philippines?

BACKGROUND: Adolescent pregnancy poses risks to the life of a young mother and her baby, and can affect their health, educational and future employment outcomes. In many low- and middle-income countries like the Philippines, the Demographic and Health Surveys (DHS) Program is among the most reliable and easily accessible sources of demographic and health data for researchers, development workers, and policymakers. Data on adolescent sexual and reproductive health (SRH) are often limited, but in the absence of other sources, there is room to make the most of the adolescent health data gathered by the DHS. The aim of this study is to explore what more can be learned about adolescent sexual initiation and pregnancy through the further analysis of demographic and health data, using DHS data from the Philippines as an example. METHODS: This study conducted trend analysis of DHS data over three survey rounds (2003, 2008 and 2013) to explore the context of adolescent sexual initiation and pregnancy over time. Bivariate and multivariate logistic regression were then used to study associations between adolescent pregnancy experience and selected demographic, socioeconomic and SRH variables using data from the 2013 DHS. RESULTS: This study found that between 2003 and 2013, proportions of Filipino young women experiencing adolescent sexual initiation and adolescent pregnancy have increased. Multivariate logistic regression affirmed the protective effect of education and belonging to higher wealth quintiles on the risk of adolescent pregnancy. Ever use of contraception was positively associated with adolescent pregnancy but is likely indicative of use after a prior pregnancy, and/or other factors relating to improper/inconsistent contraceptive use. CONCLUSIONS: In the absence of reliable, easily accessible data on adolescent SRH, the DHS data can provide important insights about adolescent reproductive transitions such as sexual initiation and first pregnancy. However, there are limited variables in the datasets that could proxy for other important social determinants which prior studies have linked to adolescent SRH outcomes. There remains a need for timely and targeted collection of quantitative and qualitative data on adolescent SRH that can guide programming and policy intended to foster positive health outcomes during this crucial transition period to adulthood.

Mediated representations of violence against women in the mainstream news in Australia.

BACKGROUND: How the mainstream news media report violence against women is significant if levels of violence are to be reduced and ultimately eliminated. Media reporting is an important indicator through which to measure progress towards shifting social and cultural norms that reinforce or challenge the place of violence against women in our society. The current study, therefore, aimed to establish a baseline picture of the extent and nature of reporting of violence against women by the mainstream Australian news media. METHODS: Descriptive and content analysis of media reports on violence against women that were collected over four months in three states of Australia. Reports were from newspapers, broadcast (television and radio) and online news sites. RESULTS: Coverage of violence against women in the mainstream news media was extensive. Explicitly situating violent experiences for women within a broader social context was infrequent. Few news reports included information for women on where to seek help. Additionally, news reports rarely elevated the voices of survivors, advocates and other experts, with a disproportionate emphasis on law enforcement, political and criminal justice perspectives. CONCLUSIONS: Despite readiness among journalists and readers to engage in news about violence against women, reporting that promotes public understanding of the issue is not always the norm.

The MuSeS project: a mixed methods study to increase understanding of the role of settlement and multicultural services in supporting migrant and refugee women experiencing violence in Australia.

BACKGROUND: Violence against women is a major human rights and public health issue globally. The experience of violence affects women across Australia, including the large number of migrant and refugee women who permanently or temporarily resettle in the country. Many women who experience violence find it difficult to access support, and evidence suggests women who have resettled in Australia face additional barriers to violence-specific services. Previous research, however, indicates many migrant and refugee women experiencing violence have contact with, and may disclose violence to, settlement and multicultural services. There has been limited research documenting current knowledge of, and practices by, settlement and multicultural services in relation to violence. The MuSeS project will address this knowledge gap and identify strategies settlement and multicultural services can use to better support women experiencing violence. METHODS: This mixed methods research project will be conducted in six geographic communities across three Australian states: South Australia, Tasmania and Victoria. The different migration and resettlement patterns seen in these jurisdictions will enable generation of data relevant to settings across the country. The project has been designed in consultation with partner organisations from the settlement and multicultural service sector to ensure the research addresses their concerns and priorities. A mix of quantitative and qualitative methods will be used to generate rich data to inform strategies for settlement and multicultural services to better support women experiencing violence. These methods include an anonymous online survey of settlement and multicultural service providers to assess current knowledge, practices and professional development needs; in-depth interviews with settlement, multicultural and specialist (refugee) mental health service providers; in-depth interviews with refugee women; and focus group discussions with frontline workers and volunteers working with settlement and multicultural services. DISCUSSION: Findings from this two-year research project will generate an in-depth understanding of the current and potential role of Australian settlement and multicultural services in supporting migrant and refugee women experiencing violence, and inform strategies to strengthen services' capacity to appropriately respond. Given the prevalence of violence against women globally, findings will be useful for services engaging with migrant and refugee populations around the world.

Expectant fathers' participation in antenatal care services in Papua New Guinea: a qualitative inquiry.

