More than 30,000 Rwandans live with hearing disabilities, and yet the use of sign language is still low. This hinders, among others, their access to Sexual and Reproductive Health and Rights (SRHR) services, where often, the service seeker needs a third party to interpret.

This not only breaches confidentiality, but its accuracy of the interpretation is also questionable.

As the world marks the international Sign Language Day on September 23, it is important to reflect on the importance of inclusivity both at the level of policy formulation and enforcement of those policies.

Inclusivity is necessary to realise the full potential of SRHR. In this endeavour, sign language is a foundational element in ensuring that SRHR services and information are available to everyone, regardless of their hearing abilities.

According to the UN, sign language is a visual form of communication that uses hand gestures, body language, and facial expressions to convey meaning. It not only provides the deaf community with full access to communication; it is also used by others such as people who can hear but can’t speak, and helps in increasing awareness of disability and inclusiveness.

Samuel Munana, the Executive Director of Rwanda National Union of the Deaf (RNUD), says the much of the information about Sexual and Reproductive Health (SRH) is often packaged in a manner not friendly to people with disability given that the materials meant to create awareness of reproductive health are often created without consideration for persons with disabilities (PwDs).

"Sexual and reproductive health materials are not readily available in sign language, thus deaf persons are often left out, hampering their access to information,” he said.

Munana highlighted that in matters regarding SRH, policymakers treat persons with disabilities as targets or passive stakeholders awaiting help and direction, explaining that oftentimes, they have an outsider's view of the sexual and reproductive health needs of PWDs, resulting in ineffective policies.

"They need to engage persons with disabilities in their decision-making to promote effective policies. Persons with disabilities know where it hurts the most. Their involvement would ensure that the policies, budgets, and laws reflect their actual needs,” he said.

Munana noted that it is important for healthcare providers to gain skills in basic Rwandan Sign Language (RSL), which could result in improved family planning provision to young deaf women.

For example, he said; "Deaf women at one health centre have reportedly been prescribed a contraceptive they did not want, and following a training, the health workers at the centre felt more confident interacting with deaf clients and have ensured these women receive their preferred choice.”

One of the programmes that have worked on addressing the issue of access to SRHR services for PWDs is ‘Make Way’. The programme aims to ensure that they are able to realise their sexual reproductive health rights and make informed decisions about relationships, their bodies, family planning, sexuality and wellbeing.

Ariane Dusenge, the Country Coordinator for the programme in Rwanda, emphasised the importance of inclusive services meeting five key requirements: availability, accessibility, affordability, acceptability, and quality.

She pointed out that individuals with hearing impairments, such as the deaf community, often encounter barriers to accessing healthcare services. These include difficulties in communication when they visit health facilities.

"We are seeing more deaf people not interested in going to the health facilities because they know they will not be able to communicate with service providers to receive any service. Additionally, there is another aspect related to privacy. In the event that a person who requires the service has a sign language interpreter who can mediate and convey their needs to the nurse or doctor, there is a breach of privacy, as some subjects may not be as flexible or comfortable to discuss when there is someone in between the two of you," she said.

To address these issues, Dusenge explained the role of the ‘Make Way’ programme, which establishes safe spaces where vulnerable people, including those with disabilities, can share their experiences and receive support and solidarity from fellow youth.

She said the issues raised within these spaces are then brought to local leaders' attention through the intersectional community scorecard processes which entails four steps; rights awareness, issue generation, scoring of issues by youth, scoring of issues by duty bearers, interface meetings youth and duty bearers which as a result generate a list of commitments to remedy on main issues. To track implementation of commitments, a monitoring committee is put in place.

Dusenge highlighted the need for enhancing advocacy efforts to promote sign language accessibility.

She said the ‘Make Way’ programme plans to train healthcare professionals at selected health facilities in the basics of sign language. Additionally, they aim to advocate at the national level to include sign language in the curriculum for nurses and doctors, recognising the importance of effective communication when serving persons with disabilities.

Annonciata Mukayitete, Senior Programmes Officer for Gender and Inclusion at HDI Rwanda, emphasised the integral role of sign language within a comprehensive national gender equality programme that prioritises inclusivity.

She stated, "Sign language is not universally available to SRHR service providers. Some have yet to realise the importance of inclusivity. They mistakenly believe that these services are not intended for individuals with hearing impairments, which is a misconception that leaves them marginalised."

Mukayitete highlighted the need for special attention and underscored that advocacy alone is insufficient; greater efforts are required.

She also pointed out the societal stigmas surrounding Persons with Disabilities (PwDs), who often face confinement indoors and exclusion from decision-making spaces, hindering their access to SRHR services.

Mukayitete called upon the government to enforce the "leave no one behind" principle by incorporating specific categories such as PwDs, adding that providing training in sign language for both service seekers and providers is crucial to ensure inclusivity.

She stressed that civil society organisations should continue their advocacy efforts at the community level, making it a top priority and collaborating with the government to address the issues.