Abstract
Social and structural supports, including children, disability social benefits, and engagement in the disability rights movement, are key for women with disabilities to meet their occupational needs and resist occupational injustices.
Being in an intimate relationship and engaging in sexual relations is an integral part of social participation in many societies and an anticipated occupation for many people. Enabling engagement in intimate relationships that people view as meaningful and that contribute to positive identities is within the domain of concern of occupational therapy, especially with more recent advances expanding the discipline’s attention to occupational injustices and the adoption of socially responsive approaches (Kantartzis, 2019; Richards & Galvaan, 2018; Trentham & Neysmith, 2018). Being in an intimate relationship has been found to improve self-esteem, self-growth, and happiness; to satisfy social needs for intimacy and social integration; and to enhance a sense of belonging (Sakellariou & Algado, 2006). The desire to be in a relationship takes on a different meaning in certain contexts and geographies, particularly when there is more at stake than occupational belongingness. Intimate relationships can also provide material support, safety, and security and help people acquire resources to increase their chances of survival (Ogolsky et al., 2017). In contexts in which material resources are scarce, occupations linked with resource seeking might be essential, yet this impetus for engagement in occupations has received little attention (Aldrich et al., 2017).
Women with disabilities living in low- and middle-income countries (LMICs) are more vulnerable to exclusion from intimate sexual relationships than men and nondisabled women as a result of gender norms and disability stigma (Devkota et al., 2019). In studies conducted in East and West Africa, women with disabilities have described feeling vulnerable and excluded when nondisabled men made false promises of marriage to engage in sex and then disappeared (Bangura et al., 2021; Kvam & Braathen, 2008; Parnes et al., 2009).
How and with whom women enter into an intimate relationship is governed by hegemonic norms. In Sierra Leone these include “husbands have full control and rights over the bodies and sexualities of their wives” and “physical and sexual violence can demonstrate affection. Men who do not beat and monitor their wives may have stopped being jealous and have, therefore, ceased to love” (Schneider, 2019, p. 133). Such institutionalized gender inequities, and the associated limited legal protections, leave women with little access to resources or opportunities to thrive and make them more likely to live in extreme poverty and experience rights violations (Davies, 2005). Under these conditions, girls and women with disabilities are more likely to be victims of physical, sexual, emotional, and economic violence (Njelesani, 2019; Njelesani et al., 2018).
Violence is an occupational injustice that limits women’s occupational choices and participation in daily activities, “particularly work performance, educational participation, home management, parenting, and leisure participation” (American Occupational Therapy Association, 2011, p. S34; Javaherian-Dysinger et al., 2016). Violence also affects women’s quality of life, relationships, and physical and mental health and, on a broader level, undermines community cohesion and development (Ortoleva & Lewis, 2012). The rate of violence against women with disabilities is unknown in Sierra Leone, but across the globe women with disabilities are 1.5 times more likely to be a victim of violence than are nondisabled women (Hughes et al., 2012). The rate is undoubtedly higher in a context such as Sierra Leone, which is characterized by conflict and displacement and where structural systems reinforce unequal gender norms and discrimination. A socially responsive approach to such occupational injustices necessarily involves attending to intimate partner violence not only at the micro level of an individual woman but also at the meso and macro levels of her local community and broader social contexts (Gerlach et al., 2018; Richards & Galvaan, 2018).
Despite recognition that being in an intimate sexual relationship is an important occupation for many women, the topic has received minimal attention in the scholarly literature, with an even greater paucity of research on women with disabilities who live in LMICs. To our knowledge, no studies have yet examined intimate relationships as a social occupation for women with disabilities in West Africa. Thus, in this study we aimed to understand the experiences of women with disabilities in Sierra Leone who have been in intimate sexual relationships. For this research, we recognized intimate sexual relationships as interactions that are mutually acknowledged and include various forms of expression and intimacy (Sedikides et al., 1994).