BACKGROUND: The importance of engaging men in maternal and child health programs is well recognised internationally. In Papua New Guinea (PNG), men's involvement in maternal and child health services remains limited and barriers and enablers to involving fathers in antenatal care have not been well studied. The purpose of this paper is to explore attitudes to expectant fathers participating in antenatal care, and to identify barriers and enablers to men's participation in antenatal care with their pregnant partner in PNG. METHODS: Twenty-eight focus group discussions were conducted with purposively selected pregnant women, expectant fathers, older men and older women across four provinces of PNG. Fourteen key informant interviews were also conducted with health workers. Qualitative data generated were analysed thematically. RESULTS: While some men accompany their pregnant partners to the antenatal clinic and wait outside, very few men participate in antenatal consultations. Factors supporting fathers' participation in antenatal consultations included feelings of shared responsibility for the unborn child, concern for the mother's or baby's health, the child being a first child, friendly health workers, and male health workers. Sociocultural norms and taboos were the most significant barrier to fathers' participation in antenatal care, contributing to men feeling ashamed or embarrassed to attend clinic with their partner. Other barriers to men's participation included fear of HIV or sexually transmitted infection testing, lack of separate waiting spaces for men, rude treatment by health workers, and being in a polygamous relationship. Building community awareness of the benefits of fathers participating in maternal and child health service, inviting fathers to attend antenatal care if their pregnant partner would like them to, and ensuring clinic spaces and staff are welcoming to men were strategies suggested for increasing fathers' participation in antenatal care. CONCLUSION: This study identified significant sociocultural and health service barriers to expectant fathers' participation in antenatal care in PNG. Our findings highlight the need to address these barriers - through health staff training and support, changes to health facility layout and community awareness raising - so that couples in PNG can access the benefits of men's participation in antenatal care.

"Freedom to go where I want": improving access to sexual and reproductive health for women with disabilities in the Philippines.

Women with disabilities experience a range of violations of their sexual and reproductive rights. The Philippines ratified the United Nations Convention on the Rights of Persons with Disabilities and have laws in place to promote the rights to sexual and reproductive health and protection from violence. However, limited resourcing, and opposition to such laws undermine access to these rights for all women. Inadequate disability inclusion within policy and programming, and limited disability awareness of services, further impedes women with disabilities from attaining these rights. The W-DARE project (Women with Disability taking Action on REproductive and sexual health) was a three-year participatory action research program designed to (1) understand the sexual and reproductive health experiences and needs of women with disabilities; and (2) improve access to quality sexual and reproductive health, including violence response services, for women with disabilities in the Philippines. In response to the highlighted need for more information about sexual and reproductive health and greater access to services, the W-DARE team developed and implemented a pilot intervention focused on peer-facilitated Participatory Action Groups (PAGs) for women with disabilities. This paper focuses on the qualitative findings from the evaluation of this PAG intervention.

Rapid assessment of disability in the Philippines: understanding prevalence, well-being, and access to the community for people with disabilities to inform the W-DARE project.

BACKGROUND: International recognition that people with disabilities were excluded from the Millennium Development Goals has led to better inclusion of people with disabilities in the recently agreed Global Goals for Sustainable Development (SDGs) 2015-2030. Given the current global agenda for disability inclusion, it is crucial to increase the understanding of the situation of people with disabilities in the Philippines. The aim of this study was to estimate the prevalence of disability and compare the well-being and access to the community between people with and without disabilities. METHODS: A population-based survey was undertaken in District 2 of Quezon City and in Ligao City. 60 clusters of 50 people aged 18 years and older were selected with probability proportion to size sampling from both locations. The Rapid Assessment of Disability (RAD) survey was used to identify people with disabilities based on their responses to activity limitations. The levels of well-being and access to the community for people with disabilities were compared with controls matched by age, gender, and cluster. Information on barriers to accessing the community was also collected. RESULTS: The prevalence of disability was 6.8 (95 % CI: 5.9, 7.9) and 13.6 % (95 % CI: 11.4, 16.2) in Quezon City and Ligao City respectively. Psychological distress was the most commonly reported condition in both locations, although it was often reported with a co-morbid condition related to sensory, physical, cognitive, and communication difficulties. The prevalence of disability was associated with age and no schooling, but not associated with poverty. People with disabilities had significantly lower well-being scores and reduced access to health services, work, rehabilitation, education, government social welfare, and disaster management than people without disability. Having a disability and negative family attitudes were reported as barriers for people with disabilities participating in work, community meetings, religious activities, and social activities. CONCLUSIONS: The prevalence of disability among adults in District 2 of Quezon City and in Ligao City is higher than the estimated national prevalence of disability derived from the 2010 Philippines census. Disability is also associated with lower well-being and reduced participation across a number of domains of community life.

Sexual and reproductive health services for women with disability: a qualitative study with service providers in the Philippines.

BACKGROUND: The Philippines has ratified the United Nations Convention on the Rights of Persons with Disabilities and recently passed domestic legislation protecting the sexual and reproductive rights of people with disability. However women in the Philippines continue to report barriers to sexual and reproductive health services, and there is limited empirical evidence available to inform policy makers' efforts to respond. This study aims to contribute to the available evidence by examining service providers' perceptions of disability and their experiences providing sexual and reproductive health services to women with disability. METHODS: The study was conducted as part of a larger three-year program of participatory action research that aims to improve the sexual and reproductive health of women with disabilities in the Philippines. Fourteen in-depth interviews and two focus group discussions were conducted with a total of thirty-two sexual and reproductive health service providers in Quezon City and Ligao. Qualitative data were analysed to identify key themes in participants' discussion of service provision to women with disability. RESULTS: Analysis of service providers' accounts suggests a range of factors undermine provision of high quality sexual and reproductive health services to women with disability. Service providers often have limited awareness of the sexual and reproductive health needs of women with disability and inadequate understanding of their rights. Service providers have had very little training in relation to disability, and limited access to the resources that would enable them to provide a disability inclusive service. Some service providers hold prejudiced attitudes towards women with disability seeking sexual and reproductive health services, resulting in disability-based discrimination. Service providers are also often unaware of specific factors undermining the health of women with disability, such as violence and abuse. CONCLUSION: Recent legislative change in the Philippines opens a window of opportunity to strengthen sexual and reproductive health service provision across the country. However the development of services that are disability-inclusive will require substantial efforts to address supply-side barriers such as prejudiced service provider attitudes and limited capacity. Disability inclusion must be prioritised for the national goal of responsible parenthood and reproductive health to be realised for all.