Financial Barriers Limiting Healthcare Access among Women Living with Disabilities in Kenya

1. Introduction

The double jeopardy concept suggests that gender and disability intersect to intensify economic exclusion, and cumulative disadvantage among marginalized groups (Hussein, 2025). Based on this concept, barriers in education, employment, and health accumulate over the life course, perpetuating poverty cycles among people. Persons living with disabilities (PLWDs) encounter profound challenges rooted in systemic inequalities that intersect gender, disability, and socioeconomic structures, potentially undermining their search for health services (Shafik, 2025). Poverty, unemployment, and other unjustifiable economic challenges tend to be higher in women with disabilities than both nondisabled women and men with disabilities worldwide (Emmett & Alant, 2006). Buettgen et al. (2015) indicate that these disparities manifest in persistent pay gaps, limited access to employment, elevated out-of-pocket healthcare costs, and barriers to financial services, and are often exacerbated by discrimination and inadequate social supports (Buettgen et al., 2015).

The Intersectionality Theory, pioneered by Kimberlé Crenshaw and extended in feminist disability studies, frames inequalities among women living with disabilities as overlapping oppression systems, including sexism and ableism (Frederick & Shifrer, 2019). According to Wolbring and Nasir (2024), these systems combine, generate and perpetuate unique, compounded financial difficulties that could prevent these women from seeking health services (Wolbring & Nasir, 2024). In light of this, women with disabilities tend to be increasingly predisposed to high joblessness rates, nearly double those of nondisabled women, lower earnings when employed, and greater reliance on means-tested benefits that impose asset limits, discouraging savings and workforce participation, limiting their ability to afford care (Buettgen et al., 2015). Mitra et al. (2017) contend that additional costs of living with disability, including the persistent need for assistive devices, accessible transportation, and medical care further strain limited incomes, pushing many into financial fragility (Mitra et al., 2017).

According to Ackerman et al. (2025), healthcare access challenges among women living with disabilities become more acute due to mobility-related barriers (Ackerman et al., 2025). For instance, the need for specialized transportation methods among these people increases travelling expenses while specialized healthcare needs surge out-of-pocket expenditure burdens (Prada & Pizarro, 2024). These environments and gendered expectations like caregiving roles disproportionately amplify the physically-disabled women’s double jeopardy, resulting in cumulative disadvantage: reduced lifelong earnings, diminished retirement security, and entrenched poverty that can limit access to care (Shafik, 2025). The main goal of this research was to examine the financial challenges that women living with physical disabilities face that could limit their access to healthcare.

2. Methods

2.1 Research Design

This research article explores mental wellness dynamics through qualitative narratives drawn from 41 women living with physical disabilities in Kenya. The study aimed to highlight finance–mental wellness pathways and bridge theory with lived experiences, underscoring the need for inclusive policies that address these interconnected challenges. Ultimately, the study advocates for a holistic approach to mental wellness that empowers rather than pathologizes women living with physical disabilities.

The study employed a cross-sectional survey design to examine the experiences, challenges, and support needs of women living with physical disabilities who use wheelchairs in Kenya. This design was selected because it enables systematic data collection from a defined population and allows for the efficient capture of both quantitative and qualitative insights.

2.2 Study Location

The research was conducted across 12 counties in Kenya. Local churches served as community mobilization points for the Zaidi ya Mama Program implemented by Necessio Wellness Community. Congregants were asked to refer individuals who might require support as outlined in the Zaidi ya Mama Program. As a result, churches functioned as the primary community settings for beneficiary identification and program mobilization.

2.3 Study Population

The target population comprised adult women living with physical disabilities who were wheelchair users across various counties in Kenya. These women were either potential or actual beneficiaries of the wheelchair distribution initiative implemented by Bethany Kids.

The focus on women emerged from preliminary observations during program sensitization, beneficiary referrals, and recruitment processes, where women appeared disproportionately represented among individuals living with physical impairments in need of assistive support services.

2.4 Sampling Strategy and Sample Size

A prospective purposive sampling strategy was employed to recruit participants. This approach was appropriate given the study’s focus on a specific and hard-to-reach population. Recruitment occurred during community sensitization visits to local churches, where congregants referred potential beneficiaries to the research team.

A total sample of 41 women who met the eligibility criteria was obtained. Eligibility criteria included being 18 years or older, living with a physical disability, and using a wheelchair.

2.5 Data Collection Procedure

Data collection was integrated into participants’ voluntary involvement in the Zaidi ya Mama Program. Following referral and identification, the researcher introduced the study objectives and invited eligible women who wished to be enrolled in the program to participate in the survey.