Sierra Leone, a West African country, ranks near the bottom of the United Nations Human Development Index (184th of 189 countries) in regard to indicators of life expectancy, mean years of schooling, and gross national income per capita; approximately half of the population lives under the poverty line (United Nations Development Programme, 2020). Central to the ranking is Sierra Leone’s history of civil war (1991–2002) and the 2014 Ebola crisis (Ladum & Haaken, 2017). Approximately 70,000 people were killed in the civil war, and human rights atrocities included amputation of body parts, sexual and gender-based violence, and forced labor of girls and women, resulting in many women acquiring disabilities. The systematic abuse of women and girls remains, with women continuing to experience sexual, physical, and psychological violence, including threats to their security and well-being (Oosterveld, 2015).
The conflict also severely damaged the country’s health infrastructure, which contributed to an increased burden of disease and disability. Disability prevalence is estimated at 17% nationally, and people with disabilities report poorer health status than nondisabled persons (Trani et al., 2011). To support people with disabilities, the Ministry of Social Welfare, Gender and Children’s Affairs was directed to provide assistance (Jolley et al., 2018), and a key piece of legislation, the Persons with Disabilities Act, 2011, which mandated a disability commission and social benefits to people with disabilities, was established (United Nations Integrated Peacebuilding Office in Sierra Leone [UNIPSIL], 2011). This support is key for women with disabilities because, within the context of Sierra Leone, a person with a disability is considered not only a responsibility of a family who is poor and living in an impoverished society but also a source of familial shame; therefore, many women with disabilities cannot access family networks or draw from group resources (UNIPSIL, 2011).
In addition to the governmental support available to persons with disabilities, many international nongovernmental agencies responded and provided support and services, given the history of conflict and disease in Sierra Leone. These agencies continue to have a large presence in country, working alongside government and local organizations. For example, leading international disability organizations, such as Humanity Inclusion, work with local disability organizations to improve the quality of life for persons with disabilities (Humanity Inclusion, n.d.). The disability sector has also been strengthened through support provided by international organizations such as Leonard Cheshire Disability, which has sponsored several cohorts of persons with disabilities to attend college. Many members of these cohorts have become highly educated advocates and have assumed leadership positions in the disability movement, including the government-supported National Commission for Persons with Disabilities.
Theoretical Framework
To understand the women’s relationship experiences as social occupations within Sierra Leone’s historical, social, political, and cultural dimensions, we took a critical occupational approach (Njelesani, Cameron, et al., 2014; Njelesani, Tang, et al., 2014). This approach oriented our examination of the purpose and meaning of the described relationships within the context in which they were situated, whose interests these relationships served, and the assumptions that underpinned participants’ decisions and actions to continue or discontinue the relationship.
To complement the critical occupational approach’s emphasis on the social, political, and cultural nature of social occupations for women with disabilities, we drew on feminist disability scholarship (Garland-Thomson, 2005; Mays, 2006; Morris, 1993). Feminist disability scholarship integrates material feminist and disability theories and provides an analytical tool for theorizing gender and disability dimensions. Inherent to using this work is understanding disability as a dynamic social construct rather than as an individual problem (Dewsbury et al., 2004), and the influence of patriarchal norms that contribute to the construction of women’s social occupations, including intimate sexual relationships. Use of a feminist disability lens enabled us to critique social models of disability in regard to their lack of attention to gender, calling attention to the intersection of various axes of difference that combine to produce forms of oppression such as violence.
Method
We used a qualitative approach to guide this study because little is known about the relationship experiences of women with disabilities in Sierra Leone. The New York University Institutional Ethics Review Board and the Sierra Leone Health Ethics Review Board granted ethics approval. To ensure the confidentiality and anonymity of participants, interviews were conducted in a private location of the participants’ choosing, and pseudonyms are used in this article. All participants provided informed consent. Given the sensitive nature of the study, further ethical considerations included referring the participants to social protection officers as needed.
Recruitment
We conducted the research in four districts of Sierra Leone: Western Sierra Leone, Koinadugu, Bombali, and Kailahun. We chose the districts for their overall representations of the demographics of the country and their inclusion of both rural and urban communities. Participants who were at least age 18 and who self-identified as a woman with a disability who had been in an intimate relationship were selected through snowball and purposive sampling (Patton, 2015). Access was gained to participants through disability networks, including the Sierra Leone Union Disability Issues (SLUDI), the national umbrella body on disability.
