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.

"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.

The dynamics of migration-related stress and coping of female domestic workers from the Philippines: an exploratory study.

Female domestic workers face many migration-related stressors that affect their mental health, but we know little about the dynamics of stress and coping in different migration phases. This exploratory study aims to assess stress and coping of female migrant domestic workers from the Philippines in different phases of the migration process; prior to migration, in the country of destination and upon return to the Philippines. Data were collected in 2010 using questionnaires (N = 500). Validation of findings took place in a work shop (23 participants) and two focus groups (13 and 8 participants). Stress levels of women were significantly higher abroad than in the Philippines. Stress and coping in the Philippines was primarily related to financial issues, while stress and coping abroad related more strongly loneliness, working conditions and employers. Findings from this study provide insight in the phase-specific and transnational dimensions of stress and coping.

Toward healthy migration: an exploratory study on the resilience of migrant domestic workers from the Philippines.

Domestic workers face many migration-related stressors that affect their mental health. Currently there is an emphasis in the literature on these workers' problems and vulnerability, while there is little insight into factors that positively affect their mental health. In this study, we describe a range of factors that potentially contribute to the resilience of female domestic workers from the Philippines, and explore their relation to stress and well-being. The study used an explorative, mixed-methods design. First, data were collected using questionnaires (n = 500) to assess self-perceived stress levels, well-being, personal resources, and social resources. Then, findings from the questionnaires were validated and elaborated on in a workshop (n = 23) and two focus groups (n = 13; n = 8). Results show that participants perceived their well-being abroad as relatively good, while they also experienced high levels of stress. Workers used a variety of resources in dealing with stress. Socially oriented coping strategies and spirituality seemed to play an important role as personal resources, while the influence of reasons for migration was less clear. Employers and (access to) social networks appeared important in determining social resources. Social resources were more often related to stress and well-being than were personal resources. Findings from this study can help to design strengths-based interventions aimed at improving the well-being of female domestic workers and preventing mental health problems. The environmental factors and structural constraints that provide the context for resilience should be further explored as they influence the ability to mobilize resources.