Structured questionnaires were administered to collect qualitative data on demographic characteristics, types of disabilities, access to assistive devices, and available support systems. Open-ended questions were also included to elicit narrative accounts of participants’ lived experiences, social challenges, and unmet needs.

2.6 Data Analysis

Data analysis involved a combination of descriptive statistics and thematic analysis. Quantitative data from structured survey items were analyzed using descriptive statistics, including frequencies and percentages, to summarize participant characteristics and service-related experiences.

Qualitative data obtained from open-ended responses were analyzed thematically. This process involved familiarization with the data, coding responses, generating themes, and interpreting emerging patterns related to barriers, support needs, and program experiences.

2.7 Ethical Considerations

The study adhered to core ethical principles of informed consent, anonymity, and transparency. Prior to participation, all respondents were informed about the purpose of the study, the voluntary nature of their involvement, and their right to withdraw at any time.

Informed consent was obtained either verbally or in writing, depending on participants’ preferences and accessibility needs. To protect confidentiality, no identifying information was recorded, and all responses were anonymized during data handling and reporting.

Transparency was ensured by clearly communicating to participants that the information collected could be used to inform future research and support resource mobilization for program improvement.

3. Findings

Table 3.1

Respondent characteristics by county

The distribution of respondents by county in table 3.1 indicates that the sample was heavily dominated by participants from Nairobi County, which accounted for 21 respondents (51.2%). Kiambu and Machakos each contributed 4 respondents (9.8%), while Kajiado had 3 respondents (7.3%) and Mombasa had 2 respondents (4.9%). The rest of the counties (Bungoma, Homabay, Kisumu, Kwale, Murang’a, Nandi, and Tharaka Nithi) contributed 1 respondent (2.4%) each. Thus, the data on respondent distribution by county depicts a highly uneven distribution based on the counties from which the respondents were drawn, with Nairobi being significantly more represented than all other counties, suggesting that most of the female persons with physical disabilities are likely to be found in more urbanized areas.

Table 3.2

Respondent age

The age distribution of the respondents in Table 3.2 shows that the average age of the female persons with physical disabilities was 33.98 years, while the median age was 32 years while the mode was 20 years. This suggests that half of the participants were younger than 32, with respondents aged 20 being the most in the dataset. A standard deviation of11.97 implies a notable variation among respondents in terms of age, as the spread of ages around the mean age was relatively wide.

Table 3.3

Respondent employment status

Table 3.3 findings show that more than half of the respondents were unemployed, representing more than half of (23) of the participants (56.1%). The self-employed participants accounted for 11 respondents (26.8%), while 7 respondents (17.1%) reported being formally employed. The percentage of the unemployed and self-employed respondents accounted for 82.9% of the respondents. Generally, the results signal that most of the female persons with physical disability respondents that participated in this study were unemployed, while the least proportion was employed.

Table 3.4

Wheelchair dependence for mobility at home

Table 3.4 findings show that a majority of the females with physical disability respondents that participated in this study were dependent on wheelchair mobility at home, with 26 participants (63.4%) reporting that they use a wheelchair in their home environment. The remaining 15 of the respondents (36.6%) stated that they do not rely on a wheelchair at home. Overall, the results suggest that wheelchair dependence at home is popular among the selected participants.

Table 3.5

Whether the respondent does not depend on anyone in their home activities

Table 3.5 results indicate that the vast majority of females living with physical disabilities that were the respondents of this study considered themselves independent, with 35 participants (85.4%) indicating that they can perform their daily tasks without needing any help. Only 6 respondents (14.6%) reported that they were dependent on others to perform those activities. Overall, the findings suggest that despite being dependent on wheelchairs for mobility, reliance on others for help to perform daily tasks is low among the study’s participants.

Table 3.6

Themes on financial challenges that women living with disabilities face

Table 3.6 findings highlight the multifaceted financial challenges that women with physical disabilities face, which affect their independence, mobility, and overall well-being. Money and income barriers were the most prevalent financial issue emerging in 32 out of 48 responses (67%). Participants reported having limited or no income sources, unstable or irregular earnings, and no reliable financial support means. These income challenges were compounded by the high cost of living, limiting access to basic necessities like meals. Discrimination in employment opportunities and overdependence on caregivers for financial support aggravated the economic strain. Combined, these results demonstrate that structural inequalities exacerbate the impact of physical disability on economic stability.