Data Collection
Qualitative data were generated through 1:1 semistructured interviews. The interview guide was developed by Janet Njelesani and Ibrahim Richard Bangura. Questions were open ended and focused on the women’s experiences in intimate relationships (e.g., “Tell me how the relationship began,” “How did the relationship end?” “How does your community view women with disabilities being in relationships?”). Details concerning how they felt throughout the course of the relationship were sought (e.g., “How did you feel/cope when that happened?”). Interviews were carried out by Ibrahim Richard Bangura, in the participant’s preferred language of Krio, Mende, or Themne. A local woman accompanied Bangura when interviewing participants who preferred to discuss sensitive matters with a person of the same sex. Interviews were digitally recorded and lasted approximately 60 min. Interview recordings were transcribed and translated into English. Translations into English were conducted by an independent translator and checked for accuracy by Bangura. Data were collected until saturation occurred.
Data Analysis
Qualitative data were analyzed using reflexive thematic analysis (Braun & Clarke, 2019). Transcripts were first reviewed over the course of multiple readings. Each member of the research team read several transcripts, and preliminary impressions of the data were documented. Transcribed data were then entered into a data management table. Data were first coded using a priori analytic codes that aligned with the study aims and theoretical frameworks (e.g., “stigmatization of women with disabilities”). Then, inductive codes (e.g., “child as instrumental support”) were generated and coded. Once data were coded, similar codes were arranged into categories. Categories were then conceptualized into initial themes, with a thematic map constructed to describe the relationship between themes. Themes were then reviewed against the whole data set to ensure they reflected the shared meanings across the data.
Trustworthiness
Trustworthiness was ensured by means of multiple strategies. After reading the transcripts, and again after coding, reflexive memos were written by Njelesani (Birks et al., 2008). Memo writing strengthened our analysis by helping us dive deeper into the data and create stronger ties between the data and our theoretical approaches. Moreover, all of the theoretical, methodological, and analytic activities were documented in an audit trail (Carcary, 2009).
Reflexivity
Njelesani and Teachman identify as nondisabled occupational therapy scholars living outside of Sierra Leone. To ensure that the findings respected and reflected the cultural implications and perceptions of disability in Sierra Leone, Bangura, who identifies as a disabled Sierra Leone researcher, was involved in all components of the study. He is also a well-known disability advocate and identifies with the participants’ race, ethnicity, disability, and class, which influenced the willingness of the women to participate and enhanced the development of rapport. We recognize that Bangura, as a man, differed from the participants, and as a result shaped data generation; however, we did not see this “as a weakness (or strength) of the design but rather as part of the multiple individual and structural factors that shape the co-creation of knowledge within the interview and research” (Gibson et al., 2013, p. 388).
Results
Thirteen women participated. All participants had been in intimate heterosexual relationships with nondisabled men. All of the women had conceived a child with those men, and none continued to be in a relationship with them. Most women left the relationship after the violence we describe in the next section, but in a few instances the men ended the relationship when the women became pregnant. Most of the women were living alone with their children in their own home, receiving no support from family. Two women were living with their parents or extended family members. They were between ages 20 and 45 and had a range of health conditions, including epilepsy, physical impairments acquired from childhood polio, and limb amputations. The participants referred to themselves interchangeably as both women with disabilities and disabled women.
Our results illuminate the experience of being in an intimate relationship for the women we interviewed. The first theme, “violence in intimate relationships,” was the overarching one of the study, given that descriptions of violence perpetrated by male partners permeated all of our dialogues with the women. Ongoing stigmatization of disability and hegemonic cultural norms prevented women with disabilities from participating in equitable, safe intimate relationships. The other themes—“becoming a wife,” “leaving as an occupational rupture,” and “mothering as an occupational identity and resource”—relate most closely to the occupational aspects of the women’s experiences.
