Rethinking Access to Sexual and Reproductive Health Services for Young People with Disabilities in Zimbabwe

Abstract Background Young people with disabilities (YPWD) remain among the most excluded populations within sexual and reproductive health and rights (SRHR) programming globally. Existing research has predominantly focused on barriers to service utilization, portraying exclusion as the consequence of inaccessible facilities, inadequate information, discriminatory attitudes, and weak health systems. While important, such explanations provide limited insight into why exclusion persists despite decades of policy commitments, rights-based frameworks, and disability inclusion initiatives. Drawing on Community Mobilization Theory and the concept of community competence, this study argues that the exclusion of YPWD from SRHR services reflects not only service-level failures but also the inability of communities to develop the collective capacities necessary to recognize, support, and respond to their sexual and reproductive health needs. The study therefore asks: what makes a community capable of supporting the sexual and reproductive wellbeing of YPWD? Methods The study draws on qualitative data collected among YPWD, caregivers, healthcare providers, educators, disability advocates, and community stakeholders across Zimbabwe. Using a participatory and community-centred approach, data were analysed thematically to identify the social, institutional, and relational processes that facilitate or constrain disability-inclusive SRHR access. Results The findings demonstrate that access to SRHR services is shaped less by the existence of services alone and more by the extent to which communities possess what this paper conceptualizes as SRHR competence. Six interconnected dimensions of SRHR competence emerged: recognition of YPWD as legitimate sexual and reproductive citizens; accessible and inclusive SRHR knowledge systems; supportive family and community networks; disability-responsive healthcare services; meaningful participation of YPWD in decision-making processes; and collective community ownership of disability inclusion. Communities exhibiting these competencies were more likely to facilitate access to SRHR information, services, protection, and support. Conversely, communities lacking these competencies frequently reproduced stigma, silence, dependency, and exclusion. Importantly, participants consistently emphasized that sustainable inclusion emerged where communities mobilized collectively around the rights and wellbeing of YPWD rather than relying solely on health facilities or externally driven interventions. Conclusions This study challenges dominant service-centred and deficit-oriented approaches to disability inclusion in SRHR. It introduces the concept of SRHR-competent communities as a novel framework for understanding how communities create the social, institutional, and relational conditions necessary for disability-inclusive SRHR. The findings suggest that improving SRHR outcomes for YPWD requires a shift from interventions focused solely on removing barriers towards approaches that strengthen community capacities for recognition, participation, inclusion, and collective action. Building SRHR-competent communities may represent a critical pathway towards reproductive justice, disability-inclusive public health systems, and the realization of sexual citizenship for YPWD in Zimbabwe and comparable settings.