Closely related to income issues were money management challenges, picked from 21 out of 48 entries (44%). These included difficulties saving money, managing unplanned expenses, and creating or adhering to budgets. Many participants indicated a lack of financial literacy, including knowledge of investment, budgeting, and economic opportunities as a significant financial challenge. The inability to manage finances effectively made them gravitate towards debt and disrupted financial planning, reinforcing a cycle of economic vulnerability.

Another critical financial challenge was the rising cost of assistive devices, appearing in 19 out of 41 entries (46.34%). Participants reported that much of their income was spent on medical treatments and essential devices, such as wheelchairs, diapers, and hygiene items. Some were unable to replace worn-out wheelchairs, while others had to hire individuals to push their wheelchairs, further increasing financial pressure. Additionally, transport costs rose due to the need for taxis instead of more affordable public transport, highlighting how mobility and financial challenges are intertwined.

Limitations on carrying out entrepreneurship opportunities emerged as one of the primary financial challenges, with 17 out of 41 entries (41.46%) reporting restricted access to capital or loans. Despite possessing relevant skills, many women could not monetize their abilities or sustain small businesses due to a lack of financing, market linkages, and support networks. Finally, 29.27% of respondents (12/41) indicated that financial challenges directly affected transport and mobility, as additional costs associated with wheelchair use and reliance on assistance increased their overall financial instability.

4. Discussion

. The findings on financial challenges reveal how structural and societal factors interact with individual impairments to create significant barriers to independence and well-being among women with physical disabilities. The study found that 67% of entries experience money and income barriers, citing limited or unreliable income, discrimination in employment, and overdependence on caregivers. Some of these are key hindrance to accessing medical care among these women. Ideally, these challenges can be effectively analysed through the lens of the Social Model of Disability (SMD), which posits that disability is socially constructed when societal barriers prevent individuals from fully participating in economic, social, and cultural life (Barnes, 2019). Ideally, society’s structural limitations play a bigger role in disabling these women by restricting access to economic opportunities and income security than physical impairment.

Closely linked to income insecurity were money management challenges, reported by 44% of entries, including difficulty saving, budgeting, and avoiding debt. Inadequate or lack of financial literacy and unplanned expenses further constrained the women’s ability to achieve financial stability, potentially limiting access to care. The SMD could frame these limitations as environmental outcomes that restrict equitable access to financial education, support services, or inclusive economic systems, as opposed to deficiencies inherent to the women themselves (Oliver, 2013).

The high cost of assistive devices, reported in 40% of the entries, further underscores the structural barriers they face that can limit their access to care. Wheelchairs, hygiene products, and mobility support required significant financial investment, with some participants unable to replace worn-out devices or relying on others for assistance. The need to pay for accessible transport also corresponds to Mitra et al’s (2017) view on how societal infrastructure and systems amplify the disabling impact of physical impairments among women living with disabilities. Inaccessible transport options and the high costs of assistive devices project environmental constraints as the major disabler, as opposed to the physical limitations themselves.

Financial barriers also extended to entrepreneurship, with 29% of entries depicting inability to access capital, loans, or market networks to support their businesses despite possessing skills. This indicates that these women may be restricted from taking on the current self-employment opportunities as a result of unfriendly financial systems consistently with Emmett and Alant, 2006) perspective. With 25% of entries reporting that mobility-related financial challenges, including extra charges on transport in public service vehicles and reliance on assistance, it is evident that physical and societal barriers intersect to restrict participation, which corresponds to intersectionality theory (Moodley & Graham, 2015). This serves as a critical indicator that limited financial access prevents women with disabilities from economic empowerment, reinforcing cycles of dependency and vulnerability, which spill over to reduced healthcare access.

5. Conclusion

In sum, the findings highlight that financial challenges among women with physical disabilities exist in Kenya, potentially limiting their healthcare access, and are largely driven by structural and societal barriers rather than individual impairments. Issues such as unstable or limited income, high costs of assistive devices, difficulty managing finances, and restricted access to entrepreneurial opportunities create persistent economic vulnerability. Dependence on caregivers and additional mobility-related expenses further exacerbate financial strain among women living with physical disabilities. The Social Model of Disability explains how these challenges arise from inaccessible economic systems, discriminatory practices, and inadequate support structures, rather than from the women’s physical limitations.

The findings of this study underscore the interaction of social, economic, and infrastructural factors to disable women with physical impairments from accessing healthcare as suggested by SDM. Addressing the financial challenges requires systemic interventions that include accessible financial services, inclusive employment opportunities, and subsidized assistive technologies. Targeting structural inequities rather than focusing solely on the individual’s physical limitations can reduce the barriers that create disability in practice and enhance the autonomy and quality of life of women with disabilities.

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