Violence in Intimate Relationships
Women disclosed incidences of several types of violence from their partners, including physical, emotional, and economic violence. These experiences resonated closely with the women, revealing that they had all experienced relationships embedded in violence. One woman described her experience of violence thus: “He started beating and abusing me, calling me all types of names, and hurting me in all sorts of ways possible until I was not able to endure the pain” (Kadiatu). Most of the women recognized this violence as explicitly tied to their disability status and reinforced by society:
Because I am a disabled woman, it was very difficult for me to stand up against him, so he was free to do whatsoever he wanted with me, he sometimes beat and shouted at me as if I was a dog. (Tenneh)
Along with these experiences of physical violence, the women spoke of emotional abuse, which encompassed a wide range of abusive tactics, including being controlled by men through hidden relationships:
I was young, so I didn’t understand that it was because of my condition he refused to let people know about our relationship. I just followed what he said of not telling anyone about our relationship, even when I became pregnant with his child. (Esther)
Another woman explained how her previous partners kept their relationship secret:
[The men] usually approach us in the afternoon, saying they like us and want to be in a relationship with us but on [the] condition that no one should come to know about it and they will only meet us at night. They will knock on your door at around midnight when everyone is sleeping and leave at 5:30 in the morning before anyone could see them. (Elizabeth)
Women described the men’s desire to overpower them, which extended to forms of economic violence as the men tried to gain control of the women’s assets. The women also spoke of how their financial assets, house, and resources then played a role in the violence: “He only showed me love or took care of me when I had money, he would behave like a good husband. But as soon as the money is gone, love also is gone for me” (Tenneh). Another woman similarly said, “From my experience, the able men tend to marry us disabled women because of what they can get from us but not for love” (Fatama). The women reported that when they realized the men were with them only for their resources and confronted them, the relationship turned abusive: “He didn’t love me. He only wanted my money and house. So because I refused to give them to him, he started abusing me” (Mariatu).
Becoming a Wife
The “becoming a wife” theme speaks to the occupational identity the women wished for themselves and the dubious reality it became as a result of the violence:
Sometimes people do not know what we can do in the house. So they are afraid to give us the chance to be a wife in the house. Maybe if they know that we can keep a house like any other woman they will not be treating us like this. (Amie)
The women discussed how they positioned themselves in line with traditional stereotypes of what it is to be a woman in Sierra Leone. When asked about their role and hopes, they spoke of having wanted to be a wife. Their ideas as to what being a wife consisted of included being treated with basic respect and not with violence, having a partner who was proud of them, knowing they were loved, and having a partner with whom to share mutual support and care. In the theme of becoming a wife, the women recognized the existing disability stigma within their communities but sensed that they were entitled to be treated with the same respect that nondisabled women would rightfully have: “Upcountry, older men support girls and openly call them their wives. Why should mine be different?” (Musu); “I want to be loved and taken care of and have no discrimination between us” (Kadiatu). All of the women largely held this occupational wish, tied to the hegemonic norms of femininity in Sierra Leone with its expectation for women to be married.
In talking about their experiences of intimate relationships, the women did not draw on feelings of happiness, support, or intimacy; instead, their accounts were full of the violence described and the hesitation on the part of the men with whom they were in a relationship. The women’s desire to be a wife was met with reluctance on the part of the men, which was rooted in assumptions emanating from the disability stigma. A belief existed that these women could not care for their spouses and would therefore not be suitable wives. This belief was strong among families of the nondisabled men; as one woman was told, “This is the type of woman you have brought home, who cannot even take care of herself, so how can she take care of you and also us?” (Yenor). The friends of their male partners also contributed to the stigmatizing rhetoric: “I used to be in a relationship which I was hoping will last into marriage, but it turned out that his friends were teasing him because he was in a relationship with a girl that was disabled” (Adama). The friends of the women also expressed such stereotypes:
My friends told me that because I am a disabled woman and this is the first man I should accept him, because I do not know if I will be able to get another man. I should accept him even though he has wronged me. (Iye)
Leaving as an Occupational Rupture
The “leaving as an occupational rupture” theme speaks to the interruption in the patterns of occupational engagement of the women after leaving the relationship. Many left the relationship—and, thereby, the associated societal benefits and occupational identity of being a wife—while pregnant or with a young child. However, this rupture was not seen as necessarily negative, or involving grief or loss, because women did not see themselves as vulnerable or as needing the material support, safety, or security of the violent relationship.
Leaving the relationship was a rupture from the occupational identity of being a wife, but the women recognized that life could be different and they did not have to stay in a relationship that was violent and loveless: “I put stop to those ill treatments I was getting because we deserve to be loved” (Marai); “I no longer want a man who comes at night so that people will not see him. I do not want this kind of relationship any more” (Amie).
After experiencing abuse, the women recognized this was not the relationship they hoped for and spoke of themselves as holding power to leave the relationship: “We will not continue to be used in this way” (Adama). Finding the strength to leave was closely linked with the financial assets they held, including a house and benefits acquired through the disability social system. These resources gave them power and placed them in a position to not be dependent on the men to survive. This empowered position was apparent in their descriptions of how they resisted the violence: “I felt strong enough to do something about him. I refused to give him the house and my money” (Mariatu).
Despite the fact that all the women were no longer in a relationship, they did not speak of any feelings of loss from no longer assuming the role of a wife. They instead focused on motherhood as their occupational identity and their source of ultimate fulfillment.
Mothering as an Occupational Identity and Resource
In the interviews, the women eagerly talked about their children from the past relationship and described the children as the best part of their lives. The theme “mothering as an occupational identity and resource” describes their role as a mother and how being a mother helped them transition in their social occupations: “Since I left that man, I have not had any abled man. I only care for my children” (Mariatu); “Everything on earth I do . . . for my children, he will not do it. I am the sole person who provides for my children” (Amie). With no partner to assist them, and limited family support, the women were raising their children alone: “My main concern is to find a way for my children to survive” (Iye). Since becoming a mother, many of the women did not wish to be in another intimate relationship; as Marai expressed, “I will only feel safe when I am with my children. So that is why I have decided not to go into a relationship ever again. I will just focus on raising my children.”
Because of the interaction of their impairments and the fact that they lived in a context with few resources for persons with disabilities, most of the women reported requiring someone to help care for them and their home: “I am not able to do [it] all by myself because of my disability” (Yenor). Many women received assistance with their activities of daily living from their children. Having a child who could help was especially important; because of the disability stigma, most of the women had been rejected by their family, so they otherwise had little physical, social, or emotional support. Children therefore functioned as instrumental supports and were valued as an asset because they could provide the care a woman might need: “But I thank God that he has given me a child. This child will be my helper” (Adama). Children also provided help with physical activities outside of the home that are unique to the culture of LMICs:
If the men fail us, we believe our children will support us when they grow up. Even when they are small, we send them to do work for us. We send them to fetch water for us. We cannot send other people. We do not have money to pay them. But our children will work for us. (Tenneh)
Discussion
In this study, we used a critical occupational approach to look at women’s occupational experiences of being in an intimate relationship that was made richer by drawing on feminist disability scholarship. All women in this study had experienced physical, emotional, and financial abuse in their intimate relationships. Their experiences of violent relationships reflect gender and disability discourses that were shaped by the historical and cultural structure and systemic abuse of women in Sierra Leone, which has inherently encouraged violence against women and persons with disabilities (Schneider, 2019). This study also illuminates the occupational aspects of the women’s experiences, including their changes in occupational identities, interruptions in patterns of occupational engagement, and transitions in social occupations. The women initially wished to become wives and then, after leaving the violent relationship, they transitioned to being mothers, a role they saw as their greatest occupation.
Stigma of Being a Disabled Wife
The women initially desired to be in meaningful intimate relationships, conforming with the occupational possibilities (Rudman, 2010) shaped by their gender and sociocultural context; however, stories of exploitation and intimate partner violence dominated their relationship narratives. The relationships therefore held different meanings and served different purposes for these women than their male partners within the context in which they were situated. The women valued being in an intimate relationship and saw this as an important occupation; they wished for this relationship to enhance their quality of life and satisfy their desire for intimacy. These reasons are similar to the ones women have previously reported for wanting to be in relationships (Lawrence et al., 2018).
The women discussed how the nondisabled men sought the relationship for other reasons. The men wanted to be in a sexual relationship and have access to the women’s resources but wished to avoid the stigma that came with being in a long-term relationship with, or married to, a person with a disability. This disability stigma permeates many contexts, such as in South Africa, where nondisabled persons reported feeling uncomfortable dating a person with a disability because of the fear of being stigmatized on the basis of their intimate proximity (Hunt et al., 2018). This was also reflected in how the men hesitated to consider the taking the women as wives, with their reluctance rooted in assumptions about the normative roles of a wife and the activities women should be able to do. The men assumed the women could not take on the role of a wife because they were perceived to be incapable as a result of their impairment. These hegemonic gender expectations have been found to shape the intimate partnerships of women with disabilities in other LMIC contexts, including South Africa, where women with disabilities are perceived as unsuitable wives by partners and community members (Van der Heijden et al., 2019). Together, these differences in the purpose and meaning of the relationships shaped the women’s decision to leave given that the relationship served neither of their interests and the women had the agency to enable them to leave.
Women’s Agency to Discontinue the Relationships
Although previous research in Sierra Leone has explored the injustices against people with disabilities (dos Santos-Zingale & McColl, 2006), no studies have discussed the strengths of women with disabilities and how they resist these injustices and act to discontinue the relationships. In our study, the women’s agency to leave the relationships was enabled by multiple factors, including social and structural supports, such as receiving disability-related social benefits and having a child to help care for them. Legislation mandating support to people with disabilities positively affected the women’s ability to leave the relationships. The Persons with Disabilities Act, 2011, guarantees this support under the National Development Fund for Persons with Disabilities, which provides resources to support income-generating activities and housing projects for people with disabilities.
Sierra Leone is one of the 10 poorest countries in the world, so this assistance is limited; however, people with disabilities in Sierra Leone are provided more opportunities than the general population (Kett, 2010). Women with disabilities were more likely to eat three meals a day than were nondisabled men (Trani et al., 2011). The resources of the women may also have contributed to feelings of empowerment to leave their violent partner, lending support to the idea that disability-related social security programs can affect disability-based violence.
In addition to the financial resources that enabled them to leave violent relationships, the women in this study could not have easily left without identifying with and internalizing the power of the Sierra Leone disability movement. All of the women were affiliated with a local disability organization (e.g., Polio Women and Girls Development Organisation) under the umbrella of SLUDI. The Sierra Leone disability movement focuses on lobbying, influencing, and engaging members of Parliament on key public policy issues affecting persons with disabilities. Key to this work was the development of the National Agenda for the Inclusion of Persons With Disabilities, which was the first document to articulate the right to nondiscrimination. This movement has also focused on keeping women with disabilities free from violence and abuse, with lobbying to include a clause in the Gender Laws of 2007 for women with disabilities (SLUDI, 2017). Under SLUDI, being a member of the collective enables the women to receive training on their right to nonviolence, education on accessing disability benefits, and self-advocacy skills, thereby helping to empower them and position them to be more likely to leave a violent relationship.
Another consideration for the women regarding their decision to leave is the fact that they had a child. For many of the women, ending the relationship meant the need to replace a person who had assisted them with their daily activities, and their children acted as this resource. Organized support services for persons with disabilities in Sierra Leone are limited, and their families were not helping them: The women described being abandoned by their family at birth or on acquiring their disability. Women therefore viewed their children as assets; mother and child engaged in caregiving occupations that were intertwined and interdependent. Previous intimate partner violence research has identified having children as one of the most common reasons inhibiting women from leaving an abusive relationship given that they may not be able to independently support themselves or their children (Meyer, 2012). This was not a primary factor discussed with the women in this study. Not only did they have economic independence but also being a mother contributed to their empowerment. Critically challenging the assumptions of which occupational roles are considered empowering, the ideology of Africana womanism suggests that “motherhood [is] a way to gain status and respect among the community” (Huff et al., 2018, p. 559). This also challenges research from high-income countries indicating that domestic violence survivors experience a loss of empowerment that affects their ability to carry out their occupations (Syron, 2010).
The decision to leave was not easy for these women; raising a child alone, with no support from a partner or other family member, is difficult in a context with limited social supports such as Sierra Leone. However, the women held high expectations for themselves. They recognized the respect that women should rightfully be given, and they wished that for themselves. Given their lower social status not only as women but also as disabled, this finding stands in contrast to those of previous research suggesting that some of the women would hold very low expectations for themselves and not feel entitled to rewarding relationships that are based on equality and respect (Scior, 2003). This finding adds important layers of complexity and nuance to the occupational therapy literature on intimate partner violence that speaks to the women being occupationally deprived while in the cycle of abuse and facing barriers to leaving the relationship (Ballan & Freyer, 2020; Cage, 2007; Smith & Hilton, 2008). The field of occupational therapy has paid scant attention to the strengths and strategies of women, especially women with disabilities living in LMICs, that enable them to terminate violent intimate relationships. There is also a dearth of discussion in the broader literature on relationship violence, although the few studies that have focused on the ability and resources of women characterized them as strong survivors (Crann & Barata, 2016). These findings on the notion of women being strong survivors align with the work of feminist disability scholars on the transformative change aspects of an individual and the recognition of the personal worth and dignity of women with disabilities, their collective identity, and political organization (Mays, 2006). Recognizing the power they held, and having the strength to leave a violent relationship, meant opportunities for our participants to challenge hegemonic constructs of womanhood to take on an occupational role as a strong survivor and mother.
Transforming to the Occupational Identity of a Mother as a Resource
Within their social context, norms dictated that these women’s worth was linked to their value to men and to being a wife. Having to leave a violent relationship destroyed the women’s occupational identity as a wife; however, although the women discussed the pain of the abuse, they did not identify experiencing a sense of loss from no longer being a wife. When no longer assuming the occupational identity of a wife, to adopt Kang’s (2017) concept of transformative change, the women transformed into their mothering role despite what, culturally, they were assumed to do. It was this role the women talked of with joy and that they assumed as their personal identity. Being a mother enabled the women to resist social norms pertaining to disability and ableist assumptions regarding child rearing. These findings highlight the ways in which, over time, women’s resistance of hegemonic norms can shape gradual social transformation (Ridgeway & Correll, 2004). In this study, women with disabilities were able to resist the deeply embedded occupational possibilities that shape the gendered identities and roles taken up by women in Sierra Leone. This examination of the experiences in intimate relationships of women with disabilities points clearly to the intersection of gender and disability with entrenched domestic violence. By bringing an occupational lens to the analysis, however, we have added an important additional layer of explanation and nuance. There is no question that disability supports in the form of financial resources helped these women find the strength to leave abusive intimate relationships. Their occupational identity as mothers opened possibilities for them to give and receive care and support through their children while letting go of the expectation that they prove their worth through being a wife.
Limitations
One limitation of this research is the demographic range of the participants. Of the 13 women we interviewed, only 2 identified as having an impairment that was not physical. Because of the lack of representation of diverse impairments, our results may not highlight the experiences of a range of women in Sierra Leone, especially women with intellectual impairments, who are most at risk of experiencing violence (Pestka & Wendt, 2014). Moreover, because we used snowball sampling, we were not able to elicit the experiences of women unknown to our participants and who may not have had access to similar supports, or have been affiliated with SLUDI, and therefore were limited in their choice to leave their relationships. Future research should include women who remain in the relationships, to better understand the complex decisions to remain or leave and the surrounding factors.
Implications for Occupational Therapy Practice
Congruent with the theoretical perspectives and the shift within practice to occupational therapy as a transformational force (Gerlach et al., 2018; Rudman, 2018), this research was oriented beyond individual factors to broader systemic issues that affect the social occupations of women with disabilities. Therefore, to address systemic issues, socially committed occupational therapists should do the following:
Advocate with women for access to disability benefits and community services to support and meet their occupational needs.
Collaborate with women with disabilities, women’s groups, and organizations for disabled persons to support mainstream programs that target economic development and women’s protection rights to strengthen their inclusivity of women with disabilities.
Advocate for states to invest resources and investigate crimes of disability- and gender-based violence.
Conclusion
In this study we examined the experiences of women with disabilities in Sierra Leone of being in an intimate relationship. The findings reveal that women with disabilities desire to be in meaningful relationships but are denied the opportunity, and when they are in relationships they are often exploited and abused. The women in this study described nondisabled men as being interested in a sexual relationship and wanting to benefit from the women’s resources but actively avoiding the stigma that comes with being in a relationship with a woman with a disability. The women’s agency to leave the relationships was enabled by social and structural supports, in particular having a child to help care for them, receiving disability-related social benefits, and their engagement in the disability rights movement.
Footnotes
Acknowledgments
We extend great thanks to the participants. We also acknowledge the contributions of Kimberly Byrne, Courtney Thomas, Daniel Min, Crystal Mulligan, Valerie Aziegbe, and Jillian Mongiove of New York University’s Department of Occupational Therapy, who contributed to the data analysis.